Instruction: Generate impression based on findings.

Input: 45-year-old female status post right lumpectomy with adjuvant radiation and chemotherapy in 2010. Additional history of left mastopexy. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.There are postsurgical changes in the right breast at the 6:00 position from prior lumpectomy. There are additional postoperative changes in the left breast from prior mastopexy. No abnormal enhancement is seen in either breast. Status post right axillary lymph node dissection with no abnormal lymph nodes identified in either axillary region.

Output: Stable postoperative appearance of both breasts with no MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

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

Output: 1.Mild chronic small vessel ischemic disease.2.Mild mucosal thickening is present within the left maxillary sinus and minimal is noted in the left sphenoid sinus.


Instruction: Generate impression based on findings.

Input: 40-year-old male with fatty liver suggested on ultrasound ABDOMEN:LIVER, BILIARY TRACT: Normal liver contour without focal liver lesions. No intrahepatic fracture. Biliary ductal dilatation. The gallbladder is within normal limits. No specific evidence of fatty liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific evidence of fatty liver. Normal liver morphology without focal liver lesion.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with sensory disturbance and a spinal lesion at the C3 level on prior cervical MRI. Assess for demyelinating lesions. Several small T2 hyperintense lesions are evident within the periventricular white matter. There are 4-5 definite lesions and perhaps several more questionable lesions or areas of ill-defined T2 signal abnormality. One or two of the lesions demonstrate a radial morphology with respect to the ventricles.No associated mass effect is seen. No pathologic enhancement is detected. No parenchymal edema is identified on this examination.There is no evidence to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is within normal limits in size.Partially visualized on the sagittal FLAIR images is a spinal cord lesion at the C3 level.Calvarial marrow is slightly lower in signal than what is typically seen, but this can be within the range of normal variation and no worrisome features are identified.

Output: Multiple small and/or ill-defined periventricular white matter lesions are identified, some showing morphology compatible with demyelinating disease.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, 24 weeks gestational age, with fetal ventriculomegaly as seen on ultrasound. The atria of the lateral ventricles are enlarged, each side measuring up to 13 mm in the axial plane. The frontal horns are within normal limits. The fourth ventricle is also normal in size. The cerebral aqueduct is not reliably visualized due to fetal motion and as such, patency of the aqueduct cannot be assessed.The cavum septum pellucidum is not confidently visualized. However, the corpus callosum is present. The brainstem and posterior fossa are within normal limits. Cerebral morphology and the degree of sulcation are appropriate for gestational age. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collections are detected.

Output: 1.Mild bilateral ventriculomegaly is seen. Although no clear etiology for this is identified, the cerebral aqueduct is not adequately visualized to assess for patency.2.The cavum septum pellucidum is not reliably visualized. However, the corpus callosum is present and appears to be normally formed.3.The remainder of the examination is within normal limits.


Instruction: Generate impression based on findings.

Input: 51-year-old male with medical history of ESRD. Presenting with altered mental status. CT of brain without infusion.Heavy vascular calcification of bilateral cavernous carotids are noted. Extensive small vessel disease of undetermined age in the supratentorial brain parenchyma. Old left posterior temporal and parietal cortical stroke with heavy calcification is noted.Images through posterior fossa are suspects of an acute/subacute stroke of the vermis. No hemorrhage is detected. Further evaluation with an MRI is recommended.CTA of cervical region.The right common carotid artery including its origin is unremarkable. No stenosis at the level of the bifurcation of right common carotid artery. Atherosclerotic calcific plaque at the level of the bifurcation and in distal cervical portion of the internal carotid artery is noted however no stenosis is detected.The left common carotid artery including its origin is unremarkable for any stenosis. The bifurcation of the carotid is normal. The left internal carotid artery remains normal. Shallow atherosclerotic calcific plaques in the left common and internal carotid arteries noted with no stenosis.Vertebral arteries are small bilaterally which is believed to be a congenital variation. No evidence of stenosis. Small shallow calcific plaques are identified.CTA of intracranial circulation.CTA of vertebral basilar system demonstrates patent bilateral vertebral arteries across the foramen magnum. Irregularity of the lumen is consistent with atherosclerotic disease with mild stenosis of distal bilateral vertebral arteries. The basilar artery demonstrate atherosclerotic irregularity and some mild stenosis at his distal segment.CTA of the carotid system demonstrate normal appearing bilateral supraclinoid internal carotid arteries with no disease. There is good visualization of bilateral middle and anterior cerebral arteries with no hemodynamically significant stenosis. Prominent bilateral posterior communicating arteries are noted. This can explain the small size of bilateral vertebral arteries.CTV. out intracranial circulation.This examination is within normal limits.

Output: 1.No area of significant stenosis in the vasculature of the cervical region including bilateral common carotid, bilateral internal carotids and both vertebral arteries.2.Calcific atherosclerotic plaques however are noted in both vertebral arteries and carotid system.3.No hemodynamically significant stenosis of the carotid systems intracranially.4.Atherosclerotic disease of distal vertebral arteries and basilar artery with mild areas of stenosis in both basilar and vertebral arteries.5.Small bilateral vertebral arteries is believed to be an anatomical variation secondary to presence of prominent bilateral posterior communicating arteries.6.Unremarkable intracranial venous sinuses.7.Advanced to small vessel disease of both hemispheres of undetermined age.8.Old left hemispheric cortical stroke within the calcification.9.Suspected acute/subacute stroke of vermis.10.Follow-up with an MRI is recommended.11.12.


Instruction: Generate impression based on findings.

Input: Clinical question: assess for mass lesions, intracranial vasculitis, spinal cord lesionSigns and Symptoms: headache, vision loss, Unqualified visual loss, left eye, normal vision right eye. Unqualified visual loss, left eye, normal vision right eye; Headache. Upper extremity hyper-reflexia, neck pain. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is reversal of the normal cervical curvature present.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level. There is a small central disk protrusion present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level. There are small uncovertebral osteophytes present at this level. At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are uncovertebral osteophytes present at this level associated with disk material and mild encroachment of the right sided exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal. There is a left lateral recess disk protrusion at this level encroaching on the left sided exiting nerve roots. There are left sided endplate reactive changes present at this level with irregular end-plates.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRA brain:There is a 2.5 mm medially directed aneurysm along the proximal portion of the opthalmic segment of the left internal carotid artery.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.There is extracranial origin of the left PICA which is not entirely included on this exam.MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal foci of contrast enhancement are present in 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.A small lesion in the left cerebellar hemispheres along the inferior semilunar lobule follows CSF on all pulse sequences .There is focal atrophy of the left middle frontal gyrus.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 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.There is a well circumscribed 10x7 mm focus of marrow replacement in the left parietal bone just posterior to the coronal suture and superior to the squamous temporal bone which enhances following gadolinium administration.Incidental note is made of choroid plexus xanthogranulomas.MRI orbits:There is T2 signal hyperintensity along the right optic nerve without associated contrast enhancement. This is associated with a smaller right optic nerve compared to the left optic nerve which is more obvious on the cisternal segment.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 a 2.5 mm left opthalmic segment aneurysm present.2.There is a small right calvarial lesion present which in isolation is non-specific. In the appropriate clinical settings it is possible that it is related to neoplasia or sarcoidosis (as was suggested in the clinical history of the chest x-ray report) for example. Please correlate with clinical history. If appropriate a follow-up with CT of the head may be helpful. Alternatively a bone scan may help evaluate for metastases in the appropriate clinical setting.3.There is a left lateral recess disk protrusion at C6-7 encroaching on the left sided exiting nerve roots.4.T2 signal hyperintensity and atrophy along the right optic nerve is a non-specific finding. One possibility is that this is related to degeneration/atrophy of the nerve or 5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 6.Focal atrophy within a portion of the left middle frontal gyrus.7.A small lesion in the left cerebellar hemispheres along the inferior semilunar lobule likely represents an enlarged perivascular space (possibly related to remote ischemic injury).8.Although there is no evidence for vasculitis on this exam, this diagnosis cannot be excluded based on this exam alone.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with history of lung cancer. A T2 hyperintense, partially FLAIR suppressing and presumably cystic lesion is identified within the right occipital lobe measuring 14 x 14 mm. There may be a small internal nodular component along the inferior aspect of the cyst versus a layer of debris. This lesion induces very mild edema in the adjacent parenchyma, but no significant mass effect.Numerous focal and patchy T2 hyperintense lesions are identified in the peri-ventricular and subcortical white matter of the cerebral hemispheres, a non specific findings which may reflect chronic microvascular ischemic disease or demyelinating disease among other possibilities. No restricted diffusion or other areas of edema are suspected.No acute intracranial hemorrhage is seen. The ventricular system is normal in size and morphology.An 18-mm region of T1/T2 hypointense marrow replacement is seen within the right parietal bone. Elsewhere, marrow signal characteristics are unremarkable.

Output: 1.A cystic or perhaps cystic and solid lesion is evident in the right occipital lobe. Given the stated history, this is concerning for metastatic disease.2.No definite additional metastases are suspected. However, postcontrast imaging is recommended, both to better assess the above lesion and to provide a more sensitive evaluation for additional small lesions.3.An area of marrow replacement within the right parietal bone is nonspecific and may simply represent sclerosis. This lesion would benefit from assessment with postcontrast imaging or CT imaging.


Instruction: Generate impression based on findings.

Input: 69-year-old female with history of basilar tip aneurysm with new headaches. Brain w/wo: There is no evidence of intracranial hemorrhage or acute ischemic infarction. There is a chronic infarction within the left parietal/occipital region appearing similar to prior. There is extensive periventricular and subcortical white matter increased T2/FLAIR signal abnormality which is nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits are unremarkable.MRA: Redemonstrated is a 9 x 7 mm wide-necked basilar tip aneurysm. The neck of the aneurysm measures approximately 7 mm. The right PCA and right superior cerebellar artery arise from the aneurysm sac. Overall the aneurysm appears similar to the study from 10/2014. There is anterograde flow within the distal bilateral vertebral arteries, basilar artery, distal bilateral internal carotid arteries and carotid siphons as well as the anterior, middle, and posterior cerebral arteries. There is no evidence of arterial stenosis or occlusions.

Output: 1. Basilar tip aneurysm measuring 9 x 7 mm appearing relatively stable (within 10% of measurement differences) when compared to the MRA from 10/2014. In the setting of new development or changing of the nature of headache, active treatment options should be discussed with the patient. Either Neurosurgical or Neurointerventional clinic consultation is recommended.2. Unchanged nonspecific periventricular and subcortical increased T2/FLAIR signal abnormality which is nonspecific but may be related to XRT and/or chronic small vessel ischemic disease.3. Stable chronic infarction in the left parietal/occipital region.Findings and plan discussed with Brittany Beach by Dr. Masse at 0900 on 3/4/15.


Instruction: Generate impression based on findings.

Input: 13-year-old male with headaches for one month. Please evaluate for mass. There is no evidence of intracranial hemorrhage, mass or edema. A small focus of hypodensity within the left occipital white matter on a single image without associated edema or hemorrhage is of nonspecific etiology. Further evaluation with MRI is recommended, if clinically warranted.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The mastoid air cells are normally pneumatized. Left ethmoid fluid collection, likely due to sinus disease. The remainder of the visualized paranasal sinuses are normally pneumatized.

Output: Small focus of hypodensity, as described above, is of nonspecific etiology. Further evaluation with MRI is recommended, if clinically warranted.


Instruction: Generate impression based on findings.

Input: 53-year-old female patient with left hand hypothenar eminence swelling and pain. A marker is placed along the palm of the hand along the hypothenar eminence. We see no signal abnormality or enhancement deep to the marker to suggest an etiology of the patient's pain. The muscles of the hand are within normal limits as are the tendons. Bone marrow signal intensity is within normal limits. Please note the large field-of-view used to evaluate the hand limits evaluation of small ligamentous structures.

Output: No specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 42 year-old female status post craniotomy with headache. Postsurgical changes from bilateral craniotomies are again seen with diffuse edema in the cerebral white matter appearing similar to the recent MRI. Expected pneumocephalus is seen in the right parietal region. Ring of hyperdensity in the left frontal lobe with small amount of adjacent blood products likely corresponds to left frontal lobe mass seen on prior MRI.The ventricles and basal cisterns are normal in size and configuration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Postsurgical changes and diffuse edema in cerebral white matter as above


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. There is faint bone marrow signal abnormality in the medial femoral condyle which may represent a resolving contusionLIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a small amount of fluid within the deep infrapatellar bursa which is likely of no clinical significance.ADDITIONAL

Output: 1. Bone marrow signal abnormality within the medial femoral condyle may reflect a resolving bone contusion. 2. Nonspecific edema type signal within Hoffa's fat pad is of questionable clinical significance.


Instruction: Generate impression based on findings.

Input: Postlaminectomy syndrome, not elsewhere classified [M96.1], Reason for Study: ^Reason: back pain s/p back surgery in 2008 History: back pain Thoracic spine MRIThere are subtle T2 high signal intensity lesions at the level of the T23 and T34 spinal cord gray matter which are not conspicuous on sagittal scan and only shows one level. Thus, these lesions are most likely artifactual.Otherwise, there is normal thoracic kyphosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. Incidental finding of T2 high and T1 iso or low signal intensity well circumscribed lesions seen on the right side of distal trachea and somewhat anterior aspect of the aortic arch level mediastinum. These lesions may indicate prominent mediastinal fat, however, if clinically indicated, chest CT can be considered for further imaging evaluation.L-spine MRIThere is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The conus medullaris terminates at the L1-2 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: diffuse bulging of disc, no significant neuroforaminal narrowing or spinal stenosis. Bilateral facet hypertrophies.L3-L4: Diffuse bulging of disc is with bilateral ligamentum flavum thickening result in mild to moderate spinal canal stenosis. L4-L5: Diffuse bulging of disc is with bilateral ligamentum flavum thickening result in mild to moderate spinal canal stenosis. L5-S1: There is Modic2 changes of endplates. There is T1 low and T2 low signal intensity lesion connected with L5S1 disc protruded into the anterior epidural space which abuts thecal sac. This lesion may represent disc herniation but could also represent postoperative fibrosis. If clinically indicated, Gad enhanced MRI can be considered. There is evidence of bilateral laminectomy at this level.

Output: 1. No evidence of spinal canal stenosis or abnormal spinal cord signal at the level of thoracic spine.2. Multilevel various degree spinal stenosis at lumbar spine including L34 and L45.3. Disc space degeneration with possible disc protrusion at the level of L5S1 with evidence of bilateral laminectomy.4. Upper mediastinal well circumscribed mass lesion which may represent mediastinal fat/lipoma. If clinically indicated, chest CT scan can be considered.


Instruction: Generate impression based on findings.

Input: Male, 5 days old, with hypotonia. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.The pituitary gland is normal for age. The brainstem and cerebellar vermis are within normal limits. The cerebellar hemispheres are fully formed, and the cerebellar tonsils terminate above the foramen magnum. The corpus callosum is fully formed and intact. Pattern of white matter myelination is normal for age.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Basal cell carcinoma of skin of right lower limb, including hip. Methicillin-resistant Staphylococcus aureus infection. Shin ulcer, history of osteomyelitis, skin cancer, radiation therapy to legs, diabetes. Evaluate for osteomyelitis. Right tibia/fibula: Again seen is ulceration of the anterior soft tissues of the lower leg approximately 6 cm above the level of the tibiotalar joint. As seen on the previous study, the signal abnormality associated with the ulcer extends through the anterior tibial cortex into the medullary bone, compatible with chronic osteomyelitis. The region of affected bone appears larger on the current study than on the prior study, with an enhancing rim that nearly abuts the posterior endosteum of the tibia. Beyond this enhancing margin, there is little, if any, edema in the adjacent medullary bone, and the remainder of the tibia is unremarkable with the exception of chronic periosteal reaction distally. The signal intensity of the fibula is likewise normal; chronic periosteal reaction distally appears similar to that seen on the prior study. There is enhancement of the skin of the lower leg and ankle suggesting cellulitis, with signal abnormality in the underlying subcutaneous fat likely representing a combination of edema and scarring. There is replacement of the anterior subcutaneous fat of the shin above the aforementioned ulcer with intermediate signal intensity on T1-weighted images and heterogeneous increased signal intensity on T2-weighted images. This tissue enhances slightly following gadolinium administration. I suspect that this represents a surgically created flap, and although I cannot exclude the possibility of superimposed tumor or infection, overall this appears similar to the prior study. I see no rim-enhancing fluid collection to confirm a soft tissue abscess. Bandlike scarring traverses the subcutaneous fat medially, also appearing similar to that seen on the prior study. There is a small knee joint effusion with synovial enhancement indicating a mild synovitis.Right forefoot/midfoot: There is a hallux valgus deformity with mild osteoarthritis of the first metatarsophalangeal joint, but I see no findings to suggest osteomyelitis of the first ray. The second toe has been amputated through the base of the proximal phalanx. I see no findings to suggest osteomyelitis of the second ray. The distal phalanx as well as the majority of the middle phalanx of the third toe are absent, presumably due to surgical resection. There is normal fat signal intensity of the proximal phalanx and remaining base of the middle phalanx, arguing against osteomyelitis. There is mild edema and enhancement of the adjacent soft tissues, with small foci of low signal intensity distal to the head of the proximal phalanx that may reflect surgical suture or subcutaneous gas. There is mild edema and enhancement of the soft tissues of the remaining fourth toe. There is also mild edema on the fat-suppressed T2-weighted images within the distal half of the proximal phalanx with relative preservation of fat signal intensity on T1-weighted images suggesting reactive osteitis rather than osteomyelitis. The distal phalanx and middle phalanx of the fourth toe are not visible, probably due to surgical resection or sequela of long-standing infection. There is a biphalangeal fifth toe. There is mild edema-type signal within the distal phalanx on the fat-suppressed T2-weighted images, with relative preservation of normal fatty signal on the T1-weighted images suggesting reactive osteitis rather than osteomyelitis. The signal intensity of the proximal phalanx of the fifth toe appears normal. The signal intensity of the metatarsals and bones of the midfoot is normal. The skin of the along the dorsum of the foot appears thickened with mild enhancement and underlying subcutaneous edema suggesting cellulitis. There is atrophy of the plantar musculature of the foot.

Output: 1.Right lower leg ulcer with underlying chronic osteomyelitis of the tibia and other findings as above.2.Soft tissue inflammation of the right forefoot and midfoot with imaging features of reactive osteitis but no specific features of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Reason: breast cancer with history of brain metastases s/p SRS. Please evaluate with interval MRI History: breast cancer with history of brain metastases s/p SRS. Please evaluate with interval MRI The CSF spaces are appropriate for the patient's stated age with no midline shift. A 3mm nodule is present in the left middle frontal gyrus which previously measured 2 mm.A punctate focus of susceptibility effect associated with contrast enhancement present along the right precentral gyrus medially which is also present on the prior exam and has not changed substantially.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.Since the prior exam there is no change in a right medial precentral gyrus lesion, however, a left middle frontal gyrus lesion appears to be slightly larger. These most likely represent metastatic foci.


Instruction: Generate impression based on findings.

Input: Male, 60 years old, with right sided weakness. MRI head:No restricted diffusion is seen. Mild patchy periventricular white matter T2 hyperintensity is noted, a nonspecific finding. No evidence of parenchymal edema or mass effect is seen. No abnormal extra-axial collections are detected. The ventricular system is normal in size and morphology.MRA head:No significant vascular stenosis or occlusion is identified. No aneurysm or vascular malformation is suspected within the limitations of technique.MRA neck:The origins of the great vessels are patent. No significant stenosis is detected in the carotid vessels by NASCET criteria. Likewise, the vertebral vessels are free of significant stenosis. The right vertebral artery is slightly larger than the left.MRI cervical spine:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is detected. No enhancing lesions are seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic cord or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Minimal facet and uncovertebral hypertrophy. No spinal canal stenosis. Moderate left foraminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Minimal disc osteophyte formation slightly asymmetric to the left foraminal region. Mild facet hypertrophy. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. C6-7: Disc osteophyte formation with a right paracentral disc extrusion. Effacement of the right ventral thecal sac without significant generalized canal stenosis. Mild facet hypertrophy. No significant foraminal narrowing. C7-T1: Facet hypertrophy. No significant spinal canal or foraminal stenosis.

Output: 1.No evidence of acute ischemia or any other acute intracranial abnormality is seen. At most, there are findings which may relate to mild chronic microvascular disease.2.No significant vascular lesions are detected in the head or neck.3.Disc osteophyte formation with a right paracentral disc extrusion is seen at C6-7. This results in effacement of the right ventral thecal sac but there is no significant canal stenosis.4.Moderate left-sided foraminal narrowing is seen at C3-4 and C5-6. No other significant spinal canal or foraminal stenosis is detected.


Instruction: Generate impression based on findings.

Input: 56-year-old female patient status post laparoscopic distal pancreatectomy/splenectomy 11/28/2011 for a mucinous cystic neoplasm. Evaluate for abnormalities. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hyperintense foci in the right hepatic lobe are too small to characterize, but unchanged. No suspicious hepatic lesion is identified. No intra- or extrahepatic biliary ductal dilatation. The hepatic vasculature is patent.SPLEEN: Status post splenectomy.PANCREAS: Post-surgical changes of a distal pancreatectomy. The remaining pancreatic duct is nondilated. No pancreatic mass is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post distal pancreatectomy and splenectomy without evidence of disease recurrence.


Instruction: Generate impression based on findings.

Input: 21-year-old male with left knee football injury presenting with knee pain and swelling. MENISCI: There is a vertical fracture within the lateral aspect of the anterior horn of the lateral meniscus. Further, there is a complex, predominantly horizontal tear of the posterior horn of the medial meniscus.ARTICULAR CARTILAGE AND BONE: The femoral, tibial, and patellar articular cartilage appear intact without significant degenerative change. Mild bone marrow edema within the lateral femoral condyle and lateral tibial plateau.LIGAMENTS: There is mild signal abnormality about the medial collateral ligament, however the fibers appear intact. The LCL complex appears intact. The PCL appears intact. There is signal abnormality within the ACL, likely indicative of complete tear. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Meniscal tears as outlined above.2. Contusion of the MCL.3. Complete ACL tear.


Instruction: Generate impression based on findings.

Input: Cerebral vascular accident. 48-year-old male. The CSF spaces are appropriate for the patient's stated age with no midline shift. A hypodense focus is present along the left cerebellar hemisphere. It is somewhat ill-defined and measures 35 x 40 mm in axial dimensions and corresponds to an area of infarction identified on the MRI of 2/18/10.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. 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.Left cerebellar hemisphere subacute infarction in PICA distribution.2.no hemorrhagic conversion.3.The ventricles are nondilated.


Instruction: Generate impression based on findings.

Input: 73-year-old female with right iliac area hematoma of unclear acuity. Please compare to 9/2015 scan and evaluate for chronicity. Presents with right hip swelling. BONE MARROW: Heterogeneous bone marrow signal abnormality likely represents residual islands of red marrow.SOFT TISSUES: Again seen is a large loculated heterogeneous collection within the soft tissues of the right hemipelvis interposed between the right gluteus medius and maximus muscles extending medially along the obturator externus and inferiorly along the posterior aspect of the proximal femoral metadiaphysis, measuring 10.0 x 7.7 x 23.9 cm, slightly decreased in size in comparison to the prior study, consistent with the stated history of hematoma. There are multiple associated fluid fluid levels internally.JOINTS: The alignment is anatomic. There is a small amount of fluid within the hips without evidence of a large effusion.ADDITIONAL

Output: Slight interval decrease in size of a heterogeneous collection within the soft tissues of the right hemipelvis consistent with the stated history of hematoma. Follow-up examination to establish resolution/evaluate for interval change is recommended.


Instruction: Generate impression based on findings.

Input: MGUS, evaluate for myelomatous lesions The medullary bone of the lower lumbar spine, pelvis, and proximal femoral demonstrates heterogeneous signal intensity likely representing residual red marrow. An subcentimeter focus of heterogeneous T1/high T2 signal is noted within the posterior column of the left acetabulum. Although this could conceivably represent a small myelomatous deposit, the lesion demonstrates small foci of hyperintense signal on T1-weighted images, and therefore may simply represent a small cartilaginous rest. There is a more discrete focus of intermediate signal intensity within the left subtrochanteric femur measuring approximately 1 cm. This is favored to represent a small island of red marrow although a small myelomatous lesion cannot entirely be excluded. Mild peritrochanteric edema is noted which is not necessarily of any clinical significance. The signal intensity of the pelvic musculature is normal. A small amount of fluid is noted within both hips, probably within normal limits.A left-sided vaginal cyst is noted demonstrating which demonstrates high T1 signal likely reflecting the presence of proteinaceous material.

Output: Subcentimeter foci of abnormal signal intensity within the posterior column of the left acetabulum with an additional 1 cm focus of intermediate signal within the left subtrochanteric femur. These findings are thought to most likely represent benign etiologies (such as a cartilaginous rest and an island of red marrow respectively); however the presence of small myelomatous deposits cannot entirely be excluded. Serial MR imaging can be obtained as clinically warranted.


Instruction: Generate impression based on findings.

Input: Reason: Area of lucency found on radiograph of the left knee History: Left knee pain There is a lesion within the proximal fibula extending from the fibular head into the proximal diaphysis over a total longitudinal distance of approximately 7.5 cm. The lesion occupies the majority of the width of the medullary canal and measures approximately 2.5 cm in its greatest transverse dimension in the fibular head. The lesion has a lobulated morphology. On T1 images it is slightly hypointense to skeletal muscle and near-fluid signal intensity on T2 weighted images. Following gadolinium administration, the lesion shows predominantly peripheral and septal enhancement. The lesion appears to be associated with mild cortical thinning but we see no frank cortical penetration. There are small round foci with similar signal intensity and enhancement characteristics in the soft tissues in the general the vicinity of the fibular head, some of which appear to erode into the proximal tibia.Severe osteoarthritis affects the knee, with tricompartmental osteophytes. The medial tibiofemoral compartment is devoid of articular cartilage with degenerative subchondral signal abnormality. There is moderate degeneration of the articular cartilage of the lateral tibiofemoral compartment with smaller full-thickness defects along the femur and tibia. There is also degeneration of the articular cartilage along the femoral trochlea.There is complex tearing of the medial meniscus. The ACL is not well visualized, presumably due to chronic tear. The PCL, MCL, and LCL are intact. The extensor mechanism is intact. There is a small joint effusion with a small amount of fluid extending into the semimembranosus-gastrocnemius recess. The visualized portions of the tibial and peroneal nerves appear normal.

Output: 1. Proximal fibular lesion as described above. Although the lesion does show heterogeneous enhancement, it is predominantly peripheral and septal in nature and furthermore similar appearing smaller lesions are seen in the soft tissues adjacent to the fibular head; thus we favor that this represents an intraosseous ganglion rather than an aggressive neoplasm, however follow-up with orthopedic oncology is recommended.2. Poor visualization of the ACL suggesting chronic tear.3. Severe osteoarthritis predominantly affecting the medial tibiofemoral compartment with complex tearing of the medial meniscus and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: MS; f/u progression History: paresthesias MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and right cerebellar punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. When compared to the prior exam these have not changed compared there is no associated contrast enhancement.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The right maxillary sinus is very small compared to the left suggesting atelectasis of the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.Redemonstration and no change of peri-ventricular white matter lesions and a right cerebellar lesion which are stable when compared to the prior exam and compatible patients known clinical history of demyelination2.no convincing evidence for thoracic spinal cord involvement of a demyelination.


Instruction: Generate impression based on findings.

Input: Myasthenia with persistent right lateral rectus paresis. Orbits: The right lateral rectus and other extraocular muscles are unremarkable. The bilateral orbital fat, globes, optic nerves, and lacrimal glands are intact bilaterally. There is no evidence of intraorbital tumors. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered cerebral white matter T2 hyperintense foci bilaterally. The brainstem and cerebellum are unremarkable. The cavernous sinuses are intact. 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 skull and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the anterior ethmoid sinuses.

Output: 1. The right lateral rectus and other extraocular muscles are unremarkable. 2. No evidence of intracranial hemorrhage, mass, or acute infarct. 3. Mild scattered cerebral white matter T2 hyperintense foci bilaterally are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of left breast DCIS with microinvasion and status post left axillary lymph node biopsy with benign results. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Within the left breast extending from less than 1 cm anterior to the pectoralis up to the nipple is suspicious nonmass enhancement compatible with the diagnosis of DCIS with microinvasion. The overall span is approximately 13.8 x 7.1 x 5.0 cm. Note is made of a focus of enhancement immediately adjacent to the nipple.Within the right outer breast, a significantly less large but still somewhat suspicious area of nonmass enhancement is seen. This measures approximately 4.9 x 1.2 x 2.9 cm. The appearance is nonspecific, though DCIS is a possibility. Based on the appearance, it is felt to be unlikely that a correlate for this finding would be seen at an MRI directed ultrasound.There are mildly prominent but largely symmetric nodes in each axilla, including the node that contains biopsy clip artifact from the previous benign biopsy.

Output: 1. Extensive nonmass enhancement in the left breast correlating with extensive calcifications on mammography and the biopsy results at 2 sites.2. Area of nonmass enhancement in the right outer breast for which MRI guided biopsy is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Chiari malformation and surgery, headaches, neck pain, numbness, and tingling both hands and arms: 3 month follow up. Brain: There are stable postoperative findings related to Chiari decompression and fourth ventricular stenting. The cerebellum displays an unchanged morphology and signal characteristics. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.Spine: There is a posterior disc-osteophyte complex that indents the spinal cord and results in mild bilateral neural foramen stenosis. Otherwise, there is no evidence of spinal cord signal abnormality or syrinx. There is no significant neural foramen stenosis. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unchanged.

Output: 1. Stable postoperative findings related to Chiari decompression and fourth ventricular stenting without evidence of syringohydromyelia or ventriculomegaly.2. A posterior disc-osteophyte complex at C6-7 indents the spinal cord and results in mild bilateral neural foramen stenosis.


Instruction: Generate impression based on findings.

Input: Mild subcortical white matter T2/FLAIR signal abnormality consistent with chronic small vessel ischemic disease. No diffusion-weighted abnormalities to suggest acute ischemia. No mass, mass-effect, or midline shift. There are no extraaxial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Mild chronic small vessel ischemic disease without evidence of a mass, mass-effect, or acute ischemia.


Instruction: Generate impression based on findings.

Input: Edema and erythema. Question of fluid collection. There is increased T2 signal within the subcutaneous tissues of the forearm, predominantly along the ulnar aspect. No discrete fluid collection is identified. The underlying musculature is within normal limits. Bone marrow signal is within normal limits.

Output: Increased T2 signal within the subcutaneous tissues of the right forearm can be seen in the setting of cellulitis. No discrete drainable fluid collection is identified. No specific evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 65 year old with ischemic cardiomyopathy presenting for evaluation of left ventricular function and scar prior to possible ICD implant. Left VentricleThe left ventricle is severely dilated. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 148 ml/m2 (normal range: 74+/-15), the LVEDV is 148 ml (normal range 142+/-34), the LV end systolic volume index is 110 ml/m2 (normal range 25+/-9), the LVESV is 243 ml (normal range 47+/-19), the LV mass index is 61 g/m2 (normal range 85+/-15), and the LV mass is 135 g (normal range 164+/-36). There is extensive enhancement reflecting myocardial infarct as result of three-vessel coronary artery disease. The most extensive enhancement is noted in the anterior and septal walls. There is subendocardial enhancement (less than 50% wall thickness) of the basal septum. At the mid chamber, there is transmural enhancement of the anterior septum with subendocardial (less than 50% wall thickness) enhancement of the inferoseptum. At the apex, the enhancement is transmural.The basal anterior wall is free from enhancement. There is transmural enhancement at the mid chamber, extending to the apex. There is subendocardial enhancement extending from the base to the mid chamber, sparing the apex.The apical two thirds of the inferior wall demonstrate transmural enhancement.No intracardiac thrombus.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal size. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 88 ml/m2 (normal range 82+/-16), the RVEDV is 193 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 116 ml (normal range 54+/-17). No enhancement is identified.Right AtriumThe right atrium is normal size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is mitral regurgitation which was not quantified on this examination but by visual inspection appears to be at least moderate. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. Extensive myocardial enhancement of the left ventricle reflective of myocardial infarct from from three-vessel coronary artery disease. No intracardiac thrombus.2. The left ventricle is moderately dilated with reduced systolic function. The left ventricular ejection fraction equals 26%.3. Moderate dilatation of the left atrium with mitral regurgitation, estimated to be at least moderate.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A 68 year old male with exertional chest pain with an echocardiography that showed a normal left ventricular function, hypertrophied septum, normal left ventricular thickness and a mid-cavity gradient. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 57 ml/m2 (normal range: 74+/-15), the LVEDV is 116 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 41 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 82 g (normal range 164+/-36). There is mild basal anteroseptal hypertrophy (13mm), and the rest of the myocardium has a normal wall thickness (8mm). There is septal anterior motion of the anterior leaflet of the mitral valve (SAM) with resulting mild flow acceleration in the left ventricular outflow tract. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Additionally, the native myocardial T1 relaxation times are within normal limits. No myocardial iron overload.No intracavitary thrombus.Left AtriumThe left atrium is normal in size (61ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 71 ml/m2 (normal range 82+/-16), the RVEDV is 145 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 69 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The aortic valve is trileaflet. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is septal anterior motion of the anterior leaflet of the mitral valve (SAM) with resulting mild flow acceleration in the left ventricular outflow tract.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal size with normal systolic function (LVEF is 64%). There is asymmetric hypertrophy of the left ventricle; however, strict MRI criteria for the diagnosis of hypertrophic cardiomyopathy are not met. However, early stage of hypertrophic cardiomyopathy should still be considered given the clear asymmetry and the presence of systolic anterior motion of the mitral valve (SAM) with mild LVOT flow acceleration. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Additionally, native myocardial T1 relaxation times are within normal limits. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 53%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Recurrent carpal tunnel syndrome following release in December 2015 Tendons: The extensor tendons are intact. The flexor tendons are intact. There is no tenosynovitis.Ligaments: The scapholunate ligament is intact. The lunotriquetral ligament is intact. The triangular fibrocartilage complex is intact.Bones/joints: There is no dislocation or subluxation and there is mild negative ulnar variance. There is no joint effusion. Cystic changes are identified within the distal radioulnar joint with additional mild osteoarthritic changes of the lunate and proximal carpal row. Otherwise the marrow signal of the wrist is normal.Muscles: There is no muscle tear or atrophy of the flexor or extensor compartments.Nerves: The level of the radiocarpal joint, the median nerve demonstrates a normal morphology. Between the levels of the distal radioulnar joint and the hook of the hamate there is a T2 hyperintense lesion measuring 8 x 3 x 9 mm demonstrating mild enhancement following contrast administration. This focus is contiguous with and distorts the ulnar aspect of the median nerve.

Output: Abnormal morphology of the median nerve with a mildly enhancing lesion identified along the ulnar aspect of the nerve between the distal radioulnar joint and the hamate concerning for scar formation.


Instruction: Generate impression based on findings.

Input: 71 year old female with acute change in mental status. Evaluate for bleed. Extensive vasogenic edema of right cerebral hemisphere is again identified. There is significant midline shift to the left secondary to mass effect. In comparison with prior MRI the midline shift on the current exam has increased and measures 10.5-mm. Minimal increase in the size of lateral ventricles is also suspected. There is however no evidence of hemorrhage as clinically is questioned.

Output: 1.No evidence of hemorrhage as clinically is questioned.2.Increase in the amount of midline shift and slight increase in the size of ventricular system since prior MRI exam.


Instruction: Generate impression based on findings.

Input: Altered mental status. Seizure like activity. Evaluate for seizure focus The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The hippocampi are symmetric.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: MRI of the brain is within normal limits. No lesion suggestive of a potential seizure focus is identified.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified persistent mental disorders due to conditions classified elsewhere. Neoplasm of unspecified nature of brain.Clinical question: A 84-year-old female, follow up brain tumor and memory impairmentSigns and Symptoms: memory impairment The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left frontal lobe surgery and left frontal craniotomy. There is gliotic change present in the left frontal lobe adjacent to the surgical site associated with some cystic encephalomalacia. Compared to the prior exam of 5/27/2005 the extent of the white matter T2 signal hyperintensity has not changed significantly.A small cystic type focus in the medial aspect of the left temporal lobe is stable. There are now some surrounding signal changes in the adjacent white matter.There is relative volume loss in the right cerebellar hemisphere relative to the left cerebellar hemisphere which is more evident on the current versus the prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Since the prior exam these periventricular and subcortical lesions have mildly increased in number.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus which to some degree is also present on the prior exam.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient status post left frontal surgery. Gliosis in the left frontal lobe remains stable compared to the prior exam.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. This has mildly progressed since the prior exam from 2005.3.Since the prior exam right cerebellar atrophy has progressed. In addition generalized atrophy has increased as would be expected with age.


Instruction: Generate impression based on findings.

Input: 39-year-old female status post a right lumpectomy in 2012 for invasive carcinoma with mixed ductal and lobular features. Status post radiation and hormonal therapy. Recent mammogram in 7/2016 was normal. There is heterogeneous amount of fibroglandular tissue in both breasts.Postsurgical changes in the right breast are noted. Mild nodular parenchymal enhancement is noted bilaterally. Multiple enhancing round to oval foci are noted in the left breast which are unchanged from prior examination. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: staging for MM History: newly diagnosed MM BONE MARROW: Diffuse foci of low T1 and high T2 signal representing myelomatous deposits throughout the pelvis, visualized femurs, sacrum, and lower lumbar spine. Largest lesion in the right iliac wing. Smaller lesion of possible note in the posterior column of the left acetabulum measuring 1.5 cm. SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Diffuse myelomatous deposits as above.


Instruction: Generate impression based on findings.

Input: 58 years, Female, Reason: Liver protocol. Elevated ammonia, cholestatic liver injury, bridging fibrosis on 2007 bx, evaluate for cirrhosis, stricturing and/ or shunting History: Intermittent encephalopathy (elevated ammonia) and elevated liver enzymes. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No focal hepatic lesions. The liver has a cirrhotic countour. No evidence of biliary stricturing or ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver morphology without focal lesions or evidence of biliary stricturing.


Instruction: Generate impression based on findings.

Input: 53-year-old woman with history of fall from horse, left pubic ramus fracture, and urinary incontinence. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Lumbar spine alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at L1. Of note there is thin, discontinuous linear T1 hyperintense signal extending from the L2/3 to lower L4 level and again from the L5 level to the distal thecal sac. This appears similar to the prior examination from 2012 and is of normal thickness.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: There is a minimal disc bulge without spinal canal or neural foraminal stenosis.L4-L5: There is a minimal disc bulge without spinal canal or neural foraminal stenosis. There is a small right perineural cyst.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. There is a small left perineural cyst.There is a curvilinear area of T1 hypointensity and T2 hyperintensity extending from the anterior left sacral ala to the left lateral margin of the S1-S2 foramen (501/3). There is increased T2 signal in the surrounding marrow, however no evidence of significant cortical displacement. There are cysts in the right lobe of the liver and right kidney, otherwise the paraspinous soft tissues are within normal limits.

Output: 1.Incompletely visualized nondisplaced left sacral alar fracture extending to the margins of the dorsal sacral foramina, with prominent associated bone marrow edema. CT can be considered for further characterization if clinically warranted.2.Incidentally noted discontinuous fatty filum terminale which can be a normal variant but could also be seen in tethered cord syndrome, please correlate with clinical history.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type II. Altered mental status and weakness. This examination was obtained at the completion of the brain/whole spine examination from the day prior which was not completed for the spine due to patient intolerance. The examination is mildly limited by motion/breathing artifact.There are changes of previous suboccipital decompression and intracranial neurofibromatosis type 2 stigmata. Please refer to the brain MRI report from the day prior for details.CERVICAL SPINE:The central, contrast-enhancing lesion involving the cervical spinal cord at C1-C2 level has not changed. The associated surrounding edema-like T2 signal is improved now extending from C1 level to just above the C2-C3 disc level, previously reaching below the C2-C3 level. Associated cord expansion is also mildly improved.Alignment is anatomic. Multilevel cervical disc desiccation is minimally increased. Disc-osteophyte complexes minimally indent the anterior aspect of the thecal sac at C2-C3 and C3-C4 levels but without significant spinal canal stenosis. There is mild left C3-C4 and C4-C5 foraminal stenoses by uncovertebral arthropathy. There is no suspicious marrow abnormality.THORACIC SPINE:Axial images are limited due to artifact. There is partial anterior fusion between T11 and T12 associated with mild but focal scoliosis, which is probably congenital and unchanged since the previous examination. This is associated with minimal central disc protrusion indenting the ventral thecal sac and ventral cord. Otherwise, the intervertebral disc are preserved in height and T2 signal. Alignment is preserved and marrow signal shows no suspicious focality. There is no signal or morphologic abnormality of the thoracic spinal cord.A 3 mm intradural extramedullary contrast-enhancing nodule on the right side of the spinal cord at T11-T12 level is not significantly changed since May 2011 examination. A 6 mm nodule left anterolateral to the spinal cord at T12-L1 level was also present previously but was not included on the axial images though appears grossly unchanged. Multiple other smaller lesions are present also on sagittal imaging, with suggestion of similar lesions also on the previous examination.LUMBOSACRAL SPINE:As described on the MRI brain/posterior spine report from yesterday, there is transitional spinal anatomy with 6 lumbar appearing vertebrae. For the purposes of this exam, the last fully formed disc is at L5-L6 with a rudimentary disc at L6-S1. Please note that the spine was numbered in a different manner on the prior exam from March 2010 .Axial images are limited due to artifact. Numerous contrast enhancing intradural extramedullary masses are present along the cauda equina nerve roots. Similar appearance was present on the previous MRI from March 2010 though accurate lesion-to-lesion comparison cannot be performed given the degraded nature of the previous postcontrast sequence caused by motion.There is asymmetric convex fullness and contrast enhancement in the right L5-L6 neural foramen. Similar finding is present along the included sacral nerve roots as well, more pronounced on the right. These may have increased since the previous examination but the previous axial postcontrast images were obtained without fat saturation.Lumbar spinal alignment is anatomic. Vertebral bodies are normal in height. Please refer to the MRI report from yesterday for other lumbar spine findings. There are mild opacities at the lung bases dependently, likely atelectasis.

Output: 1.The contrast enhancing component of an expansile intramedullary lesion at C1-C2 level has not changed but the surrounding T2 hyperintense signal and mild cord expansion are slightly improved since May 2011.2.Numerous intradural, extramedullary contrast-enhancing lesions in the lumbar and thoracic regions are not grossly changed since the previous examinations from May 2011 and March 2010 although accurate, lesion-to-lesion comparison cannot be performed given the different nature of the examinations and motion degradation. 3.Asymmetric fullness and increased contrast enhancement involving the sacral nerve roots, more on the right, may have slightly progressed since the previous examination from March 2010 and may represent schwannomas.4.Please refer to the brain and total spine MRI reports from the day prior for details regarding the other findings. Please note that transitional spinal anatomy is present in the surgery is to be contemplated, correlation with imaging of entire spine is recommended.


Instruction: Generate impression based on findings.

Input: Male, 75 years old, with fever and lethargy. Evaluate for etiology of fever and altered mental status. No restricted diffusion is seen. No evidence of parenchymal edema or mass effect is detected. There are no intracranial enhancing lesions. No evidence of acute or chronic intracranial hemorrhage is seen. Mild prominence of the CSF along the superior surface of the cerebral hemispheres is unchanged and may reflect underlying cerebellar volume loss or subdural effusions. The ventricular system is normal in size and morphology. Minimal left frontal periventricular white matter T2 hyperintensity is seen, a nonspecific finding. Patchy opacification of the mastoid air cells is seen, right more than left. Opacification of the right frontal sinus and the ethmoid air cells is seen with mucosal thickening and minimal fluid in the left sphenoid sinus.

Output: 1.No acute intracranial abnormality.2.No intracranial findings to account for the patient's symptoms.3.Evidence of mucosal inflammation is seen in the paranasal sinuses and mastoid air cells. Correlation with clinical signs of sinus or mastoid infection is suggested.


Instruction: Generate impression based on findings.

Input: There is straightening of the cervical spine, otherwise alignment is within normal limits. There is a normal relationship of the dens with the arch of C1. There is no acute fracture or pre-vertebral soft tissue swelling. Low T1 signal throughout the vertebral bodies likely reflects red marrow. Multilevel disc desiccation without significant disc space loss. No abnormal signal within the visualized cord.C2-C3: No significant disc disease. No spinal canal or neural foraminal stenosis.C3-C4: Small central protrusion with minimal effacement of the ventral thecal sac. Mild uncovertebral joint arthropathy. Mild bilateral neural foraminal narrowing. C4-C5: No significant disc disease. No spinal canal stenosis. Mild uncovertebral joint arthropathy. Mild bilateral neural foraminal narrowing.C5-C6: No significant disc disease. No spinal canal or neural foraminal stenosis. C6-C7: There is an eccentric right paracentral disc extrusion which is slightly decreased in size compared to the prior exam, with stable 8 mm of superior migration. There is effacement of the right lateral recess and flattening of the hemicord, mildly improved. Moderate right neural foraminal stenosis is unchanged. No left neural foraminal stenosis.C7-T1: No significant disc disease. No spinal canal or neural foraminal stenosis.

Output: 1.Eccentric right paracentral disc extrusion at C6-C7 is slightly decreased in size with mild improvement in effacement of the ventral thecal sac and mass effect on the cord. Resultant moderate right neural foraminal stenosis is unchanged.2.Small central protrusion at C3-C4 is stable.


Instruction: Generate impression based on findings.

Input: Disseminated malignant neoplasm. Malignant neoplasm of prostate. Now with weakness. Evaluate for cord compression. There is diffuse heterogenous marrow replacement throughout the spine. There are multilevel degenerative changes in the cervical spine worse at C4-5, C5-6 and C6-7 where there is narrowing of the spinal canal and encroachment of exiting nerve roots.There is a ventral epidural mass at T2 without significant compromise to the spinal canal, however, it encroaches on the right sided exiting nerve roots at T2-3There is an epidural mass centered along the posterior aspect of the spinal canal at T5 which results in effacement of spinal fluid surrounding the spinal cord. There is associated narrowing of the left T4-5 and T5-6 neural foramina with encroachment of the exiting nerve roots.There is a T8 vertebral body malignant appearing compression fracture with 50% loss of height and convex posterior appearance impressing on the thecal sac and narrowing of the spinal canal and near completely effacing spinal fluid around the spinal cord.There is an epidural mass at the ventral aspect of the spinal canal at L5 which narrows the spinal canal and encroaches on the left sided exiting nerve roots.There is a small right sided pleural effusion present

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. There are diffuse spinal metastases present.2.There is a malignant compression fracture at T8 narrowing the spinal canal causing moderate spinal stenosis. 3.There is posterior epidural mass at T5 narrowing the spinal canal and creating moderate spinal stenosis. There is associated narrowing of the left T4-5 and T5-6 neural foramina with encroachment of the exiting nerve roots.4.There is an epidural mass at the ventral aspect of the spinal canal at L5 which narrows the spinal canal and encroaches on the left sided exiting nerve roots.5.There are degenerative changes in the cervical spine causing spinal stenosis and neural foramen encroachment.6.There is a ventral epidural mass at T2 without significant compromise to the spinal canal, however, it encroaches on the right sided exiting nerve roots at T2-37.There is a small right sided pleural effusion present8.An email was sent to Dr Everett Vokes with the results at the time of this dictation.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Patient with right knee pain. MENISCI: There is elongated globular intermediate signal intensity within the body and posterior horn of the medial meniscus that contacts the tibial articular surface. This likely represents intrasubstance degeneration and degenerative undersurface tearing. The anterior horn appears intact. Lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is minimal edema type signal in the medial tibial plateau subjacent to the aforementioned suspected meniscal tear. However, the articular cartilage of medial compartment appears normal for age. Lateral compartment cartilage appears normal for age. There is a signal heterogeneity of the articular cartilage of the patella, indicating mild to moderate degenerative changes, with at least one near full-thickness cartilage cleft. There is also mild thinning of the articular cartilage of the femoral trochlea centrally.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.There is mild edema within the anterior subcutaneous tissue of the knee which is nonspecific.ADDITIONAL

Output: 1.Intrasubstance degeneration and undersurface degenerative tearing of the medial meniscus.2.Mild to moderate degenerative changes of the articular cartilage of the patellofemoral joint.3.Joint effusion and other findings as described above.


Instruction: Generate impression based on findings.

Input: Male; 48 years old. Reason: elevated psa History: elevated psa PELVIS:PROSTATE:Prostate Size: 3.8 x 4 x 3.3 cm. Peripheral Zone: No focal lesions suspicious for prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality notedExtracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of prostate cancer.


Instruction: Generate impression based on findings.

Input: Ependymoma brain, resection, new headaches, normal LP opening pressure. Evaluate for recurrence.. Brain:Unchanged areas of T2 hyperintensity within the pons, cerebellar peduncles, and right greater than left cerebellar hemispheres compatible with treatment changes. Redemonstrated is the patient's left frontal approach ventriculoperitoneal shunt with the tip of the catheter with the tip at the foramen of Monro and unchanged in position. There is minimal increase in size of the lateral and third ventricles compared to 10/29/2014. For example the third ventricle currently measuring 6 to 7 mm, previously 5 mm. There is susceptibility artifact related to the catheter. No reduced diffusion in the visualized brain to suggest acute ischemia. Evidence of prior right transfrontal ventriculostomy catheter also seen. There are innumerable foci of susceptibility throughout the brain compatible with radiation-related cavernous malformations better seen on prior VENBOLD sequence. The relatively largest of these measures 5 mm on the susceptibility sequence at the right temporal operculum and likely similar to prior allowing for differences in technique. Moderate degree of parenchymal calcifications within the cerebellar hemispheres are better appreciated on CT. Supratentorial T2/FLAIR hyperintense foci may represent chronic small vessel ischemic changes and/or treatment changes.Previously seen diffuse dural enhancement is markedly improved. No new or suspicious enhancement is appreciated in the brain. No intracranial mass or evidence of mass effect. Spine:There is deformity of the left ventral thecal sac at the cervicothoracic junction from C6 to T2 with mass effect on the left ventral cord, which maybe related to CSF loculation. Findings are unchanged from examinations dating back to 6/16/2010. No cord signal abnormality.No cord signal abnormality. There is thickening and abnormal leptomeningeal enhancement along the nerve roots of the cauda equina in the upper lumbar spine, not significantly changed since 3/26/2013. There is prominent T1 hyperintensity involving the lower cauda equina nerve roots at the level of the lumbar spine with mild enhancement, and also similar to prior.Small disk bulges at mild degenerative changes including small disk bulges in the lower lumbar spine are again noted. No high-grade spinal canal or neural foramina stenosis is seen. Left renal cyst

Output: 1. Post-treatment changes in the brain without evidence of intracranial mass or abnormal enhancement to suggest tumor recurrence.2. Compared to 10/29/2014, there is minimal interval increase in size of the ventricular system and decrease in diffuse dural enhancement. These findings would be compatible with improvement in previously seen findings suggestive of (relative) overshunting on 10/29/2014.3. Multiple subcentimeter foci of susceptibility throughout the brain which given remote history of radiation, are favored to represent multiple radiation-related cavernous malformations. No significant interval change allowing for differences in technique.4. Thickening of the cauda equina nerve roots with areas of nodular enhancement, findings which are not significantly changed since prior. Although persistent leptomeningeal disease can not be excluded, given stability since 3/26/2013 finding may represent treatment-related change. 5. Deformity of the left ventral thecal sac from C6 to T2 with mass effect on the left ventral cord likely related to adhesion/CSF loculation. Findings are unchanged from examinations dating back to 6/16/2010. No cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with history of metastatic nasopharyngeal cancer and concern for new brain metastasis on CT. A somewhat heterogeneously enhancing lesion is evident centered on the anteromedial left inferior temporal gyrus measuring 19 x 15 x 14 mm. On axial images, the lesion demonstrates a gyriform or stellate morphology and is ill-defined on T2-weighted images. The lesion induces moderate edema in the surrounding anterior temporal parenchyma.The lesion sits immediately above the foramen ovale. However, no clear abnormality of the V3 nerve is demonstrated. The lesion abuts the dural margin of the left Meckel's cave, but no abnormalities are seen within Meckel's cave. No lesions are detected along the cisternal segment of the left trigeminal nerve.No additional intracranial enhancing lesions are seen. There is a punctate focus of diffusion restriction within the left superior frontal gyrus. However, this occurs in the context of numerous scattered small foci of FLAIR hyperintensity within the bilateral cerebral hemispheres. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology. Fatty marrow replacement is evident in the clivus and upper cervical spine compatible with prior radiotherapy.

Output: An enhancing lesion is evident centered on the anterior medial aspect of the left inferior temporal gyrus. The differential diagnosis for this lesion would certainly include metastatic disease, potentially via perineural spread given its location relative to the foramen ovale. However, no evidence of tumor involvement of the V3 nerve is seen.Some of the features of the lesion, however, are not completely typical of metastatic disease. Consequently, if a review of the radiation oncology records indicates that the anterior temporal lobes received a sufficient dose of radiation, then radiation necrosis should also be considered in the differential.A punctate focus of diffusion restriction within the left superior frontal gyrus is nonspecific. However, given the context of moderately extensive scattered small foci of signal abnormality, this may simply represent an incidental acute microvascular ischemic lesion.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: eval s/p rt mca stroke History: lt side weakness, lt sided facial droop Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion.There are multiple scattered high signal intensity lesions on bihemispheric white matter which are non specific.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. 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.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate significant in flow signal drop on the right MCA proximal M2 segment. This finding may represent an artifacts due to arterial tortuosity but could also represent focal luminal stenosis. Therefore, if clinically indicated CT angiography of head can be considered.Left ICA, ACA and MCA appears to be normal. And Vertebrobasilar system appears to be normal.There is no evidence of intracranial arterial aneurysm.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Focal signal drop on the right MCA proximal M2 segment which could be either an artifact or focal luminal stenosis. Thus if clinically indicated, CTA of head could be considered.


Instruction: Generate impression based on findings.

Input: Pituitary tumor and meningioma: yearly follow up. Pituitary: There are postoperative findings related to transsphenoidal surgery. There is no significant interval change in the pituitary mass with suprasellar and bilateral cavernous sinus extension, as well as invasion into the clivus. The tumor measures up to approximately 40 mm. Furthermore, there is unchanged encasement of the left juxtasellar internal carotid artery and mass effect upon the optic apparatus, which displays volume loss. Brain: There are postoperative findings related to right frontal craniotomy with anterior right frontal lobe encephalomalacia. There is no significant interval change in the multiple dural-based enhancing mass lesions, including along the tentorium with mass effect and edema in right occipital lobe, in the left anterior sylvian region, right frontal convexity and along the left anterior falx cerebri. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, paranasal sinuses, skull, and scalp soft tissues appear unchanged.

Output: 1. No significant interval change in the invasive pituitary macroadenoma with massa effect upon the optic apparatus and encasement of the left internal carotid artery.2. No significant interval change in the multiple intracranial meningiomas, including the dominant left tentorial lesion with associated right occipital lobe edema.


Instruction: Generate impression based on findings.

Input: Other musculoskeletal symptoms referable to limbs(729.89) [729.89], Reason for Study: ^Reason: Evaluate for ischemic stroke History: RUE weakness and numbness with R facial droop There is restricted diffusion on the left precentral and postcentral gyrus around left central sulcus indicating acute ischemic stroke. There is no evidence of acute hemorrhagic conversion.Multiple scattered high signal intensity lesions on bilateral periventricular white matter indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, midline shift, intra or extra-axial fluid collection/hemorrhage. 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: Acute ischemic stroke on both left precentral and postcentral gyrus without evidence of hemorrhage transformation as described above.Minimal nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of right breast DCIS and lumpectomy with positive margins, patient declined mastectomy, additional biopsy also positive for DCIS (in March 2013), presents for MRI surveillance There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Clip artifact identified in the right breast 8 o'clock position anterior depth. Few enhancing foci seen in both breasts, none of them are uniquely enhancing. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:6/22/1952)Reason: pre dbs for parkinsons History: tremorPROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. Examination is limited and was performed the purpose of stereotactic guidance.


Instruction: Generate impression based on findings.

Input: Spine pain. Evaluate for compression fracture. Patient on chronic high-dose steroids. Thoracic spine: The bones are diffusely demineralized, suggesting osteopenia or osteoporosis. Anterior wedging of multiple thoracic vertebral bodies and severe compression deformity of T9 appear grossly stable from prior CT. There is resultant marked kyphosis of the thoracic spine. No obvious acute fracture is present.Lumbar spine: The bones are diffusely demineralized, suggesting osteopenia or osteoporosis. Anterior osteophytes and mild multilevel degenerative disc disease are noted. Lucency of the left L4 pedicle is questioned, raising the possibility of age-indeterminate fracture, not present on prior MRI. The left L4 transverse process is also not well visualized. CT of the lumbar spine can be considered for further evaluation.Pelvis: The bones are diffusely demineralized, suggesting osteopenia or osteoporosis. Linear lucency and sclerosis of the right pubis/inferior pubic ramus may represent acute to subacute fracture. Mild degenerative changes affect the sacroiliac joints and left hip joint.

Output: 1.Multiple thoracic vertebral compression fractures, likely chronic. 2.Questionable age-indeterminate left L4 pedicular fracture; CT may be considered for further evaluation. 3.Right pubis/inferior pubic ramus fracture, likely acute to subacute.Findings were discussed via telephone with Dr. Curran at 1:33 PM on 8/13/2015.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of right main bronchus [C34.01] No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Patchy bilateral periventricular white matter FLAIR/T2 high signal intensity lesions indicate nonspecific small vessel ischemic disease. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: A 49 year old male with alcohol abuse and recently diagnosed biventricular heart failure (LVEF 10% by echo). An apical clot was suspected and anticoagulant treatment was started. Normal coronary arteries by left heart catheterization. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 15%, the LV end diastolic volume index is 177 ml/m2 (normal range: 74+/-15), the LVEDV is 398 ml (normal range 142+/-34), the LV end systolic volume index is 151 ml/m2 (normal range 25+/-9), the LVESV is 340 ml (normal range 47+/-19), the LV mass index is 89 g/m2 (normal range 85+/-15), and the LV mass is 200 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying focal replacement fibrosing, infiltrative, or inflammatory process.Native myocardial T1 times are mildly increased (~1100ms), suggesting the presence of mild, diffuse, interstitial fibrosis. No intracavitary thrombus was noted.No myocardial iron overload was noted.Left AtriumThe left atrium is severely dilated (166ml). Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 29%, the RV end diastolic volume index is 123 ml/m2 (normal range 82+/-16), the RVEDV is 277 ml (normal range 142+/-31), the RV end systolic volume index is 88 ml/m2 (normal range 31+/-9), and the RVESV is 198 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation (functional).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 upper normal size (37 X 38mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (32mm).Venous AnatomyThe SVC and IVC drain into the right atrium. There is a catheter on the right subclavian vein. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere is a large right pleural effusion with likely associated compressionn atelectasis. There is a small left 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. The left ventricle is severely dilated with severely reduced systolic function, the LVEF 15%. 2. There is no late gadolinium enhancement to suggest the presence of an underlying focal replacement fibrosing, infiltrative, or inflammatory process. However, native myocardial T1 times are mildly increased, suggesting the presence of mild interstitial fibrosis.3. No intracavitary thrombus was noted.4. No myocardial iron overload was noted.5. The right ventricle is mildly dilated with severely reduced systolic function, the RVEF is 29%. 6. The left atrium is severely dilated and the right atrium is mildly dilated7. There is mild to moderate mitral regurgitation (functional).8. The main pulmonary artery is mildly dilated.9. There is a small pericardial effusion.10. See extracardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pt with trochlear nerve palsy/recovering encephalopathy, hx of Multiple Myeloma. Please obtain CT head with special attention at skull bases, cavernous sinuses and orbits. There is no evidence of intracranial hemorrhage, mass or edema. Brain parenchyma is normal in attenuation and morphology. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bilateral globes, optic nerves, retro-orbital fat and extra-ocular muscles are unremarkable. MRI examination may be helpful to further evaluate patient's cranial nerve palsy, if clinically indicated.

Output: Normal brain/orbit CT.


Instruction: Generate impression based on findings.

Input: The examination is slightly limited. The myelination is appropriate for patient's corrected age. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Unremarkable noncontrast MRI.


Instruction: Generate impression based on findings.

Input: Reason: R/O nerve root impingement on the L (?C7). Please compare to last MRI from 2013. History: Neck pain radiating to LUE Examination is motion degraded, particularly the axial T2 sequences. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is straightening of the cervical spinal curvature with minimal anterolisthesis of C4 on C5, which appears new, and minimal retrolisthesis of C6 on C7, which was present previously. Bone marrow signal is benign with small foci of T1 hyperintensity involving the inferior C5 and C6 endplates on a degenerative basis and similar to prior.The cervical spinal cord has grossly normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex and uncovertebral hypertrophy contributes to up to moderate right-sided neural foraminal stenosis which appears worse. No spinal canal or left neural foraminal stenosis.C5-6: Disc osteophyte complex including bilateral uncovertebral hypertrophy with contact of the ventral cord. There is mild spinal canal stenosis at this level. There is severe left and moderate right neural foraminal stenosis.C6-C7: Disc osteophyte complex with bilateral uncovertebral hypertrophy. There is severe left and moderate to severe right neural foraminal stenosis. There is at most mild spinal canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Examination is motion degraded, particularly the axial T2-weighted sequence. There appears to be very mild overall progression of degenerative changes in the cervical spine compared to 2/15/2013. Again seen is severe left C5-C6 and left C6-C7 neural foraminal stenoses where there may be impingement of the left C6 and C7 nerve roots.2. Mild spinal canal narrowing at the C5-C6 and C6-C7 levels similar to prior. No high-grade spinal canal stenosis or cord signal abnormality. Additional details as above.


Instruction: Generate impression based on findings.

Input: Leg and arm weakness, paresthesias, urinary incontinence. 2004 Bell's palsy surgery. Examination is mildly motion degraded. There is development narrowing of the spinal canal with suggestion of disc protrusion at the C4-C5 level which can be better assessed with dedicated cervical spine study. Vertebral bodies are appropriate in the overall alignment and height. The spinal cord has grossly normal signal characteristics. There is no significant spinal canal stenosis in the thoracic or lumbar spine. There is diffuse low T1 marrow signal which is nonspecific. No focal destructive osseous lesions.

Output: 1. Limited exam per cord compression protocol which is also mildly motion degraded. There is developmental narrowing of the cervical spinal canal with suggestion of superimposed disc protrusion at the C4-C5 level and associated up to moderate spinal canal stenosis at this level. Recommend dedicated cervical spine study for better evaluation. No significant spinal canal stenosis in the thoracic or lumbar spine.2. Diffuse low T1 marrow signal which is nonspecific and can be seen with marrow reconversion related to anemia, chronic illnesses, as well as marrow proliferative disorders.Dr. Ali discussed findings with Dr. Greenwald in the ED at 1045 hrs on 8/25/2016.