Instruction: Generate impression based on findings.

Input: 37 years Male (DOB:10/13/1978)Reason: MRI STEALTH - Pre-op, please page neurosurgery resident to place fiducials; CCD History: Cavernoma, OR for resection todayPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is an arachnoid cyst within the fourth ventricle measuring 26 x 19 mm in sagittal dimensions which displaces the quadrigeminal plate superiorly. This cyst is stable in size compared to the prior exam.The aqueduct of Sylvius is visualized.There is intraventricular blood layering within the trigones of the lateral ventricles which was also present on the prior exam does not appear to have changed substantially. There is redemonstration of subdural collections. On coronal imaging the right subdural collection measures 5 mm in thickness and previously measured the same. The left subdural collection measures 17 mm in thickness and is unchanged. These collections are septated. The septations do demonstrate some contrast enhancement. There is redemonstration of bilateral frontal porencephaly. There is redemonstration of blood products along one of the components of porencephaly adjacent to the left sylvian fissure.There is redemonstration of ventriculomegaly which appears stable and compared to the prior exam. The third ventricle measures 14 mm in width on the current exam and previously measured the same. Biventricular diameter is approximately 53 mm on the current exam and previously was the same. There is absence of the septum pellucidum. The pituitary gland measures approximately 5 mm in height and 12 mm AP dimension. The sella appears to be distorted. The optic nerves do not appear to be particularly atrophic. The optic nerves are however tortuous and the dural sleeves are relatively dilated. Findings raise the question of papilledema based on its impression on the retina.The right eye is significantly larger than the left eyeThere is redemonstration of siderosis.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a stable ventriculomegaly. The aqueduct of Sylvius is identified and appears to be small..2.There is an arachnoid cyst which occupies and deforms the fourth ventricle. In the face of ventriculomegaly this suggests that this may be a potential cause for the ventriculomegaly.3.There is intraventricular blood present associated with superficial siderosis along the brain surface.4.Bilateral frontal porencephaly.5.Bilateral multiseptated subdural effusions are present which are stable compared to prior exam.6.Buphthalmos is suspected on the right eye. Please correlate with clinical history.7.Findings are suggestive of papilledema. Please correlate with physical findings on clinical exam.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm related pain (acute) (chronic)Clinical question: 31 y/o with metastatic breast ca, please restage The CSF spaces are appropriate for the patient's stated age with no midline shift. There is diffuse marrow replacement throughout the visualized osseous structures. This was also present on prior exams. There is a particular lesion along the right parietal bone which has some extraosseous extension in the subgaleal tissues as well as the epidural and subdural tissues. The dura is thickened by approximately 3 mm.The right mandibular condyle appears irregular and associated with partially exophytic lesion.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a calvarial metastasis which has associated dural extension and thickening and minimal displacement of the adjacent brain. This was not present on the prior exam. There is no evidence for brain metastases. 2.Diffuse skeletal metastases. Please refer to nuclear medicine exams for further comments.3.There is involvement of the right mandibular head with some destruction of the right head.


Instruction: Generate impression based on findings.

Input: A 55 year old female with Chronic kidney disease, hyperlipidemia, non-obstructive coronary artery disease, LBBB, chronic heart failure with a 2013 cardiac MRI that showed LVEF of 35% with late gadolinium enhancement in the inferoseptal wall. Referred now to cardiac MRI for further evaluation with concerns about cardiac amyloid. Left VentricleThe left ventricle is severely dilated with severe systolic dysfunction. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 117 ml/m2 (normal range: 65+/-11), the LVEDV is 216 ml (normal range 109+/-23), the LV end systolic volume index is 86 ml/m2 (normal range 18+/-5), the LVESV is 159 ml (normal range 31+/-10), the LV mass index is 89 g/m2 (normal range 67+/-11), and the LV mass is 167 g (normal range 114+/-24). There is mild left ventricular hypertrophy of the basal inferolateral wall (13mm wall thickness); the remainder of the myocardium has normal wall thickness (10mm wall thickness). There is global left ventricular dysfunction with regional variation. Abnormal septal motion compatible with LBBB. There are two regions of late gadolinium enhancement. The first is a focal region of transmural late gadolinium enhancement in the mid-inferior wall, and the second is a patch of late gadolinium enhancement in the basal infero-lateral wall. These findings are atypical for prior myocardial infarction. Also, given the normal "Gadolinium Kinetics ons the TI scout," the findings are also not typical for the diagnosis of cardiac amyloidosis. The native myocardial T1 time is moderately increased suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Compared side by side with cardiac MRI of 4/25/2013: no significant change in the LGE pattern was noted.No intracardiac thrombus is noted.No myocardial iron overload.Left AtriumThe left atrium is normal in size. The LA volume is 76 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 53 ml/m2 (normal range 69+/-14), the RVEDV is 98 ml (normal range 110+/-24), the RV end systolic volume index is 18 ml/m2 (normal range 22+/-8), and the RVESV is 34 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size (26 x 26 mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (24mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.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. The left ventricle is severely dilated with severe systolic dysfunction, the LVEF is 26%. The basal inferolateral wall is mildly hypertrophied and has evidence of a patch of late gadolinium enhancement within it. There is a second region of focal, transmural late gadolinium enhancement in the mid-inferior wall. Overall, these patterns of late gadolinium enhancement are not typical for either prior myocardial infarction or cardiac amyloidosis. However, they do suggest the presence of some form of myocardial fibrosis, inflammation, or infiltration. Compared side by side with cardiac MRI of 4/25/2013: no significant change in the LGE pattern was noted.2. The right ventricle is normal in size with normal systolic function, the RVEF is 65%. 3. Small pericardial effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 18 years old, left lower leg pain since 8/2014, positive left straight- leg exam, concern for radiculopathy. Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No evidence of marrow replacement or marrow edema is seen.The visualized spinal cord, conus and cauda equina are unremarkable.The L5-S1 disk demonstrates loss of T2 signal. There is, in addition, a left paracentral disk protrusion which narrows the left ventral thecal sac and probably impinges upon the transiting left S1 nerve root.Mild facet hypertrophy is seen at L5-S1 which, along with the disk herniation, contributes to a mild left neuroforaminal narrowing. No significant degenerative disease is seen at the remaining levels and there are no other areas of spinal canal or foraminal stenosis.

Output: Left paracentral L5-S1 disk herniation with probable impingement of the left S1 nerve root.


Instruction: Generate impression based on findings.

Input: Male, 33 years old, with seizures, status post laser ablation. Sequelae of prior left mesial temporal laser ablation are seen. The ablated tissue is mildly encephalomalacic and hemosiderin stained. Patchy enhancement within the ablated region persists but is smaller when compared to the immediate postprocedural examination. The left hippocampal head also demonstrates volume loss when compared to the right side and to preprocedural exams.Brain parenchymal morphology is otherwise unremarkable. No evidence of edema or mass effect is seen. No additional areas of pathologic parenchymal or extra-axial enhancement are observed. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles remain normal in size and morphology.

Output: Expected findings are seen status post laser ablation treatment of the left mesial temporal lobe. Encephalomalacia and enhancement within the ablation bed is an expected finding. Also noted is some interval volume loss of the left hippocampal head.


Instruction: Generate impression based on findings.

Input: 79 years Male (DOB:8/13/1937)Reason: small vessel disease, focal atrophy History: memory problemsPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is generalized brain atrophy which is common at this age. The hippocampi are smallNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. There is generalized atrophy which is not unusual at this age but no focal atrophy appreciated.


Instruction: Generate impression based on findings.

Input: 13-week-old male status post trauma; evaluate for subdural hematoma There is prominent CSF density surrounding the cerebral hemispheres bilaterally with multiple small hyperdense foci suspicious for blood product. These hyperdense foci are best visualized on: the left frontal parafalcine region (image 12 and 13), the right frontal lobe (image 21), the left frontal lobe (image 30), the right parietal lobe (image 34), and the left parietal lobe (image 29). These findings are suspicious for posttraumatic subdural hemorrhage/hematoma of indeterminate age and should be followed up with with an MRI to evaluate the extent of parenchymal injury.There is also a area of low density consistent with edema in the posterior frontal lobe best seen on axial images 25 through 27. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base show no fractures. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Multiple hyperdense foci within a prominent CSF density surrounding the cerebral hemispheres, as described above, highly suspicious for posttraumatic subdural hematoma/hemorrhage. Recommend MRI for further evaluation.


Instruction: Generate impression based on findings.

Input: 89 year-old male status post fall. Examination shows patchy hypoattenuation in the cerebral white matter. The ventricles, sulci and cisterns are symmetric and prominent, consistent with brain volume loss. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No acute intracranial abnormality. 2. Small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Right vestibular schwannoma treated with resection and radiosurgery. There are postoperative findings related to right suboccipital cranioplasty, including right cerebellar encephalomalacia. There has been interval decrease in size and increased heterogeneity of the nodular component within the right cerebellopontine angle cistern, measuring 7 x 9 mm in axial cross-section, previously 8 x 12 mm. Otherwise, the linear enhancement along the anterior aspect of the skeletonized right internal auditory canal is unchanged to slightly more prominent, measuring up to 4 mm in thickness, previously 3 mm. There is absent fluid signal within the vestibule and semicircular canals, which may indicate labyrinthitis ossificans.

Output: Interval decrease in size of the treated right cerebellopontine angle vestibular schwannoma. Otherwise, the adjacent linear enhancing component along the anterior aspect of the skeletonized right internal auditory canal is unchanged to slightly more prominent.


Instruction: Generate impression based on findings.

Input: 62 years Male (DOB:2/3/1954)Reason: lumbar stenosis PROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a mild degree of anterior subluxation of L1 on L2. The patient is status post lower lumbar spine surgery.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is left-sided facet hypertrophy present at this level which was also present on the prior exam and associated with mild encroachment of the nerve roots of the left lateral recess. There is ligamentum flavum hypertrophy present bilaterally at this level. Overall compared to the prior exam there appears to be some mild progression of the facet hypertrophy.At L4-5 there is a diffuse disc bulge present associated loss of disc space height and disc desiccation as well as a moderate degree of bilateral facet and ligamentum flavum hypertrophy. There is disc desiccation present at this level. There is obliteration of CSF within the thecal sac at this level. Disc material extrudes behind the adjacent endplates at this level. Overall the spinal stenosis has not progressed since the previous exam. There is narrowing of the neural foramina bilaterally at this level with the encroachment of the left-sided exiting nerve roots within the neural foramen due to combination of disc disease and facet disease. There is a superimposed left far lateral disc protrusion at this level which is stable compared to the prior exam. The neural foraminal encroachment of the left exiting nerve root is stable since the prior exam. There is redemonstration crowding of the nerve roots within the spinal canal at this level. Overall there is moderate to severe spinal stenosis at this level.At L3-4 there is redemonstration no change of loss of disc space height and a diffuse disc bulge as well as ligamentum flavum hypertrophy. The endplate reactive changes are predominantly bright signal on T1 and suppresses on the inversion recovery T2 images. There is effacement of the fat at the lateral recesses bilaterally at this level which was also present on the prior exam. There is effacement of the CSF surrounding the nerve roots at this level. There is partial effacement of the fat surrounding the exiting nerve roots within the neural foramina at this level. There is a left far lateral disc protrusion at this level which encroaches on the left exiting nerve root which was not evident on the prior exam. There is redemonstration crowding of the nerve roots within the spinal canal at this level. Overall there is moderate to severe spinal stenosis at this level.At L2-3 there is loss of disc space height and diffuse disc bulge as well as mild ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recess bilaterally at this level. There is some narrowing of the neural foramina at this level, however, the exiting nerve roots are surrounded by fat within the neural foramina. Compared to the prior exam loss of disc space height has been unchanged. These endplate reactive changes are predominantly bright signal on T1 and suppresses on the inversion recovery T2 images and unchanged since prior exam. Overall there is a moderate degree of spinal stenosis at this level.At L1-2 there is loss of disc space height, disc desiccation and diffuse disc bulge which has progressed since the prior exam. There is ligamentum flavum hypertrophy present this level as well as a small left-sided ligamentum flavum cyst. Overall there is a mild degree of spinal stenosis at this level.

Output: There are multilevel degenerative changes present in the lumbar spine which have remained stable since 10/26/2015. There is a moderate to severe spinal stenosis at L4-5 and L3-4 and moderate spinal stenosis at L2-3 as detailed above. There is encroachment of exiting nerve roots on the left-sided L4-5 and L3-4 as detailed above. Please note that a contrast enhanced exam may help differentiate postsurgical scar formation from degenerative change.


Instruction: Generate impression based on findings.

Input: stroke, right facial weakness and dysarthria There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There are encephalomalacia with high signal intensity lesion on FLAIR images on the left external capsule, basal ganglia and caudate head indicating chronic ischemic infarction. The right external capsule also shows similar lesion.There are also multifocal scattered high signal intensity lesions on bilateral periventricular white matter and centrum semiovale on FLAIR images indicating non specific small vessel disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections show Left ACA A2 segment shows more than 50% of luminal narrowing. In addition, there is proximal right MCA M1 segment narrowing about 50%. These two findings may indicate intracranial atherosclerosis. Acom artery and right Pcom artery are patent but the left Pcom artery is not seen.Vertebrobasilar system appears to be normal.There is no evidence of intracranial arterial aneurysm or major vessel occlusion. 3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal chronic ischemic infarctions with encephalomalacia as described above.3. Non specific small vessel disease.4. Intracranial atherosclerosis demonstrating left ACA A2 and right MCA M2 segment stenosis (more than 50%).5. Normal neck MRA.


Instruction: Generate impression based on findings.

Input: 76 years Male (DOB:11/8/1940)Reason: eval for ischemia History: R-sided weakness, aphasiaPROVIDER/ATTENDING NAME: DAVID HOWES MRI of the brainThere is diffusion restriction involving the majority of the left MCA territory. There is associated loss of signal in the perimedullary draining veins on SWI images. There is associated subtle FLAIR signal abnormality.There is redemonstration of encephalomalacia involving the right superior frontal gyrus.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eye lens is thin.There is motion artifact present.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is occlusion of the left MCA at the distal m1 segment with involvement of both inferior and superior divisions and sparing of a stenotic left rolandic branch. There is a stenosis at the junction of the left A1 and A2 segments.There is no evidence for intracranial aneurysm .The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There is occlusion of the left MCA at the distal m1 segment with involvement of both inferior and superior divisions and sparing of a stenotic left rolandic branch. 2.There is a stenosis at the junction of the left A1 and A2 segments.3.There is a large left MCA territory infarction currently evolving.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.No evidence for intracranial aneurysm.6.Unchanged encephalomalacia within the right superior frontal gyrus. This is most likely vascular related7.Findings were reviewed with the Dr Martinez.8.Patient motion artifact may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: The exam is significantly limited by motion artifact. In addition, thin section post contrast images are not available through the level of Meckel's caves. The left Meckel's cave remain enlarged with minimal nodular enhancement, similar to the prior exam compared across coronal postcontrast images, but appears slightly decreased compared to 2014. A small soft tissue nodule remains along the left lateral prepontine cistern, although unchanged compared to prior exams. The left cavernous sinus is again slightly prominent. There is continued asymmetric absence of the left aspect of the clivus. The right Meckel's cave and trigeminal nerve are unremarkable.Postoperative changes are again seen from previous left frontal temporal craniotomy and left occipital cranioplasty. There is left frontal and temporal lobe encephalomalacia. Adjacent to the foci of encephalomalacia is a stable prominent extra axial space. There is stable focal encephalomalacia of the ventral left pons. Persistent fatty atrophy of the left sided muscles of mastication is likely related to surgical denervation. Right parietal approach ventriculostomy catheter is partially visualized. Ventricular caliber appears grossly stable. Pituitary stalk remains slightly deviated to the right. There is scattered mucosal thickening throughout the paranasal sinuses

Output: Significantly motion limited exam. Compared to most recent prior exam, no significant interval change in appearance of left Meckel's cave, with decreased enhancing tissue compared to 2014 as well as more remote exams, favored to represent granulation tissue. Minimal nodular enhancement remaining in the left lateral prepontine cistern.


Instruction: Generate impression based on findings.

Input: Post resection follow-up after anterior cranial fossa, cribriform plate, meningioma. There is evidence of right fronto temporal craniotomy with resection of the anterior cribriform meningioma.On FLAIR images, there are high signal intensities on the right temporal anterior aspect and right frontal inferior aspect which indicate postoperative changes.On Gad enhanced scans, there is no evidence of abnormal enhancement indicating residual meningioma.There is no interval change of scattered high signal intensity lesions on FLAIR images on bilateral hemisphere white matter since prior exam.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no evidence of acute ischemic or hemorrhagic lesion.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Postoperative status of the anterior cranial fossa meningioma with postoperative changes as described above.2. Postoperative no unusual finding.3. No change of scattered FLAIR high signal intensity lesions.


Instruction: Generate impression based on findings.

Input: There is a subcentimeter T2 hyperintense enhancing focus within the dorsal columns of the cervical cord at the level of the C3 vertebral body, without appreciable expansion of the spinal cord. At C3-4, there is a posterior disc-osteophyte complex that slightly effaces the anterior thecal sac CSF. At C4-5, there is a disc-osteophyte complex with an eccentric left disc protrusion that indents the anterior aspect of the spinal cord. At C5-6, There is a central disc bulge, with a normal canal stenosis. There is no significant neural foraminal stenosis in the cervical spine. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. The cerebellar tonsils extend up to 2 mm inferior to the foramen magnum.THORACIC SPINE

Output: 1. A subcentimeter enhancing lesion within the cervical spinal cord at the level of C3 may represent active demyelinating disease, an infectious myelitis, or autoimmune process, or vasculitis, for example. A brain MRI with contrast may be useful for further evaluation of disease extent if clinically warranted.2. Multilevel posterior disc-osteophyte complexes within the cervical spine, with impingement upon the spinal cord at C4-5. 3. The thoracic spine is unremarkable.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 68-year-old man with history of laryngeal cancer, evaluate for metastases. There is no intracranial mass or mass-effect. There is a moderate degree of confluent T2 hyperintensity in the bilateral cerebral white matter and pons, along with chronic lacunar infarcts in the left corona radiata, right cerebellum, and right basal ganglia. There is no restricted diffusion to suggest acute ischemia. There are punctate foci of susceptibility effect in the right posterior temporal lobe, which may represent chronic microhemorrhages, but otherwise no evidence of acute intracranial hemorrhage. There is no abnormal parenchymal or meningeal enhancement. The ventricles are within normal limits in size and configuration. The major flow-voids are preserved. There is a small amount of secretions in the maxillary sinuses, right greater than left. Otherwise, the paranasal sinuses, orbits, skull, and overlying scalp are unremarkable.

Output: 1. No evidence of intracranial metastasis.2. Probable chronic small vessel ischemic disease in the cerebral white matter and pons, along with chronic lacunar infarcts in the left corona radiata, right cerebellum, and right basal ganglia. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Shoulder dislocation ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal. There is no fluid or gadolinium within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is flattening of the posterolateral aspect of the humeral head reflecting a Hill-Sachs deformity. Although we see no gadolinium entering the anterior inferior labrum, there is lobular deformity of the labrum suggesting the presence of a nondisplaced tear. Furthermore, a thin linear band of intermediate signal traverses the anterior inferior labrum as seen on the ABER view which further suggests the presence of a tear. There is gadolinium separating the anterior superior labrum from the underlying glenoid which may reflect extension of the tear versus a sublabral foramen. The posterior labrum is intact and there is no evidence of a SLAP tear. Inferior extension of contrast may reflect the presence of a prominent axillary recess although we cannot exclude the possibility of a humeral avulsion of the glenohumeral ligament with subsequent scarring. BICEPS TENDON: No significant abnormality noted.

Output: Hill-Sachs deformity and nondisplaced anterior labral tear as detailed above.


Instruction: Generate impression based on findings.

Input: Developmental delay. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain appears unremarkable, aside from mild perivesicular spaces in the bilateral subinsular regions. 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: No evidence of gross structural abnormalities of the brain.


Instruction: Generate impression based on findings.

Input: Assess for lumbar stenosis. Known cervical stenosis. Right leg pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen including mild generalized facet arthropathy. Individual levels as below:L1-L2: Minimal disc desiccation and bulge. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Minimal degenerative changes in the lumbar spine. No spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 17 years Female (DOB:7/2/1998)Reason: structural abnormalities History: migraines with visual changes, losing visionPROVIDER/ATTENDING NAME: PATRICIA OGDEN MICHAEL H. KOHRMAN MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. 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 right A1 segment appears to be small.The visualized portions of the paranasal sinuses demonstrate opacification of the frontal sinuses and some minor mucosal thickening in the ethmoid air cells and maxillary sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: 1.There is no evidence for mass lesion in the midbrain or other lesion within the brain parenchyma to explain the patient's migraines.2.No mass lesion or other abnormalities identified within the orbits.3.There is opacification of the frontal sinuses bilaterally associated with a small amount of opacification of anterior ethmoid air cells. This nonspecific. It's most likely inflammatory in nature. A point of obstruction is not clearly defined on this exam.


Instruction: Generate impression based on findings.

Input: Abdominal/pelvic swelling PELVIS:UTERUS, ADNEXA: The uterus is markedly enlarged with numerous well-defined masses compatible with fibroids.Some of these masses are poorly defined such as in the right intramural body with foci of T2 weighted hyperintensity suggestive of focal adenomyomas. Additional scattered foci of T2 weighted hyperintensity suggests diffuse adenomyomatosis.In the right adnexa there is a septated lesion measuring at least 11.1 x 5.1 cm demonstrating T1 weighted hyperintensity and T2 weighted hypointensity without enhancement most likely representing a endometrioma.Suspected small corpus luteal cyst in the left ovary.At the level of the rectosigmoid there is an exophytic/pedunculated mass from the uterine fundus which at the very least abuts the rectosigmoid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mass effect on the rectosigmoid by an exophytic/pedunculated uterine fundal mass.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Markedly enlarged uterus containing numerous presumed fibroids. Please note that the superior extent of the uterus was not imaged on this dedicated pelvic MRI.2.Suspected focal adenomyomas and adenomyomatosis of the uterus.3.At least 11.1 cm right adnexal mass with imaging characteristics most suggestive of an endometrioma.4.There is an exophytic mass from the posterior uterine fundus resulting in at least mass effect of the rectosigmoid. If there is persistent rectal/pelvic pain a CT should be considered to exclude invasion of the colon.


Instruction: Generate impression based on findings.

Input: Headache. 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.

Output: No evidence of acute intracranial hemorrhage, mass, or infarct.


Instruction: Generate impression based on findings.

Input: 64-year-old female with pancreatic lesion noted on abdominal ultrasound, abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without specific evidence of cholecystitis. There are subcentimeter T2 hypointensities within the left and right lobe of the liver most compatible with cysts. Trace amount of perihepatic fluid.There is a focus of susceptibility artifact in the inferior right lobe of the liver that is nonspecific.SPLEEN: Trace amount of perisplenic fluid.PANCREAS: There is loss of the intrinsic T1 signal of the pancreatic parenchyma. There is a hypoenhancing, intrinsic T1 and T2 isointense enhancing mass within the body of the pancreas measuring up to 5.1 x 4.0 x 4.7 cm (series 1103, image 35). There is dilation of the distal pancreatic duct measuring up to 8 mm. There is at least 180 degree encasement of the proximal SMA and common hepatic artery. There is encasement of the SMV with marked mass effect without evidence of occlusion. The splenic vein is chronically occluded with gastric varices present. The portal vein is patent.Pancreatic divisum anatomy is noted. ADRENAL GLANDS: Nodularity/thickening of the left adrenal gland is nonspecific.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderately prominent left para-aortic lymph nodes measuring up to 8 mm in short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pancreatic mass in the body of the pancreas as described above is suspicious for cancer. Focal pancreatitis may result in these findings as well. An endoscopic ultrasound is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 18 years Female (DOB:6/14/1998)Reason: 3 t scanner hht History: surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainThere is redemonstration of patchy T2 signal hyperintensity along the anteromedial aspect of the medulla bilaterally as well as along the anterior aspect of the pons.There is redemonstration of a small T2 and FLAIR hyperintense focus along the superior aspect of the cingulate gyrus adjacent to the bend of the marginal ramus of the cingulate sulcus which is unchanged since prior exam.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Along the left cingulate sulcus there is a dilated artery present which connects to a draining vein which involves the adjacent cingulate gyrusAntegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is some vague vascular structures present along the medial aspects of the medulla and pons on the postcontrast MRA.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.Findings are suspicious for a small arteriovenous malformation located along the left cingulate gyrus just adjacent to the cingulate sulcus and marginal ramus which is unchanged compared to prior exam.2.There are small lesions present in the medulla and pons which are stable compared to the prior exam. These are nonspecific. There is no direct evidence for arteriovenous malformation on the MRA. There are some small vascular structures that can be discharged within these are Given the patient's known clinical history of HHT, however, underlying vascular lesions such as so-called capillary telangiectasia is suspected.


Instruction: Generate impression based on findings.

Input: Male 58 years old Reason: please evaluate for left meniscus injury/tear History: unstable knee, pain on left side MENISCI: There is complex tearing of the posterior horn and body of the lateral meniscus predominantly horizontal component in the posterior horn and a radial component in the body. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild generalized cartilage thinning of the medial facet of the patella. Along the lateral facet of the patellar cartilage there is a partial-thickness focal defect (series 3, image 16). There is no associated bone marrow edema within the patella or trochlea. Cartilage of the medial and lateral compartments is intact.LIGAMENTS: Ligaments including the ACL, PCL, MCL, and LCL complex are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Complex, predominantly horizontal tearing of the posterior horn and body of the lateral meniscus.2.Focal partial thickness cartilage defect along the lateral facet of the patella.


Instruction: Generate impression based on findings.

Input: Reason: Please assess suprascapular soft tissue mass overlying the supraspinatus. ? Lipoma? History: Soft tissue mass over R shoulder, overlies the supra/infraspinatus 2 skin markers are placed along the superior aspect of the shoulder presumably representing the location of the patient's palpable mass. There is slight prominence of the subcutaneous fat along the superior aspect of the shoulder between the 2 skin markers. The signal of the mass suppresses on fat-suppressed images compatible with a lipoma. There is minimal, if any, mass effect on the underlying trapezius muscle. There is no infiltration of the underlying muscle. We see no additional masses. Although this examination was not protocoled for detailed evaluation of the rotator cuff, there are tiny foci of high signal intensity within the supraspinatus, infraspinatus, and subscapularis tendons, at their insertion, which may represent tiny insertional tears, but we see no full-thickness tear. The imaged musculature of the right shoulder is normal in appearance. Mild to moderate osteoarthritis affects the acromioclavicular joint. There is minimal enhancement of the subdeltoid bursa which may represent minimal inflammation of questionable clinical significance. Within the limitations of a non arthrogram examination, the glenoid labrum appears intact. The tendon of the long head of the biceps appears intact within the limitations of a non arthrogram study. The bone marrow signal intensity is within normal limits.

Output: Subcutaneous lipoma and other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 52 years old. Bilateral hip/groin pain. ACETABULAR LABRUM: The acetabular labrum is grossly intact bilaterally on this nondedicated study.ARTICULAR CARTILAGE AND BONE: The right hip shows findings of mild osteoarthritis with mild joint space narrowing, small osteophytes, and a subchondral cyst along the anterior superior acetabulum. The left hip shows mild osteoarthritis, with joint space narrowing and mild marrow reactive changes along the superior acetabulum. There is a small left hip joint effusion.SOFT TISSUES: The imaged soft tissues are unremarkable. ADDITIONAL

Output: Mild bilateral hip osteoarthritis as above.


Instruction: Generate impression based on findings.

Input: The craniocervical junction is unremarkable. There is an apex leftward spinal curvature centered at T9-T10. There is a butterfly vertebrae at T6. The vertebral column sagittal alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus terminating at L2-L3. There is no evidence of filar thickening or fibrofatty infiltration and there is normal anterior translation of the conus upon prone positioning. The paravertebral soft tissues are unremarkable.

Output: 1.Apex leftward spinal curvature centered at T9-T10 without evidence of paraspinal mass or tethered cord.2.Partial (posterior) unfused vertebrae at T6.


Instruction: Generate impression based on findings.

Input: 66 year old woman with history of lymphoma s/p chemotherapy and chest radiation, referred for evaluation of possible cardiac constriction. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 86 ml/m2 (normal range: 65+/-11), the LVEDV is 135 ml (normal range 109+/-23), the LV end systolic volume index is 45 ml/m2 (normal range 18+/-5), the LVESV is 70 ml (normal range 31+/-10). LV dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 48 ml/m2 (normal range 69+/-14), the RVEDV is 75 ml (normal range 110+/-24), the RV end systolic volume index is 24 ml/m2 (normal range 22+/-8), and the RVESV is 38 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is tri-leaflet. Aortic regurgitation is mild by QFlow quantification (RF 18%), on visual inspection it appears somewhat more than mild.Mitral ValveThe mitral valve is thickened with restricted leaflet opening. Mitral regurgitation is mild by Q Flow quantification (RF 19%), however visually appears mild to moderate.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.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. PericardiumThe pericardium is minimally thickened (4mm). There is a "septal bounce" during real time free breathing imaging, most prominent during inspiration indicative of interventricular dependence. These findings may suggest presence of pericardial constriction. Extracardiac FindingsThere are liver cysts as described in other dedicated abdomen imaging. There is a large left pleural effusion and small right pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild LV systolic dysfunction2. Mild-moderate AR3. Mild-moderate MR4. Lower normal RV systolic function5. Minimally thickened pericardium with respirophasic IVS bounce, suggests possible constrictive physiology.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 45-year-old female with multiple sclerosis. Since the MRI exam from 2005, there has been progression of the predominately supratentorial periventricular and subcortical Flair hyperintense signal. The majority of the signal abnormality is hypointense on T1 but there are multifocal areas of enhancement indicating active demyelinating disease. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are stable 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: Interval progression of the periventricular and subcortical predominant white matter demyelinating lesions with multifocal areas of enhancement indicating active disease.


Instruction: Generate impression based on findings.

Input: 69-year-old female with a history of sacral decubitus ulcer, worsening pain, evaluate for osteomyelitis. There is a large decubitus ulcer that extends to the lower sacrum and coccyx. There is abnormal signal intensity within the coccyx, highly suggestive of osteomyelitis. There is also suggestion of abnormal signal intensity within the lower sacral segments which may represent osteomyelitis, but this is equivocal. Normal bone marrow signal is preserved in the upper sacral segments. No findings to suggest osteomyelitis of the ilium, ischium or pubic symphysis. The left proximal femur is within normal limits. Evaluation of the right proximal femur is limited by metallic susceptibility artifact due to the patient's prior orthopedic fixation. We see no evidence to suggest osteomyelitis. There is increased signal abnormality within the right femoral head which likely represents avascular necrosis. There is diffuse muscle atrophy. There is diffuse edema within the subcutaneous fat. Note is made of a left lower quadrant colostomy. Degenerative arthritic changes affect the lower lumbar spine and pelvis. There is a Foley catheter within the bladder. There is a small amount of free fluid within the pelvis.

Output: Limited study with findings suggestive of osteomyelitis of the coccyx and possibly the lower sacrum. An addendum can be logged if the patient is able to return for a complete study.


Instruction: Generate impression based on findings.

Input: Assess for secondary parkinsonism, NPH: stooped posture and bradykinesia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is nonspecific mild scattered cerebral white matter T2 hyperintensity. There is moderate diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There are bilateral lens implants. There is diffuse mucosal thickening and secretions in the left maxillary sinus.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct. 2. Moderate diffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: 69 years Male (DOB:6/16/1947)Reason: 69 yo male with history of ALL, post CART cell infusion History: evaluatePROVIDER/ATTENDING NAME: PETER A RIEDELL PETER A RIEDELL The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some opacities seen signs. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. No abnormal enhancing lesions are appreciated within the brain parenchyma to suggest leukemic involvement brain.


Instruction: Generate impression based on findings.

Input: Clinical question: Based on the study. Signs and symptoms: Metastatic melanoma. Please measure. Enhanced CT of brain:The examination demonstrates no evidence of metastatic disease to the brain or leptomeninges.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. No abnormal enhancement. Calvarium is intact, limited view of the orbits are unremarkable, mastoid air cells and middle ear cavities are unremarkable.There is complete opacification of the left chamber of the splenic sinus. This is associated with subtle thinning of the bone at the level of planum sphenoidale on the left. This finding is best appreciated on axial bone density (series 5) image 10, coronal reformatted bone density (series 8036) image 46, sagittal reformatted bone density image 28 through 30. There are also minimal increased density of the contents of the left chamber of the sphenoid sinus. Although all of the above findings could represent long-standing chronic sinus disease the associated bony changes are concerning and further follow-up or dedicated MRI exam is recommended to exclude the less likely possibility of a small metastatic bony lesion.120 cc of Omnipaque 350 was administered for the study.

Output: 1.Negative enhanced CT of brain parenchyma and the leptomeninges.2.Complete opacification of the left chamber of the sphenoid sinus with some subtle bony thinning of planum sphenoidale which remotely could represent a bony metastatic disease considering provided clinical data. The findings could also represent changes related to long-standing chronic sinus disease or even a small fibrous dysplasia. Please see above comments for exact location of the lesion. Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Restaging of myxopapillary ependymoma. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.Spine: There are stable postoperative findings related to myxopapillary ependymoma resection and radiation therapy with confluent fatty bone marrow signal in the lumbosacral spine and unchanged minimally enhancing tissue in the spinal canal at the S2-S3 level. There is also degenerative endplate signal alteration affecting L1-L2 associated with an anterior disc-osteophyte complex. The spinal cord and nerve roots are unremarkable. The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. However, there is prominence of the ligamentum flavum in the thoracic spine, which results in neural foramen stenosis. There is an unchanged mass that measures up to nearly 4 cm in the region of the right adrenal gland.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Unchanged post-treatment findings without evidence of tumor recurrence.3. Unchanged right adrenal regional mass. Nevertheless, dedicated imaging of this lesion may be useful.


Instruction: Generate impression based on findings.

Input: 49 years old female with a history of architectural distortion in the right central breast identified on screening mammogram dated 11/20/15. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate nodular 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. Annual surveillance with breast MRI is recommended as per the research protocol.Annual screening mammogram is also recommended. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: seizures History: seizures No evidence of acute ischemic or hemorrhagic lesion.There is about 5.6 mm downward displacement of bilateral cerebellar tonsil through the foramen magnum.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. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. About 5.6 mm dominant displacement of bilateral cerebellar tonsil through the foramen magnum.


Instruction: Generate impression based on findings.

Input: Medial knee pain MENISCI: There is a complex tear of the medial meniscus consisting of a radial tear of the body and horizontal tear of the posterior horn. The horizontal tearing extends to the tibial articular surface with additional thin branching signal abnormality peripherally within the body of the meniscus. A slab-like focus of low signal intensity adjacent to the anterior horn of the medial meniscus likely represents a displaced flap fragment.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild edema type signal within the medial tibial plateau underlying the torn medial meniscus. The articular cartilage of the medial, lateral, and patellofemoral compartments is intact. A cortically based ovoid focus of low signal intensity seen in the lateral aspect of the distal femoral metaphysis is likely the sequela of a healed nonossifying fibroma and is of doubtful clinical significance.LIGAMENTS: The cruciate and collateral ligaments are intact, including the superior band of the MCL.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tearing of the medial meniscus with probable displaced flap fragment. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Complex febrile seizure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, brainstem, and cerebellum 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, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid in the right maxillary sinus.

Output: No evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: 48-year-old female with pain and weakness. ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus indicating mild tendinosis. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is no significant amount of fluid within the subacromial subdeltoid bursa. Moderate degenerative changes affect the acromioclavicular joint. There is a small amount of fluid within the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is subtle increased bone marrow signal abnormality and deformity of the superolateral humeral head suggestive of a Hill-Sachs fracture deformity. There is also linear increased signal abnormality and heterogeneity traversing the anterior and inferior glenoid labrum and glenoid consistent with a bony Bankart lesion. There is also heterogeneity of the posterior labrum which may represent degeneration/tearing. There are subchondral cysts within the humeral head.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Tendinosis of the supraspinatus without evidence of full-thickness rotator cuff tear.2. Findings consistent with a Hill-Sachs fracture deformity and osseous Bankart lesion as described above.3. Osteoarthritis of the acromioclavicular joint. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with nocardiosis, on therapy for seven months. Assess for lesion progression. Edema in the right occipital lobe has improved. There remains evidence of an underlying lesion or lesions this location which are partially diffusion restricting and partially susceptibility inducing which could reflect either chronic hemosiderin deposition or mineralization.A lesion in the right centrum semiovale which is mildly diffusion restricting but which does not cause significant surrounding edema is unchanged when compared to the immediate prior examination, and smaller when compared to older exams. A very small focus of abnormal T2 signal and susceptibility in the left superior frontal gyrus is unchanged as well.No other diffusion restricting or edema producing lesions are seen. No other areas of significant susceptibility effect are demonstrated. There are numerous scattered foci of nonspecific T2 hyperintensity within the cerebral white matter. Ill-defined signal abnormality also persists within the dorsal pons and medulla. No abnormal extra-axial collections are seen. The ventricles are stable in size and morphology.An opacity is unchanged involving the left ostiomeatal unit and adjacent nasal cavity. Bilateral globe staphylomas are seen.

Output: 1.Continued interval reduction of edema in the right occipital lobe likely related to one or more underlying lesions.2.Additional non-edematous lesions in the right centrum semiovale and left superior frontal gyrus are unchanged.3.No new or progressing lesions are seen.


Instruction: Generate impression based on findings.

Input: Patchy spontaneous activity and lumbar myotomes muscle weakness. Malaise and fatigue. Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is minimal retrolisthesis of C3 on C4 on C5, and C5 on C6. Alignment is otherwise maintained. Alignment is maintained. There is diffuse low T1 marrow signal which is nonspecific and can be seen in conditions such as chronic anemia. T1 and T2 hyperintense lesion at C7 is compatible with hemangioma. 6The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancement.Degenerative changes are seen in the cervical spine with disc osteophyte complexes at C3-C4, C4-C5, and C5-C6 and mild multilevel facet arthropathy. Individual levels as below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex with uncovertebral hypertrophy and facet hypertrophy on the right. There is no significant spinal canal stenosis. There is moderate to severe right neural foraminal stenosis. No significant left neural foraminal stenosis. C4-5: Small disc osteophyte complex with uncovertebral hypertrophy and facet hypertrophy on the right. There is mild spinal canal stenosis with effacement of the ventral thecal sac. There is moderate to severe right neural foraminal stenosis. No significant left neural foraminal stenosis. C5-6: Minimal disc osteophyte complex. There is uncovertebral hypertrophy, particularly on the right with moderate right neural foraminal stenosis. Mild left foraminal narrowing. No significant spinal canal stenosis. 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. Lumbar:Five lumbar type vertebral bodies are presumed to be present. Examination is motion degraded slightly limiting evaluation. Vertebral body heights are within normal limits. Alignment is within normal limits. Diffuse low T1 marrow signal is noted without focal suspicious lesions. The conus medullaris is normal in position. Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L5-S1: Minimal disc bulge and dorsal annular fissure.. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. There is multilevel facet arthropathy relatively worse at the left L4-L5 and left L5-S1 levels. Left nephrectomy noted.

Output: 1. Moderate degenerative changes in the cervical spine with mild spinal canal stenosis at C4-C5. No high-grade spinal canal stenosis in the cervical spine or cord signal abnormality.2. Significant neural foraminal stenosis at the right C3-C4, right C4-C5, and right C5-C6 levels, which may be impinging the right C4-C6 nerve roots. Individual levels as detailed above.3. No significant spinal canal or neural foraminal narrowing in the lumbar spine.4. Diffuse low T1 marrow signal which is nonspecific but can be seen in conditions such as chronic anemias.


Instruction: Generate impression based on findings.

Input: 61 year old woman with history of recently diagnosed breast cancer, hypertension, mild LV dysfunction and LBBB on ECG referred for vasodilator stress cardiac MRI to evaluate for etiologies MEDICATIONS: lisinopril First Pass PerfusionDuring hyperemia, a perfusion defect is noted in the basal anterior and septal walls and the apical septal walls. Although this finding may be due to ischemia, the possibility that it is secondary to the LBBB.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is moderately dilated with low-normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 101 ml/m2 (normal range: 65+/-11), the LVEDV is 186 ml (normal range 109+/-23), the LV end systolic volume index is 48 ml/m2 (normal range 18+/-5), the LVESV is 87 ml (normal range 31+/-10), the LV mass index is 47 g/m2, and the LV mass is 86 g. There is abnormal septal wall motion abnormality due to LBBB. The native T1 myocardial relaxation time is normal (1030ms).Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 85 ml/m2 (normal range 69+/-14), the RVEDV is 155 ml (normal range 110+/-24), the RV end systolic volume index is 45 ml/m2 (normal range 22+/-8), and the RVESV is 82 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThyroid enlargement involvement. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, a perfusion defect is noted in the basal anterior and septal walls and the apical septal walls. Although this finding may be due to ischemia, the possibility that it is secondary to the LBBB must also be considered.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and lower normal systolic function (LVEF 53%).4. Normal RV size and mildly reduced systolic function (RVEF 47%).5. Left atrial dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Upper extremity pain, neck pain. Patient also has back pain and lower extremity pain. History of cervical disc herniation, now with worsening symptoms. Evaluate for herniation/stenosis. Cervical:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of normal cervical lordosis with mild kyphosis which appears positional. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: Small disc osteophyte complex. No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild right relatively worse than left neural foraminal stenosis. C4-5: There is disc osteophyte complex, loss of disc height, and bilateral uncovertebral hypertrophy. There is moderate spinal canal stenosis including mild deformity of the cervical cord without cord signal abnormality. There is moderate to severe left and moderate right neural foraminal stenosis similar to prior. Again seen small Schmorl's node involving the right aspect of the inferior C4 endplate.C5-6: Small disc osteophyte complex and uncovertebral hypertrophy. No significant spinal canal stenosis. There is moderate to severe left and moderate right neural foraminal stenosis, similar to prior. C6-7: Minimal disc osteophyte complex. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal. There is uncovertebral hypertrophy and facet arthropathy with minimal narrowing of the neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar:Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is exaggeration of lumbar lordosis as well as grade 1 anterolisthesis of L4 and L5. Bone marrow signal is benign. Schmorl's node is noted involving the superior endplate of L2. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge as well as facet arthropathy. There is no significant spinal canal stenosis. No significant neural foraminal narrowing.L2-L3: Minimal disc bulge and facet arthropathy. There is no significant spinal canal stenosis. No significant neural foraminal narrowing. L3-L4: Minimal disc bulge. Advanced bilateral facet arthropathy and ligamentum flavum thickening which contribute to mild narrowing of the spinal canal in the lateral dimension. Otherwise no significant central canal stenosis. There is mild to moderate bilateral neural foraminal narrowing.L4-L5: There is grade 1 anterolisthesis with disc uncovering and advanced bilateral facet arthropathy. Disc desiccation and mild disc height loss. There is moderate spinal canal stenosis. There is also moderate left neural foraminal stenosis with possible impingement of the left L4 nerve root. There is also mild to moderate right neural foraminal narrowing.L5-S1: There is disc desiccation and moderate disc height loss. There is also a disc bulge and bilateral facet arthropathy. No significant associated central canal stenosis. There is moderate left worse than right neural foraminal stenosis where there may be impingement of the exiting L5 nerve roots.

Output: 1. Multilevel degenerative changes in the cervical spine. There is moderate spinal canal stenosis at the C4-C5 level related to combination of disc and osteophyte, similar to prior. There is also significant neural foraminal stenosis at the C4-C5 and C5-C6 levels.2. Multilevel degenerative changes in the lumbar spine. There is moderate spinal canal stenosis at the L4-L5 level related to advanced bilateral facet arthropathy and grade 1 anterolisthesis. There is also significant neural foraminal narrowing at the left L4-L5 and bilateral L5-S1 levels. Please see additional details above.


Instruction: Generate impression based on findings.

Input: Clinical question: h/o ALL s/p chemo and cranial radiation. Small, enhancing extra-axial mass along the right frontal lobe on recent MRI, monitor for changes. Signs and Symptoms: recent onset eye squinting Pre and post enhanced brain MRI:Unremarkable diffusion weighted series.Examination redemonstrate stable mild patchy foci of flair hyperintensity in the periventricular and few in subcortical white matter of cerebral hemispheres without change. Although nonspecific this appearance could represent post treatment/ radiation change.The cortical sulci are mildly prominent for age however less conspicuous since prior study. Mild prominence of the lateral ventricles with maintained midline similar to prior study. There is also prominence of the cerebellar and vermian folia for age without change since prior exam..Post enhanced images demonstrate a small dural based appearing enhancing lesion along the inner table of right paramedian anterior frontal bone without change since prior study. This finding could represent a meningioma. There is no associated parenchymal edema or mass effect which is a similar observation as prior exam. Unremarkable calvarium, orbits and well pneumatized paranasal sinuses/mastoid air cells/middle ear cavities.

Output: 1.No acute intracranial findings and no convincing evidence of new finding since prior study.2.Stable mild patchy foci of flair hyperintensity in periventricular and subcortical white matter likely representing post therapy change. 3.Stable small focus of dural based right paramedian inferior frontal enhancement since prior which could represent a meningioma. Further follow up is recommended.4.Prominence of cerebral and cerebellar/vermian folia as mentioned above.


Instruction: Generate impression based on findings.

Input: Chronic low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5. Alignment is otherwise within normal limits. Bone marrow signal is slightly heterogeneous which is nonspecific, but without discrete suspicious osseous lesions. There is advanced facet arthropathy at L4-L5 and L5-S1 with moderate degree of associated bone marrow edema. The conus medullaris is normal in position.Multilevel degenerative changes are seen with multilevel disc desiccation, additional details as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc desiccation and minimal bulge. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation and mild bulge. No spinal canal stenosis. There is mild narrowing of the bilateral neural foramina. L4-L5: There is disc bulge and advanced bilateral facet arthropathy as well as ligamentum flavum thickening. There is moderate left neural foraminal stenosis and mild to moderate right neural foraminal stenosis. There is also prominence of the epidural fat, which in association with the degenerative changes, results in moderate spinal canal stenosis at this level. L5-S1: Mild disc bulge and advanced bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Right renal cyst.

Output: 1. Multilevel degenerative changes in the lumbar spine, worst at the L4-L5 level where there is moderate spinal canal stenosis and up to moderate left neural foraminal stenosis. Additional levels as described above.2. Advanced facet arthropathy at L4-L5 and L5-S1 with moderate degree of bone marrow edema associated. These findings are suspected to be contributing to patient's low back pain.3. Mild degenerative spondylolisthesis at L4-5.


Instruction: Generate impression based on findings.

Input: Evaluate for placenta accreta. History of sickle cell disease. Please note that this study was not performed for fetal assessment.PELVIS:UTERUS, ADNEXA: Gravid uterus. Anterior uterus implantation.On today's study the uterus is more than 2 cm away from the internal cervical os. Redemonstrated are hypointense T2 bands within the myometrium compatible with placenta accreta/increta. In addition demonstrated again is poor delineation of the left anterior uterine wall and the adjacent inner surface of the rectus muscle concerning for placenta percreta. Additionally there is a nodular density in the posterior dome of the bladder (series 10 image 15) which although may be artifactual appears to have been present on the prior study and may represent placenta percreta into the bladder.BLADDER: See discussion above.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right-sided hydroureteronephrosis, likely physiologic given gravid state.Osseous stigmata of sickle cell disease and possible mild avascular necrosis of the femoral heads.OTHER: No significant abnormality noted.

Output: 1.Again the left anterior uterine wall is inseparable from the underlying left rectus muscle and remains suspicious for placenta percreta appearing similar to the prior study. 2.There is also concern for placenta percreta involving the posterior dome of the urinary bladder where there is a persistent nodular focus of signal abnormality.3.Correlation with ultrasound findings which are not available for comparison is recommended.


Instruction: Generate impression based on findings.

Input: There are scattered areas of abnormal T2/FLAIR hyperintensity in the periventricular and subcortical white matter, which are nonspecific, but favored to represent age-indeterminant small vessel ischemic changes. There is a partially empty sella. Otherwise, the midline structures and craniocervical junction are within normal limits. No intracranial mass is identified. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures.The orbits appear grossly unremarkable. There is no significant distention of the optic sheath or papilledema by imaging criteria.

Output: 1.No intracranial mass.2.Partially empty sella which can be a normal variant, but can also be seen with intracranial hypertension; correlate with CSF opening pressures as clinically indicated.3.Minimal nonspecific white matter signal abnormality, favored to represent small vessel ischemic changes. 4.


Instruction: Generate impression based on findings.

Input: Infrequent episodes of unpleasant smell. Frequent episodes of staring. History of left temporal hemorrhage. There is no evidence of mass or acute infarct. There is patchy susceptibility effect in the posterior left temporal lobe. The brain otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is a partially empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial tumor. 2. Sequela of prior hemorrhage involving the left temporal lobe.3. A partially empty sella may represent pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Male 50 years old; Reason: Right hip pain, PET scan showed hypermetabolic soft tissue activity associated with a significant right hip joint History: Right hip pain There is serpiginous low T1 and low T2 signal extending across the superior aspect of the right femoral head, compatible with osteonecrosis. There is mild associated edema-type signal within the bone, without articular surface collapse or fracture. A small joint effusion is present, with enhancement of the joint capsule compatible with synovitis. No enhancing osseous or soft tissue lesions are seen. There is patchy low T1 signal throughout the visualized bones compatible with reconverted red marrow. A similar, though smaller, focus of signal abnormality is seen in the superior left femoral head on the large field of view STIR images, likely also representing osteonecrosis.

Output: 1. Osteonecrosis of the bilateral femoral heads, right worse than left, without articular surface collapse.2. Small right hip joint effusion, with enhancement of the joint capsule compatible with synovitis.


Instruction: Generate impression based on findings.

Input: Anterior knee pain. Assess for ACL and meniscal injury. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal appearing knee, without meniscal or ligamentous injury.


Instruction: Generate impression based on findings.

Input: 77-year-old male Reason: ligamentous tear? History: right knee pain and inflammation MENISCI: There is mild globular signal intensity within the posterior horn of the lateral meniscus indicating intrasubstance degeneration. The lateral meniscus appears intact. There is intrasubstance degeneration of the posterior horn of the medial meniscus. There is blunting of the posterior horn of the medial meniscus consistent with superficial fraying/degenerative tearing. No fluid-filled tear is evident. The anterior horn medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is subjective thinning of the lateral compartment cartilage. The medial tibiofemoral compartment appears relatively spared. There is full-thickness articular cartilage degeneration along the lateral facet of the patella and femoral trochlea with large areas completely devoid of articular cartilage with associated underlying degenerative signal abnormality. There is also full-thickness articular cartilage defect identified along the medial facet of the patella, centrally. There are tricompartmental osteophytes.LIGAMENTS: There is increased signal abnormality within the proximal fibers of the superficial band of the MCL indicating a sprain/partial thickness tearing. There is edema within the underlying medial femoral condyle with an apparent small avulsion fracture (16; series 901). This could be further evaluated with dedicated radiographs if clinically warrented. The ACL appears intact. The PCL appears intact. The LCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Partial thickness tearing/sprain of the MCL with possible minimally displaced subacute avulsion fracture from the medial femoral condyle.2. Intrasubstance degeneration and superficial fraying/degenerative tearing of the medial meniscus. 3. Osteoarthritis of the right knee with full-thickness articular cartilage degeneration as described above. 4. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Pain. Evaluate for labral pathology with intra-articular arthrogram. ROTATOR CUFF: There is mild increased T2 signal within and thickening of the supraspinatus tendon near its insertion compatible with mild tendinopathy. The tendons of the rotator cuff are otherwise intact. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is linear increased T2 signal within the anterior superior labrum at approximately the 2 o'clock position, which is most clearly seen on image 13, series 401. This likely represents a nutrient canal, which is normal variant anatomy. The labrum is otherwise intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Mild supraspinatus tendinopathy.2. No evidence of a labral tear; linear T2 signal abnormality isolated to the anterior superior labrum likely represents normal variant anatomy.


Instruction: Generate impression based on findings.

Input: Patient presents with left radial wrist swelling and nodule on thumb extensor tendon; evaluate for tenosynovitis or tendon rupture. LIGAMENTS: The scapholunate and lunotriquetral ligaments are intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is intact.TENDONS: There is mild interstitial tearing of the extensor pollicis brevis tendon along with signal changes surrounding the extensor pollicis brevis and abductor pollicis longus tendons, consistent with tenosynovitis. Mild subcutaneous edema is noted in the surrounding soft tissues. Flexor tendons are intact. BONES: There is no acute fracture.ADDITIONAL

Output: Mild interstitial tearing of the extensor pollicis brevis tendon along with mild tenosynovitis of the extensor pollicis brevis and abductor pollicis longus tendons.


Instruction: Generate impression based on findings.

Input: Limited sequences were obtained for surgical localization purposes. Susceptibility artifact is noted along the right temporal and parietal scalp where the the depth electrodes transverse the calvarium. There is a stable position of 3 distinct depth electrodes through the more anteriorly placed burr hole, the tips of which are in the anterior, mid, and posterior medial right temporal lobe. There is a focal somewhat oval area of associated T2 hyperintensity in the subcortical and deep white matter of the anterior right lateral temporal lobe as seen on 401/86. This area measures approximately 8 x 25 mm and is not present on the preoperative MRI. Additional T2 hyperintensity likely extends peripherally and posteriorly on image 401/92 although exact extent is obscured by susceptibility artifact. There is an additional linear area of T2 hypointense signal essentially parallel and just anterior to the most posterior of these 3 electrodes, which could represent an additional tract.Via the right posterior parietal burr hole, there is a single electrode inserted, with tip at the anterior mesial right temporal lobe, along the inferior aspect. This is also grossly stable in position since prior CT.There is mild right-sided dural thickening and enhancement, likely postoperative. No pathological enhancement is appreciated. There is slight prominence of extra-axial space along the right posterior parietal region towards the convexity, likely relating to minimal subdural blood products, which are hyperintense with respect to adjacent CSF on the T1 weighted images. This measures approximately 4 mm in greatest thickness, as coronal reformats are not currently available. Additional extra-axial intrinsic T1 hyperintensity is noted more caudally along the right occipital lobe, likely representing slightly older blood products, measuring 3 mm in greatest thickness. Findings of known right mesial temporal sclerosis are again suggested but not as well appreciated on this exam.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is partial opacification of the lateral aspect of the right frontal sinus. Scattered trace ethmoidal thickening is seen bilaterally. Multiple mucous retention cysts are seen along the posterior nasopharyngeal soft tissues

Output: 1.Stable position of multiple right-sided depth electrodes. Small area of focal oval T2 hyperintensity in the lateral right temporal lobe likely relating to an area of vasogenic edema in the area of the electrodes, with possibility of associated blood products not entirely excluded.2.Minimal right posterior parietal and occipital subdural blood products of slightly different ages, likely postoperative.3.Findings of known right mesial temporal sclerosis are suggested but not as well appreciated on this exam.


Instruction: Generate impression based on findings.

Input: 27 years Male (DOB:9/7/1988)Reason: Chiari malformation , redo decompression /syrinx growth on last MRI, please do with CSF flow through foramen magnum stent. Post surgical exam-3month flu History: 3month post surgicalPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM MRI brain: The patient is status post suboccipital craniotomy. Since prior exam a fluid collection at the craniotomy site has become a little more organized. It measures approximately 36 x 37 mm in axial dimensions. It appears to be separated from the cisterna magna with dura. A small communication cannot be excluded. There is a fourth ventricular stent extending from the aqueduct through the fourth ventricle and through the foramen of Magendie. There is T2 and FLAIR signal hyperintensity present within the adjacent cerebellar hemispheres and along the inferior medial aspects and along the cerebellar vermis posteriorly and inferiorly. This associated with volume loss.There is a ventriculostomy tube for shunt which crosses to the right occipital lobe and enters the occipital horn of the right lateral ventricle and has its tip in the body of the right lateral ventricle. The lateral ventricles are similar in size the prior exam and nondilated the left lateral ventricle remains larger than the right lateral ventricle.There is evidence for syrinx in the upper cervical cord. There is no significant stenosis at the foramen magnumNormal 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.CSF flow study demonstrates no significant obstruction at the level of the foramen magnum.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is kyphotic angulation at the cervicothoracic junction.There is a syrinx redemonstrated extending from the C3-3 disc space level down to the C7-T1 disc space level maximal dimensions are currently 9 x 5 mm and on the 3/3/2016 exam or 12 x 8 mm.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a broad-based left paramedian disc protrusion present at this level associated with ligamentum flavum hypertrophy is greatest a mild to moderate degree of spinal stenosis. At C7-T1 there is a central disc protrusion present which impresses on the ventral aspect of the sac and effaces spinal fluid ventral to the spinal cord but not posterior the spinal cord. This was also present on the March exam and has not changed significantly in size.The vertebral artery flow voids appear to be intact.

Output: 1.Status post the posterior fossa craniotomy, fourth ventricular stent and ventriculostomy tube placement. There is a fluid collection behind the surgical site which appears more organized on the current exam. Etiology is uncertain2.There is no change in the size of the lateral ventricles since the prior exam and no evidence for ventriculomegaly. The patient's syrinx has decreased in size compared to the March exam.3.There is encephalomalacia present along the inferior medial aspects of the cerebellar hemispheres and vermis.4.There are degenerative changes present in the lower cervical spine which are stable. They narrow the spinal canal causing mild to moderate spinal stenosis at C6-7 and mild spinal stenosis at C7-T1


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:1/18/1960)Reason: hx of multiple myeloma/compression fx at T7 seen on thoracic MRI, pt has pain at thoracic and lumbar spine History: lumbar and thoracic painPROVIDER/ATTENDING NAME: SEON-KYU LEE SEON-KYU LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. The lumbar vertebrae has a mottled appearance on T1 and T2 imaging.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild disc desiccation at this level and some T2 signal hyperintensity in the peripheral aspect of the disc annulus at the right lateral recess.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.There is no evidence for compression fracture in the lumbar spine.3.Normal appearance to the marrow signal is a nonspecific finding but likely related to patient's multiple myeloma.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: please do dr javed MS protocol compare to prior History: gait disorder, memory loss Brain MRIMultifocal mainly bihemispheric FLAIR high signal intensity white matter lesions including bilateral corpus callosum are demonstrated and are consistent with demyelinating disease such as multiple sclerosis. Comparing to prior scan performed on Sep 5 2014, although the scan parameters (FOV and slice thickness) are different, there is no significant interval change in terms of number, extent and configuration of white matter lesions.There is no evidence of abnormal enhancement. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage or 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.C-spine MRIThere are multifocal T2/STIR high signal intensity lesions in spinal cord at the level of C2, C2-3 disc, and T3 to T4 level indicating involvement of demyelinating disease.There are ligamentum flavum hypertrophy at the level of C45 to C67 without evidence of neural foraminal stenosis. The C67 intervertebral disc shows diffuse bulging which abuts thecal sac.The cervical spine intervertebral discs show disc degeneration.The bone marrow and end plates demonstrate a normal MR appearance. There is no evidence of cord compression.

Output: 1. Unchanged multifocal bihemispheric white matter multiple sclerosis lesions since prior scan.2. No evidence of abnormal enhancement.3. Multiple cervical and thoracic spinal cord lesions which are consistent with spinal cord involvement of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: There is redemonstration of numerous periventricular and subcortical T2/FLAIR hyperintense white matter lesions in the supratentorial and infratentorial brain parenchyma. There are also lesions involving the medulla and left middle cerebellar peduncle and cervicomedullary junction. Some of these lesions are better visualized on the current exam probably due to imaging on 3 Tesla MRI as compared to 1.5 Tesla prior. The lesions overall remain unchanged from the previous study and no new lesions are seen. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is mild mucosal thickening in the bilateral ethmoid air cells and right maxillary sinus.

Output: Multiple T2/FLAIR hyperintense white matter lesions in the supratentorial and infratentorial brain parenchyma without significant interval changes from the previous exam. No new lesions seen.


Instruction: Generate impression based on findings.

Input: Asymptomatic female presents for routine screening mammography. Family history of breast cancer in her mother diagnosed at age 60 and ovarian cancer at 86, maternal grandmother diagnosed at age 60, and paternal aunt diagnosed at age 60. Personal history of skin cancer diagnosed at age of 52. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Benign calcifications are present bilaterally, including arterial calcifications. No new masses, suspicious microcalcifications or areas of architectural distortion are present in either breast. Stable benign obscured masses previously seen to be cysts on prior MRI breast.

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