Instruction: Generate impression based on findings.

Input: On the localizer sequence imaging there is increased edema in the left superior frontal gyrus compared to prior examination.

Output: Nondiagnostic examination with only localizer sequences obtained due to patient intolerance. There appears to be increased edema in the left superior frontal gyrus compared to prior examination. If clinically indicated, repeat imaging can be obtained with sedation.


Instruction: Generate impression based on findings.

Input: Reason: eval for internal derangement /meniscus tear right knee History: eval for internal derangement /meniscus tear right knee MENISCI: The medial meniscus appears intact. The lateral meniscus appears intactARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness articular cartilage degeneration along the weightbearing portion of the medial femoral condyle above the posterior horn and body of the meniscus. There is subjective thinning of the lateral compartment cartilage. There is relative sparing of the patellofemoral articulation.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: 1. Osteoarthritis of the knee including articular cartilage degeneration most pronounced along the weightbearing surface of the medial femoral condyle. 2. Edema within the quadriceps fat pad is nonspecific, but can be seen in patient's with fat pad impingement.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with history of T3N0 acinic cell carcinoma of the right parotid status post parotidectomy and radiotherapy. Postoperative findings are seen compatible with right parotidectomy. The lobular, cystic and solid enhancing tumor seen on the prior examination within the superficial anterior aspect of the parotid gland has been resected. No evidence of residual or recurrent tumor is demonstrated at the operative site.Soft tissue and mucosal edema is demonstrated in the pharynx, masticator space and soft tissues surrounding the right parotid bed, all likely post treatment in nature. Findings are seen compatible with right neck dissection. No evidence of any pathologic adenopathy is seen.The residual salivary glands are free of focal lesions. Marrow signal characteristics are within normal limits. Patchy fluid signal is seen in the right mastoid air cells. An eyelid weight is evident on the right.

Output: Postoperative and posttreatment findings are seen in the right neck with no evidence of residual or recurrent parotid tumor and no pathologic adenopathy.


Instruction: Generate impression based on findings.

Input: Reason: assess for stenosis or disk herniation History: low back pain with radiculopathy Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disk desiccation presentAt L5-S1 there is no significant compromise to spinal canal. There is marked bilateral facet are present at this level associated with narrowing of the neural foramina and mild encroachment of the exiting nerve roots within the neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is marked bilateral facet hypertrophy present.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.Examination is mildly compromised due to patient motion which may obscure more subtle abnormalities.

Output: 1.Degenerative changes are present in the lumbar spine worse at L4-5 and L5-S1 where there is marked bilateral facet hypertrophy and some mild encroachment of exiting nerve roots at L5-S12.Examination is mildly compromised due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Clinical question: Low back pain. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:The alignment of vertebral column is anatomical.The signal intensity of the vertebral column is unremarkable other than changes related to degenerative disease.T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate mild degenerative disc disease, mild ligamentum flavum hypertrophy, minimal T2 hyperintensity of the bilateral articulating facets suggestive of effusion. There is a tiny right-sided synovial cyst projecting posterior to the articulating facet at this level measuring 5 x 8 mm in transaxial dimensions (axial T2 series 6 image 18). No spinal stenosis or neural foraminal compromise.L3-L4 demonstrate minimal degenerative disc disease, moderate bilateral ligamentum flavum hypertrophy, mild bilateral facet disease and including increased T2/T2 STIR signal intensity of the facet spaces suggestive of effusion. No spinal stenosis however mild right neural foraminal compromise is noted.L4-L5 demonstrate minimal disc disease, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L5-S1 demonstrate advanced disc disease and loss of disc height, mild bilateral facet and ligamentum flavum degenerative changes. No spinal stenosis or neural foraminal compromise.On axial and sagittal T1-weighted there is a long segmental fatty filum terminale measuring maximum of 5 x 3 mm in transaxial dimensions at L2 level. The finding could represent a tethered cord however there is normal termination of the cord at L1-L2 disc level.

Output: 1.Moderate to advanced disc disease at L5-S1 level and minimally at other levels as detailed.2.No evidence of spinal stenosis at any level.3.Mild neural foraminal compromise as detailed per level above.4.Fluid signal intensity within the articulating facets and including a synovial cyst posterior to articulating facet on the right at L2-L3 level as detailed.5.Long segmental fatty filum terminale measuring maximum of 5 x 3 mm in transaxial dimensions however with normal termination of the cord at the L1-L2 disc level.


Instruction: Generate impression based on findings.

Input: Clinical question: Atrophy. Signs and symptoms: Memory loss. Nonenhanced head CT:The cortical sulci, ventricular system and CSF cisterns are within normal range for patient's stated age of 85.Periventricular and subcortical patchy foci of low attenuation are concerning for mild small vessel ischemic strokes of indeterminate age.MRI is more sensitive for assessment of the extent of this finding.Mild calcification of cavernous carotid bilaterally is present.No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium is intact.Image images through the orbits are unremarkable.Mastoid air cells and middle ear cavities as well as all visualized paranasal sinuses are unremarkable.

Output: Mild small vessel ischemic strokes of indeterminate age and unremarkable exam otherwise. In particular no convincing evidence of atrophy for patient's stated age.


Instruction: Generate impression based on findings.

Input: Yearly follow-up, tethered cord. Examination is slightly motion degraded. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The patient is status post laminectomies from L2 through L5 and partial at L1.The conus medullaris has its inferior tip at the L3 vertebral body level in stable position compared to the prior exam and directed posteriorly. There is redemonstration of a tiny syrinx in the distal spinal cord which is unchanged when compared to the prior exam. It measures 2 mm in diameter. Conjoined left L5 and S1 nerve roots incidentally noted.There is a no change in the position of the conus medullaris when placing the patient in the prone position.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.

Output: 1.Postsurgical changes of spinal cord untethering with unchanged appearance of the conus and cauda equina nerve roots. No anterior motion is appreciable in the prone sequence, which in the appropriate clinical setting may suggest retethering. Finding remains unchanged.2.Prominent central canal/tiny syrinx in the distal cord again seen. No new or enlarging syrinx.


Instruction: Generate impression based on findings.

Input: 12 years, Female, with progressive memory loss since October, 2014. No evidence of cortical dysplasia or gray matter heterotopia. No intracranial mass or mass-effect. Bilateral hippocampi are symmetric in size and signal characteristics. No areas of restricted diffusion. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Brain parenchymal volume appears within normal limits. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No structural lesions in the brain are appreciated. No findings to suggest seizure focus.


Instruction: Generate impression based on findings.

Input: Diffuse pain and weakness, evaluate for cervical or segmental cord compression. Examination is obtained per screening adult cord compression MRI protocol. There is 6 mm anterolisthesis of C7 on T1 with severe loss of intervertebral disk space and T2 hyperintensity within the disc space. There is low T1 and T2 signal involving the adjacent endplates compatible with sclerosis. There is moderate loss of height involving the anterior aspect of the T1 vertebral body and minimal loss of height involving the C7 vertebral body.There are degenerative changes throughout the cervical spine with disk osteophyte complexes and moderate spinal canal stenosis at C3-C4, C4-C5, C5-C6, and moderate to severe spinal canal stenosis at C7-T1. There is T2 hyperintensity within the cervical cord at the C7-T1 level. Advanced facet arthropathy is also seen at the C7-T1 level bilaterally. There is bone marrow edema which extends into the posterior elements at C7 and T1. There is severe neural foramina stenosis at C7-T1, worse on the right than the left.Remainder of the cervical, thoracic, and lumbar vertebral body heights appear preserved. There is straightening of the lumbar spine curvature. Advanced degenerative changes are noted at the L3-L4 and L4-L5 levels and to a lesser degree at L2-L3 and L5-S1. Axial images were not obtained, however, there may be up to moderate spinal canal stenosis. There is up to severe neural foraminal narrowing at the L3-L4, L4-L5, and L5-S1 levels.

Output: Limited exam for cord compression protocol demonstrating degenerative changes throughout the cervical spine, worst at the C7-T1 level, where there is 6 mm of anterolisthesis, severe loss of intravertebral disk space, endplate sclerosis, and mild anterior wedging of the T1 vertebral body. These findings are most likely related to advanced degenerative changes. Given the advanced degenerative/destructive changes at the C7-T1 level described above including the anterior and posterior elements, Charcot/neuropathic joint can also be considered, although uncommon, in the appropriate clinical setting.Moderate to severe spinal canal stenosis at C7-T1 with T2 hyperintensity within the cord compatible with edema.Degenerative changes also noted in the lumbar spine, worst at the L3-L4 and L4-L5 levels. There is T2 hyperintensity within the disk space and adjacent endplates which may be on a degenerative basis. There may be up to moderate spinal canal stenosis which is difficult to evaluate without axial images. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine. Consider dedicated cervical and lumbar spine imaging.


Instruction: Generate impression based on findings.

Input: Female 38 years old Reason: length of cervical canal before surgery. please place coil in vagina. History: cervical cancer PELVIS:UTERUS, ADNEXA: Postsurgical changes from cervical trachelectomy. Length of cervical canal is approximately 1.5-cm craniocaudally (series 801/18). No evidence of residual or recurrent disease.Left ovary simple cyst measuring up to 2.4-cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postsurgical changes from cervical trachelectomy without evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: Subacute weakness and dysphagia. There are patchy areas of subcortical, deep, and periventricular T2 hyperintensity without restricted diffusion involving the bilateral occipital and parietal lobes, with extension into the temporal lobe and precentral gyrus on the left side. There are also linear T2 hyperintensities along the periventricular white matter of the bilateral frontal horns of the lateral ventricles and patchy and punctate T2 hyperintense areas in the deep and subcortical white matter of the bilateral anterior frontal lobes. There is associated cerebral volume loss, particularly in the left posterior cerebral hemisphere. In addition, there is a small patchy area of high T2 signal involving the medial portion of the left superior cerebellar hemisphere. The brainstem and deep grey matter structures appear to be spared. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mucosal thickening and fluid in the bilateral sphenoid, right maxillary, and left frontal and anterior ethmoid sinuses.

Output: 1. Extensive cerebral white matter disease with brain parenchymal volume loss, as well as a small area of left cerebellar hemisphere white matter abnormality, may represent a neurodegenerative leukoencephalopathy, perhaps related to a mitochondrial disorder or toxic-metabolic process, for example.2. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Ankylosing spondylitis; evaluate for disc herniation. There mild disc dessication and loss of height at L4-5 and L5-S1. There is no significant spinal canal or neural stenosis. The vertebral column alignment is within normal limits. The vertebral body are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Mild disc dessication at L4-5 and L5-S1 without significant spinal canal.


Instruction: Generate impression based on findings.

Input: 64-year-old female patient with HCV, cirrhosis. Two subcentimeter lesions noted on MRI from 5/2016. Evaluate for change in lesions. ABDOMEN:LIVER, BILIARY TRACT: There is a cirrhotic morphology of the liver. No intra or extrahepatic biliary ductal dilatation. There is mild paradoxical shift of signal on in and out of phase imaging suggesting iron deposition. The hepatic vasculature is patent with the suggestion of a left arterioportal fistula as seen on a prior CT.Previously described new hyperintense T2 lesions are no longer demonstrated. Several punctate and peripheral wedge-shaped foci of arterial enhancement without washout or associated signal abnormality are otherwise unchanged and are likely perfusional in etiology. There is no arterially enhancing lesion with imaging features suspicious for hepatocellular carcinoma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are small left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Previously demonstrated new T2 hyperintense lesions are no longer demonstrated.2.Cirrhotic morphology of the liver without suspicious lesion suggestive of hepatocellular carcinoma. Multiple arterially enhancing foci without washout are likely perfusional in etiology, however, continued attention should be paid on subsequent imaging.


Instruction: Generate impression based on findings.

Input: 33 year old man with elevated d-dimer and chest pain presents for cardiac MRI to evaluate for etiology of chest pain and to rule out aortic dissection Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVEDV is 193 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 84 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 130 g (normal range 164+/-36). 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.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 218 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 110 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and without significant aortic regurgitation.Mitral ValveThe mitral valve opens widely without obvious mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely without obvious pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely without obvious tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. There is no evidence of aortic dissection or aneurysm to the infra-renal level of the aorta. There is normal origin of the coronary arteries. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 57%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 50%).3. No evidence of aortic dissection or aneurysm to the infra-renal aorta level.4. Normal origin of the coronary arteries.


Instruction: Generate impression based on findings.

Input: 9-year-old nonambulatory boy with history of Chiari malformation and speech apraxia. Brain:There is a right frontal approach ventriculostomy catheter with tip at the foramen of Monro. There is dysplasia of the corpus callosum with dysmorphic lateral and third ventricles, roughly stable in size compared to the CT from 5/2014. The posterior fossa is small and crowded with peglike morphology of the cerebellar tonsils and approximately 23 mm caudal descent. There is tectal beaking. There is no restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage. A small amount of T2/FLAIR hyperintensity is seen in the subcortical white matter of the cingulate generous, likely gliosis from prior instrumentation. Additionally, there are a few punctate foci of susceptibility artifact, likely related to hemosiderin deposition. Biphasic CSF flow is seen ventrally at the cervical medullary junction. There is no dorsal CSF flow visualized. There is no abnormal parenchymal or leptomeningeal enhancement. The major flow-voids are preserved. The orbits, paranasal sinuses, and calvarium are unremarkable.CERVICAL SPINE

Output: 1.Intracranial findings compatible with Chiari II malformation. No significant interval change. No acute abdominal disease.2.Dysplastic corpus callosum with dysmorphic lateral and third ventricles. Ventriculostomy in place with stable ventricular size.3.Syrinx extending through much of the spinal cord with atrophy of the thoracic and lumbar cord.4.Multiple findings in the lumbosacral junction compatible with spinal dysraphism and likely prior surgery perhaps for myelomeningocele repair.5.The spinal cord is low-lying and does not appear to change position on prone imaging, findings which may indicate tethered cord.


Instruction: Generate impression based on findings.

Input: 58-year-old female with two years history of left cheek swelling on 3 separate occasions. Swelling decreases with antibiotics. Patient has bony defect in the left maxillary sinus anterior wall in the region of intra-orbital foramina. Also asymmetric enlargement of the left infera-orbital canal along the roof of the left maxillary sinus with a small defect in orbital floor. Examination demonstrates soft tissue thickening anteriorly to the anterior wall of left maxillary sinus which appears to extend superiorly anterior to the body of the zygoma. There is also evidence of increased soft tissue density along the floor of the orbit lateral to the infraorbital nerve groove. There is also soft tissue thickening within the maxillary sinus immediately posterior to the anterior wall of the left maxillary sinus. Soft tissue prominence appears to extend slightly posteriorly and posterior laterally to the left maxillary sinus. Bony density of area of the exam demonstrates subtle suspected lytic changes of the left zygoma. There is also uniformly enlarged infraorbital nerve groove which is filled with soft tissue density which is contiguous with above described soft tissue changes. Considering provided clinical data the findings are suspicious for an infectious process. However possibility of a mass cannot be entirely ruled out particularly considering presence of expansion of infraorbital nerve groove (V2). Further evaluation with an MRI examination with infusion is recommended. The retro-orbital fat remains within normal limits. Extraocular musculature and globe remain within normal limits. No definitive abnormality of cavernous sinus or Meckel's cave on this exam is detected. Limited view of nasopharynx demonstrates no abnormality. Minimal chronic sinus disease of bilateral ethmoids is also present.

Output: Abnormal soft tissue within the left maxillary sinus, left orbit, left inter-temporalis fossa with associated bony changes of zygoma and anterior wall of the maxillary sinus as well as left infraorbital nerve groove as detailed. Follow-up been an MRI examination with infusion is highly recommended. Please see above comments.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or mass-effect. There are no acute diffusion abnormalities. There are scattered foci of T2 hyperintensity throughout the periventricular and subcortical white matter which may be related to chronic small vessel ischemic disease. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size and enhances normally. There are no extraaxial fluid collections. Flow voids are present within the major vessels indicating patency. There is no abnormal enhancement within the brain. There is slight widening of the atlantondental interval measuring up to 4 mm. There are multiple areas of punctate T2 hyperintensity diffusely throughout the parotid glands bilaterally. The right ostiomeatal unit is opacified.

Output: 1. Scattered foci of T2 hyperintensity within the periventricular and subcortical white matter likely represent chronic small vessel ischemic disease. No evidence of acute infarct.2. There is slight widening of the atlantodental interval, which is never completely imaged on prior exams. In the absence of trauma this could relate to inflammatory arthritic changes. Correlation with history and physical exam is recommended, and dedicated follow-up imaging could be considered.3. Punctate T2 hyperintensity diffusely throughout the parotid glands bilaterally is nonspecific although may be related to Sjogren's, sarcoid, or other inflammatory etiology.


Instruction: Generate impression based on findings.

Input: Male, 28 years old, with left temporal epilepsy, assess for language and motor areas. Sensorimotor cortical activity maps as expected along the pre- and postcentral gyri.The most reliable language related cortical activity was achieved with the sentence completion paradigm. Language is left dominant. Cortical activity related to Broca's area maps as expected along the left inferior frontal gyrus. Cortical activity related to Wernicke's area maps as expected along the left superior temporal sulcus.

Output: Successful functional MRI for surgical planning. Sensorimotor cortical activity maps as expected along the pre- and postcentral gyri. Language is left dominant with Broca's and Wernicke's areas identified as above.


Instruction: Generate impression based on findings.

Input: At the junction of the left occipital and temporal lobes is large area of hemosiderin stained encephalomalacia correlating with the patient's prior traumatic intraparenchymal hematoma. The tissues surrounding this lesion are mildly T2 hyperintense likely indicating gliosis. There is no evidence of acute intracranial hemorrhage, mass effect, midline shift or herniation. There are no intra- or extra-axial fluid collections. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.No evidence of acute intracranial hemorrhage or mass.2.Hemosiderin stained encephalomalacia and gliosis at the junction of the left temporal occipital lobes correlating with the site of prior traumatic intraparenchymal hematoma.


Instruction: Generate impression based on findings.

Input: 63-year-old man with newly diagnosed small cell lung cancer, evaluate for metastases. There are a few, scattered foci of T2 hyperintensity in the pons, nonspecific. There are no abnormal enhancing lesions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens replacements. There is mild thickening and enhancement of the right maxillary sinus and nasal mucosa. The orbits, skull, paranasal sinuses, and scalp soft tissues are otherwise grossly unremarkable.

Output: No evidence of intracranial metastasis.


Instruction: Generate impression based on findings.

Input: Brain tumor. Status post biopsy. Since the previous MRI examination, there has been a stereotactic biopsy and aspiration of the cystic hypothalamic/third ventricular lesion. Expected postoperative changes are present along the surgical tract through the left frontal lobe and within the cystic lesion. The lesion show mildly nodular rim of contrast enhancement peripherally and layering debris/blood products centrally. The CT scan from February 23, 2016 shows punctate calcifications in the inferior aspect of the cystic mass. The lesion now measures 2.8 cm x 2.2 cm, compared to 2.8 cm x 2.4 cm previously. The associated mass-effect has improved with improved lateral ventricular dilatation. There is no other contrast enhancing brain lesion. The brain parenchymal T2-hyperintensity surrounding this cystic lesion which also involves the posterior limb of left internal capsule is not significantly changed. There is mild dural enhancement over the left cerebral convexity consistent with postsurgical change. Postoperative changes also include left sided scalp swelling and fluid overlying the burr hole.

Output: 1.Postoperative changes of biopsy and aspiration of cystic suprasellar mass. 2.The cystic component has been partially drained with improved mass-effect and hydrocephalus.


Instruction: Generate impression based on findings.

Input: A 58 year old male with history of abnormal ECG (negative T waves in V1-V5) while he is asymptomatic. Referred to stress cardiac MRI for further evaluationMEDICATIONS: none First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 198 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 85 ml (normal range 47+/-19), the LV mass index is 41 g/m2, and the LV mass is 92 g. There are no regional wall motion abnormalities present. Along the apical anterior wall, there is a bright signal of SSFP imaging. On the TI scout, the region behaves differently from fat, normal myocardium, and blood pool. The region does not demonstrate late gadolinium enhancement. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 166 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 71 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.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 57%).4. Normal RV size and systolic function (RVEF 57%).5. Along the apical anterior wall, there is a bright signal of SSFP imaging. On the TI scout, the region behaves differently from fat, normal myocardium, and blood pool. The region does not demonstrate late gadolinium enhancement. The native myocardial T1 may be reduced in this area but the wall is fairly thin making measurement unreliable. The finding is not likely to represent an imaging artifact but the mechanism of the finding is unclear to me based on the available images. Recommend bringing patient back, at no charge, for more non-contrast imaging to better elucidate the abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache. Pituitary abnormality on CT scan. BRAIN MRI:There is extensive mucosal thickening involving the paranasal sinuses. In addition, there is fluid in the maxillary sinuses. In the appropriate clinical setting, this may reflect sinusitis, which may account for patient's symptoms.Brain demonstrates normal structure and signal. There is no mass. The ventricles and the other CSF-containing spaces are normal in size. There is no abnormal diffusion restriction or susceptibility effect to indicate recent infarct or intracranial hemorrhage. Focal flow void abutting the left internal carotid terminus and indenting the under surface of the anterior aspect of the left putamen, where there is minimal apparent surrounding T2-hyperintense signal, is probably a saccular aneurysm arising from the carotid terminus. The left carotid terminus itself is also mildly dilated compared to the right carotid terminus. While the neck seems to be small, the maximum width of this presumed aneurysm is 4 mm. It is likely 7 mm apex to base. Otherwise, the major intracranial vascular flow voids are preserved, reflecting gross patency.There is no destructive skull lesion. The orbits are normal.PITUITARY MRI:The pituitary gland shows homogeneous contrast enhancement without focal lesion. It is not enlarged. The pituitary infundibulum is of normal thickness and is midline. The cavernous sinuses are also normal.

Output: 1.While this study is not optimal for vascular assessment, there is suggestion of a complex appearing 7 mm saccular aneurysm arising from a mildly dilated left internal carotid artery terminus. There is no intracranial hemorrhage. Dedicated cranial MR angiography without contrast is recommended.2.There is extensive mucosal thickening and fluid in the paranasal sinuses. In the proper clinical setting, this may reflect sinusitis, which may account for or contribute to patient's symptoms.3.There is no brain abnormality.Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Rita M Rossi-Foulkes over the phone on December 31, 2015 at 1643 hours.


Instruction: Generate impression based on findings.

Input: Reason: hx of renal carcinoma, survey exam History: see above ABDOMEN:LIVER, BILIARY TRACT: Hepatic dome T2 hyperintensity, likely a cyst. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes of right nephrectomy. Simple cyst in the lower pole of the left kidney. There is susceptibility artifact in the left nephrectomy bed adjacent to the IVC which is narrowed in this region. No evidence of recurrent disease.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: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: There is persistent T2 hyperintensity within the white matter, specifically involving periatrial terminal myelination zones (which normally should have resolved by 12 years of age), however there are also more punctate foci within both periventricular and subcortical bifrontal white matter. There is no associated restricted diffusion, enhancement, or susceptibility abnormality. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Incidental note is made of tiny postinflammatory cysts in the nasopharynx.A review of the temporal bone CT favors a uniform facial nerve appearance bilaterally with an adjacent stapedius muscle.Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: 1.There is persistent T2 hyperintensity within the white matter, specifically involving periatrial terminal myelination zones (which normally should have resolved by 12 years of age), however there are also more punctate foci within both periventricular and subcortical bifrontal white matter. There is no associated restricted diffusion, enhancement, or susceptibility abnormality. This constellation of features is most consistent with a prior gliotic inducing process such as periventricular leukomalacia.2.MRI demonstrates intact bilateral seventh and eighth nerve complexes.3.The course of the facial nerve is better demonstrated by previous CT which demonstrates a uniform facial appearance bilaterally with an adjacent stapedius muscle.


Instruction: Generate impression based on findings.

Input: There has been continued decrease in size of a sella based lesion compared to the prior two MRI studies. There remains hypoenhancing material within the pituitary gland proper, which now demonstrates a normal morphology measuring 7 mm in height. The pituitary infundibulum inserts on the midline of the gland and there is no cavernous sinus involvement. There are no suprasellar or parasellar masses and the cavernous sinuses are symmetric bilaterally. The cerebellar tonsils are in normal position. There is no abnormal enhancement within the brain.

Output: There has been continued decrease in size of a sella based lesion compared to the prior two MRI studies. There remains hypoenhancing material within the pituitary gland proper, which now demonstrates a normal morphology measuring 7 mm in height. The differential diagnosis would most likely an involuting adenoma, prior pituitary apoplexy, or a resolving pituitary inflammatory process.


Instruction: Generate impression based on findings.

Input: Worsening right arm weakness and tingling. Evaluate for spinal pathology. Craniovertebral junction appears within normal limits. Mild anterior wedging of C4, C5, and to a lesser degree C6 vertebral bodies is stable to minimally worse. Again seen is moderate to severe loss of disc height at the C3-C4, C4-C5, C5-C6, and C6-C7 levels. Associated endplate marrow signal changes are similar to prior aside from minimal worse marrow signal abnormality involving the posterior C6-C7 endplates. Reversal of normal cervical lordosis with kyphosis centered at the C4 level appears worse, although these findings are at least in part positional. Mild retrolisthesis of C3 on C4, C4 and C5, C5 on C6, and C6 on C7 again seen. There is minimal worsening of C6 on C7 retrolisthesis in the interval. No suspicious osseous lesions.There is abnormal T2 signal in the cervical cord at the right C4-C5 level likely reflecting myelomalacia and present previously although more conspicuous on the current study.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: Disc osteophyte complex, kyphosis, and mild retrolisthesis contribute to moderate spinal canal stenosis, which appears minimally worse in the interval. There is also moderate to severe bilateral neural foraminal stenosis. C4-5: Disc osteophyte complex, mild retrolisthesis, ligamentum flavum thickening, and kyphosis contribute to moderate spinal canal stenosis similar to prior. There is moderate to severe bilateral neural foraminal stenosis.C5-6: Minimal retrolisthesis and small disc osteophyte complex with fairly mild narrowing of the spinal canal. There is moderate to severe bilateral neural foraminal stenosis.C6-7: Retrolisthesis with small disc osteophyte complex. The disc component has decreased in the interval. There is no significant spinal canal stenosis. There is moderate bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.No significant enhancement within the cervical spine aside from related to the degenerative changes. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Enlarged multinodular thyroid gland again seen. Mildly prominent level 1B lymph nodes are noted and are nonspecific, best seen on the axial post gadolinium sequence.

Output: 1. Moderate kyphotic deformity and multilevel degenerative changes in the cervical spine have overall slightly progressed since 2/13/2012. Again seen is moderate spinal canal stenosis at the C3-C4 and C4-C5 levels. 2. There is focus of T2 signal abnormality involving the cervical cord at the right lateral C4-C5 level favored to represent myelomalacia.3. Moderate to severe neural foraminal stenoses at the C3-C4, C4-C5, and C5-C6 levels again seen. Additional details as above.4. Mild prominent left level 1B lymph nodes are nonspecific.


Instruction: Generate impression based on findings.

Input: Chemoradiation for left orbital stage 1 rhabdomyosarcoma: light sensitivity in left eye. There are post-treatment findings in the left orbit without evidence of gross measurable tumor. The right orbits is intact. The imaged portions of the brain appear unremarkable. The skull base appears unchanged. There is scattered paranasal sinus mucosal thickening and secretions. There is bilateral tympanomastoid fluid, left more than right.

Output: 1. Post-treatment findings in the left orbit without evidence of gross locoregional tumor.2. Persistent scattered paranasal sinus inflammation.3. Nonspecific inflammatory changes in the bilateral mastoid air cells, perhaps associated with Eustachian tube dysfunction, particularly on the left side.


Instruction: Generate impression based on findings.

Input: 63-year-old female with history of chronic back pain and lumbar spondylolisthesis, preop planning for fusion. There are degenerative changes, epidural lipomatosis, and congenital narrowing of the spinal canal in the lower lumbar spine. In particular, at L3-L4, there is facet arthropathy and ligamentum flavum hypertrophy causes slight left neural foraminal stenosis, at L4-L5, there facet arthropathy, ligamentum flavum hypertrophy and a disc bulge causes mild to moderate bilateral neural foraminal stenosis and narrowing of the left lateral recess, and at L5-S1, there is facet arthropathy, ligamentum flavum thickening and a mild disc bulge with minimal bilateral neural foraminal stenosis, but severe spinal canal stenosis. There is associated degenerative bone marrow signal alteration at L4-5 and L5-S1. The vertebral body heights are within normal limits. The vertebral column alignment is within normal limits. The conus medullaris is normal in position. The paraspinous soft tissues are within normal limits.

Output: Degenerative spondylosis, epidural lipomatosis, and congenital narrowing of the spinal canal of the lower lumbar spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: eval for right ischioanal fossa abscess tract extent History: right ischioanal fossa abscess seen on CT A, planning surgery vs IR PELVIS:UTERUS, ADNEXA:A 1.8 cm T1 hyperintense lesion in the left adnexa likely represents a hemorrhagic cyst.Fistulous communication from the vagina to a right ischioanal fossa abscess as below.There is a low-lying ID within the lower uterine segment and cervix.BLADDER: No significant abnormality noted.LYMPH NODES:Enlarged right inguinal lymph node measuring 1.8 x 1.4 cm (1501/40). Enlarged right external iliac node measuring 1.3 x 2.1 cm (1501/73).BOWEL, MESENTERY:Fistulous communication from the anal canal to a right ischioanal fossa abscess as below.BONES, SOFT TISSUES: There is a rim-enhancing collection containing debris and air in the right ischioanal fossa measuring 3.8 x 2.1 cm in transverse dimension and 3.6 cm in craniocaudal dimension (601/29, 901/29), likely representing an abscess. This collection extends through the inferior portion of the right puborectalis muscle. There is edema throughout the right puborectalis musculature, likely representing inflammation. An enhancing tract is present from the collection to the anal canal at the 9:00 position (1501/48), There is an additional tract extending from the collection to the right aspect of the vagina (1501/55)OTHER: Small amount of free fluid in the pelvis.

Output: 1.Abscess in the right ischioanal fossa with fistulous communication to the anal canal and vagina.2.Pelvic lymphadenopathy is likely reactive.3.Low lying IUD.


Instruction: Generate impression based on findings.

Input: CTLA4 deficiency autoimmune disease, inflammatory arthritis, AIHA status post splenectomy on Rapamune, pulmonary nodules, now presenting with new onset severe headache and nausea/vomiting. There are multiple infiltrative cortical and white matter enhancing lesions with high T2 signal within the right frontal lobe, bilateral parietal lobes, occipital lobes, left insula, and right cerebellum, which are generally more prominent. In addition, there is a newly apparent subcortical enhancing lesion in the left middle frontal lobe. The lesions display minimal mass effect and there is no midline shift. There are no associated susceptibility or restricted diffusion. There is an unchanged linear T2 hyperintense lesion in the superior right frontal white matter without associated enhancement. The ventricles and basal cisterns are normal in size and configuration. There is diffuse paranasal sinus mucosal thickening and fluid levels in the maxillary sinuses. There are partially-imaged prominent cervical lymph nodes, particularly on the left side. The orbits are unremarkable.

Output: 1. Slightly increased prominence of multiple supratentorial and infratentorial lesions may represent lymphocytic infiltration associated with CTLA4 deficiency versus lymphoma. 2. Partially-imaged prominent cervical lymph nodes, particularly on the left side may also be related to the autoimmune disorder or lymphoma.3. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Encephalopathy, unspecified [G93.40], Reason for Study: ^Reason: Persistently encephalopathic with R gaze deviation and R sided weakness History: pls see above Multifocal scattered bihemispheric restricted diffusion lesions involving bilateral frontal, parietal temporal, left occipital bilateral basal ganglia and bilateral cerebellar hemisphere indicating acute ischemic infarct.There is also 53.7 mm (AP) x 30.2 mm (RL) x 15 mm (CC) sized left basal ganglia acute/subacute ICH with the surrounding edema and mass effects. There is midline shift toward the right side about 8 mm at the level of foramen of Monro measured on axial scan. Considering underlying multifocal acute ischemic infarcts, this hemorrhagic lesion could demonstrate hemorrhagic conversion.Underlying brain shows patch scattered bihemispheric periventricular white matter FLAIR/T2 high signal intensity lesions indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Mucosal thickenings on bilateral maxillary sinuses, ethmoid sinuses, sphenoid sinus and frontal sinus. Bilateral mastoid air cells show opacifications.

Output: 1. Multifocal supra and infratentorial ischemic infarctions.2. Left basal ganglia ICH with mass effects with midline shift toward right side, likely represent hemorrhagic conversion.3. Underlying non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: There appear to be six enhancing lesions in the bilateral cerebral hemispheres, the largest of which is located in the left superior frontal gyrus and measures up to 15 mm. Additional lesions are present in the left superior frontal gyrus, right precentral gyrus, left middle temporal gyrus, and right superior and inferior parietal lobules. There is minimal vasogenic edema associated with the lesions, There may also be associated leptomeningeal involvement and faint susceptibility effect within some the lesions, suggestive of microhemorrhage or hypervascularity, for example. There are confluent and punctate T2 hyperintense areas in the periventricular and subcortical cerebral white matter. There are also small areas of encephalomalacia in the right corona radiata, left pons, and left thalamus. The ventricles and sulci are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Multiple bilateral brain metastasis, without evidence of midline shift.2. Chronic small vessel ischemic disease and chronic lacunar infarcts in the right corona radiata, left pons, and left thalamus.


Instruction: Generate impression based on findings.

Input: Male 63 years old; Reason: assess for rotator cuff tears History: right shoulder pain. Previous attempt of rotator cuff repair, possible failure ROTATOR CUFF: The anchor of the rotator cuff repair is intact. There is mild tendinosis and partial tearing of the supraspinatus tendon, without full thickness tear. The supraspinatus muscle is unremarkable. The remainder of the rotator cuff is within normal limits. SUPRASPINATUS OUTLET: There is moderate acromioclavicular joint osteoarthritis with a subacromial hook noted. There is a small amount of fluid in the subacromial and subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: There is degenerative tearing of the superior labrum. BICEPS TENDON: The biceps tendon is not seen in the bicipital groove.

Output: 1. Tendinosis and partial tearing of the supraspinatus tendon, without full thickness tear.2. Moderate AC joint osteoarthritis3. Degenerative superior labral tearing.


Instruction: Generate impression based on findings.

Input: Reason: left knee meniscus tear History: left knee pain and swelling MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Bone marrow edema in the medial femoral condyle with loss of hyaline cartilage and underlying degenerative subchondral cyst. Thinning of the patellar hyaline cartilage without focal defect.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Loss of hyaline cartilage with adjacent bone marrow edema and underlying subchondral cyst in the medial femoral condyle.2.Thinning of the patellar hyaline cartilage without focal defect.


Instruction: Generate impression based on findings.

Input: Elbow pain Right: There are minimal chronic appearing enthesopathic changes of the medial and lateral epicondyles. Otherwise radiographs of the elbow are unremarkable.Left: Radiographs of the elbow appear normal.

Output: Minimal chronic enthesopathic changes of the right elbow with normal radiographic appearance of the left elbow. There are no specific findings to account for the patient's elbow pain.


Instruction: Generate impression based on findings.

Input: Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: acute ischemia History: left arm weakness Brain MRIThere are multiple focal restricted diffusion on the left frontal lobe indicating acute ischemic infarction without evidence of hemorrhagic conversion. Underlying brain shows scattered patchy FLAIR high signal intensities on periventricular white matter and centrum semiovale indicating non specific 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. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Right Pcom is patent and Acom is also patent. The left Pcom is not seen.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Left vertebral artery is hypoplastic.

Output: 1. Acute ischemic infarction on the left frontal lobe without evidence of hemorrhagic conversion.2. Underlying non specific small vessel ischemic disease.3. Normal Brain MRA.4. Normal Neck MRA.


Instruction: Generate impression based on findings.

Input: Myeloma with shoulder pain. X-ray shows stable myelomatous lesions of the left proximal humerus, but partial thickness tear seen on MRI of the left shoulder from May 2014. Reevaluate cause of pain. ROTATOR CUFF: There is thickening and increased signal intensity of the supraspinatus tendon indicating moderate tendinosis. Increased signal intensity along the bursal surface fibers of the posterior supraspinatus tendon at its insertion represents superficial tearing that appears similar to that seen on the prior study accounting for technical differences. Mild signal abnormality in the underlying greater tuberosity is likely degenerative in etiology and likewise appears similar to that seen on the prior study. There is mild fatty infiltration along the myotendinous junction of the supraspinatus, similar to that seen on the prior study. Tendinosis extends posteriorly to involve anterior fibers of the infraspinatus tendon, but I see no infraspinatus tendon tear. There is mild fatty infiltration of the myotendinous junction of the infraspinatus appearing similar to that seen on the prior study. The teres minor tendon and muscle appear normal. There is slight thickening of the subscapularis tendon suggesting mild tendinosis that has perhaps increased slightly when compared with the prior study. I see no subscapularis tendon tear, and the muscle appears normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is moderate amount of fluid within the subacromial/subdeltoid and subcoracoid bursae with septations. Foci of intermediate signal intensity within the bursae likely represent a combination of synovitis and debris.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint but no large effusion. Intermediate signal intensity within the anterior and superior portions of the labrum likely represent degeneration.BICEPS TENDON: There is mild increased signal intensity within the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular sulcus, suggesting mild tendinosis.ADDITIONAL

Output: 1.Progression of multiple myeloma compared with the prior MRI study.2.Rotator cuff tendinosis and partial thickness tearing as described above that appears similar to that seen on the prior study, although there has perhaps been slight increase in the degree of tendinosis of the subscapularis.3.Subacromial/subdeltoid/subcoracoid bursitis that has progressed when compared with the prior study.


Instruction: Generate impression based on findings.

Input: Pituitary tumor surveillance. There is no significant interval change in the pituitary macroadenoma with resultant mass-effect and upon the optic apparatus. The mass superiorly extends to the third ventricle and posteriorly into the interpeduncular cistern. The tumor measures up to approximately 35mm. There is no invasion ofcavernous sinuses and no significant deformity of the floor of sella.

Output: No significant interval change in the pituitary macroadenoma with resultant mass-effect and upon the optic apparatus.


Instruction: Generate impression based on findings.

Input: Male, 51 years old, with altered mental status and meningitis. Evaluate for spinal involvement. Cervical:The cervical lordosis is straightened. Sagittal alignment is otherwise unremarkable. Vertebral body morphology and signal characteristics are within normal limits.The spinal cord shows normal signal intensity and morphology. No epidural abnormalities are suspected within the limitation of motion artifact.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Mild facet hypertrophy. Mild left foraminal narrowing. Otherwise unremarkable. C5-6: Mild facet hypertrophy. Otherwise unremarkable. C6-7: Facet hypertrophy. Right greater than left uncovertebral hypertrophy. No significant spinal canal stenosis. Moderate right foraminal narrowing. C7-T1: Facet hypertrophy. Otherwise unremarkable. Thoracic:Alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits.The spinal cord shows normal signal intensity and morphology within the limitations of motion artifact. No epidural abnormalities are suspected.No significant disc bulge or disc herniation is seen. The spinal canal and neural foramina are patent.Lumbar:Alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits.The distal spinal cord and conus are unremarkable. Conus tip terminates at the L1-2 level. The nerve roots of the cauda equina disperse evenly. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet arthropathy and ligamentum flavum thickening. Mild loss of disc height and disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Moderate facet arthropathy. Mild bulging disc. No significant spinal canal stenosis. Mild foraminal narrowing. L5-S1: Moderate facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1.Within the limitations of a noncontrast examination, no abnormalities of the spinal cord or cauda equina are detected. Likewise, no epidural abnormalities are seen.2.Relatively mild degenerative findings are seen as discussed above without high-grade spinal canal or foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 37 years Female (DOB:6/18/1979)Reason: f/u Chiari malformation History: dizzy and headachePROVIDER/ATTENDING NAME: JAMES X. TAO SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils extend below the level of foramen magnum extend approximately 5 mm below the level of foramen magnum. There is no associated ventriculomegaly.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.CSF flow study demonstrates biphasic flow ventrally.

Output: The cerebellar tonsils are low lying suggestive of Chiari I malformation, however there is no significant CSF flow obstruction at the foramen magnum appreciated.


Instruction: Generate impression based on findings.

Input: 62-year-old male patient status post liver transplant with perihepatic abscess. Evaluate size of abscess and for biliary leak. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from choledochojejunostomy noted. Rim-enhancing fluid collection the gallbladder fossa with drain in place with layering, likely iatrogenic, air currently measures 1.5 x 3.6 cm (series 10 image 34), previously 0.8 x 2.7 cm. At 20 minutes in the hepatobiliary phase, contrast is seen in the biliary system and does not appear to infiltrate the drained collection, suggesting there is no biliary leak or fistulous communication.Branching susceptibility artifact in the intrahepatic biliary system compatible with pneumobilia. Minimal intrahepatic biliary ductal dilatation appear similar compared to prior examination. The portal vein is patent and mildly attenuated at the anastomosis, which is not unexpected. Enlarged lymph node at the porta hepatis is unchanged compared to prior.SPLEEN: Mild splenomegaly, measuring up to 12 cm in craniocaudal dimension.PANCREAS: Atrophic pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple and proteinaceous cysts, similar compared to prior.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: Mild interval increase in size of collection in the gallbladder fossa with drain in place. There is no definite connection with the biliary system on delayed images.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, with back pain and leg numbness. Evaluate for cord compression. Alignment is grossly anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is seen.Mild degenerative spondylosis is seen in the cervical region appearing similar to the prior examination and resulting in at most mild narrowing of the spinal canal. Multiple disc protrusions are evident within the thoracic spine, again similar to prior and resulting in only mild spinal canal narrowing. In the lumbar spine, disc protrusions are evident at L3-4 and L4-5. In combination with posterior element hypertrophy, these findings result in moderate narrowing of the spinal canal. However, these findings appear not to be significantly changed.No acute cord compression is seen on this examination.A suspected adnexal cystic lesion measuring up to 16 cm is partially visualized on this examination. This lesion was noted on a CT examination from 2013.

Output: 1.No evidence of acute cord compression.2.Multilevel disc degeneration and disc protrusions are seen. At L3-4 and L4-5, these result in at least moderate narrowing of the spinal canal. However, there does not appear to been a significant interval change when compared to the prior examination from 4/9/2014.3.A large presumed adnexal cystic lesion is partially visualized on this examination.


Instruction: Generate impression based on findings.

Input: 33 year old male with history of ventriculoperitoneal shunt placement; please evaluate. Enlarged supratentorial ventricular system with a right-sided ventricular catheter with its tip abutting the septum pellucidum. The size of the lateral ventricles remain similar to prior MRI examination from 11 -- 26 -- 2008.The cortical sulci, basal cisterns remain within normal limits. No evidence of hemorrhage, edema, mass-effect or midline shift is detected.

Output: 1.No evidence of acute intracranial findings.2.Stable size of ventricular system since prior MRI from November of 2008.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 63 year old female with metastatic breast carcinoma to liver, pleura, and bone, complaining of shortness of breath, compare to previous CHEST:LUNGS AND PLEURA: Stable pleural thickening and nodularity with contrast enhancement. No pulmonary nodules or masses can be identified.MEDIASTINUM AND HILA: Right paratracheal lymph node now measures 10 mm x 5 mm (image 31, series 4), previously, measuring 12 mm x 6 mm.Redemonstration of a hiatal hernia.Cardiac size is normal. No evidence of pericardial effusion.CHEST WALL: Bilateral breast implants. Partial collapse of the T6 vertebrae, without interval changeABDOMEN:LIVER, BILIARY TRACT: Stable well-defined cystic lesions. However, laterally in the right lobe of the liver. Ill-defined hypodense lesion most likely represents metastatic disease. This is better visualized than on the prior exam and may be related to phase of contrast enhancement.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Peripelvic cysts versus caliectasis on the left kidney is unchangedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lumbar metastatic disease noted on the recent MRI exam is not visualized on this CTOTHER: No significant abnormality noted

Output: Stable intrathoracic disease. Better delineated hepatic metastases may be related to phase of contrast enhancement. However, progression of metastatic disease cannot be excluded. Dedicated CT or MR imaging of the liver would be of value.


Instruction: Generate impression based on findings.

Input: Ms. Ryan is a 58 year old female presenting for high risk MRI screening. Strong family history of breast cancer in 3 sisters and maternal grandmother. She is currently on tamoxifen therapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.There is a stable enhancing subcentimeter mass identified in the left superior breast with internal nonenhancing septation and high T2 signal intensity, likely representing a fibroadenoma. This is stable in size and appearance when compared to multiple prior MRIs dating back to 2013. There is no new abnormal enhancement 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: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate right shoulder labral tear for worsening since 2009 History: Right shoulder pain ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The infraspinatus and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: No significant fluid or intra-articular gadolinium is identified within the subacromial subdeltoid bursa. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Again seen is intra-articular gadolinium extending into the anterior labrum in a branching pattern indicating a tear. There is also extension of this tear to involve the articular cartilage of the glenoid indicating a GLAD lesion appearing similar to the prior study. There is heterogeneity and irregularity of the anterior inferior glenoid which likely represents a combination of degeneration and postsurgical change.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Tearing of the anterior glenoid labrum as described with extension of the tear to involve the articular cartilage of the glenoid, appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: A 63 year old male with a recent (11/1/2015) ST elevation myocardial infarction, the left cardiac cath showed Left Anterior Descendent artery with a 100% thrombotic occlusion on the proximal portion and a 100% occlusion of the Right coronary artery. The LAD was opened with PCI and stent. The echocardiography showed severely decreased left ventricular function. A non-sustained ventricular tachycardiac was noted on the monitor. Referred to cardiac MRI for further investigation. Left VentricleThe left ventricle is moderately dilated with severely decreased systolic function. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 291 ml (normal range 142+/-34), the LV end systolic volume index is 96 ml/m2 (normal range 25+/-9), the LVESV is 213 ml (normal range 47+/-19), the LV mass index is 77 g/m2 (normal range 85+/-15), and the LV mass is 171 g (normal range 164+/-36). There are two large myocardial infarctions. The first involves the LAD territory (basal antero-septum and inferoseptum; mid anterolateral, anterior, anteroseptal, and inferoseptal walls; apical lateral, anterior, and septal walls; and the apical cap). This is the acute infarction and is transmural with extensive amounts of associated microvascular obstruction and a severe wall motion abnormality. These territories are not viable. The second myocardial infarction is chronic and involves the entire inferior wall. This infarction is nearly transmural and is also not likely to be viable. This territory is all associated with hypokinesis. No left ventricular thrombus was seen.No myocardial iron overload was noted.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 194 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 95 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.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated.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 mild pericardial effusion.Extracardiac FindingsPulmonary congestion was noted. 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 moderately dilated with severely decreased systolic function (LVEF 27%) without evidence of an LV thrombus. 2. There are two large myocardial infarctions. The first involves a very large portion of the LAD territory . It is the acute infarction and is transmural with extensive amounts of associated microvascular obstruction. The second myocardial infarction is chronic and involves the entire inferior wall. This infarction is nearly transmural. Neither territory is likely to be viable. 3. No left ventricular thrombus was seen.4. The left atrium is mildly dilated. 5. The right ventricle is normal in size and systolic function, the RVEF is 51%. 6. There is mild to moderate mitral regurgitation.7. There is mild pericardial effusion.8. Pulmonary congestion was notedI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 52-year-old female presenting for evaluation of labral tear, femoral acetabular impingement. ACETABULAR LABRUM: Intermediate signal and irregular contour is indicative of diffuse degeneration and degenerative tearing. No specific evidence of large territory.ARTICULAR CARTILAGE AND BONE: Intermediate signal and irregular contour is indicative of diffuse degeneration and degenerative tearing. Osteophyte formation and subchondral cysts are consistent with osteoarthritis.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Osteoarthritis of the left hip.


Instruction: Generate impression based on findings.

Input: Female, 75 years old, with new left lower extremity radicular symptoms in the S1 distribution, history of lumbar degenerative disease. A trace retrolisthesis of L5 relative to S1 is unchanged. Sagittal alignment is unremarkable.Mild endplate irregularity and concavity at T11-12 is seen, similar to prior. Vertebral body height is otherwise preserved. No pathologic marrow replacement or marrow edema is identified.The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.T10-11 through T12-L1: As assessed on sagittal imaging, there is loss of disc height and mild disc bulging but no significant spinal canal or foraminal stenosis.L1-2: Minimal facet arthropathy. No significant spinal canal or neuroforaminal stenosis. No interval changes. L2-3: Mild facet arthropathy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Mild facet arthropathy and ligamentum flavum thickening. Mild disc bulging. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. No interval changes. L4-5: Advanced facet arthropathy, left worse than right, with progressive facet effusion is. There also appears to be a new 5 mm synovial cyst at which may impinge upon the left lateral recess and the descending left L5 nerve root. The right neural foramen is mildly narrowed but the left foramen is patent. L5-S1: Advanced facet arthropathy and ligamentum flavum thickening. Loss of disc height with disc osteophyte formation. Mild generalized spinal canal stenosis. There is some encroachment upon the lateral recesses bilaterally, and it appears that the left S1 nerve may be mildly impinged between the disc osteophyte and facet. Just before the nerve enters the osseous foramen, it demonstrates T2 hyperintensity which could represent edema or perineural cyst formation. Moderate left and mild right foraminal narrowing. These findings are unchanged.

Output: 1.Progressive facet arthropathy at L4-5, particularly on the left where there is a new 5 mm synovial cyst which may upon the descending left L5 nerve root.2.A combination of facet arthropathy and disc degeneration result in lateral recess stenosis at L5-S1. On the left, the descending S1 nerve root may be impinged. This finding, however, is relatively unchanged compared to the prior examination.


Instruction: Generate impression based on findings.

Input: History of diffuse large B-cell lymphoma. Reason: patient with RUQ pain and new 1.8cm hypodense lesion in segment 5 of the liver seen on ultrasound. MRI is to further evaluate this lesion History: RUQ pain and segment 5 lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity and enhancement. There is a subcentimeter structure within hepatic segment 6 compatible with a benign cyst. There is an additional T2 hyperintense structure within hepatic segment 7 which does not appear to be a simple cyst but lacks significant associated enhancement and is also most likely benign. No enhancing hepatic lesions are identified.The gallbladder appears within normal limits. No biliary 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: There are areas of increased T2 signal and corresponding decreased T1 signal within the mid lumbar vertebral bodies.OTHER: No significant abnormality noted.

Output: 1.Hepatic cyst and additional segment 7 indeterminate T2 hyperintense hepatic structure, likely benign. No suspicious hepatic lesions. 2.Nonspecific bone marrow signal abnormality in the mid lumbar spine; recommend correlation with clinical history and prior outside imaging. Additional dedicated imaging can be considered as clinically warrented.


Instruction: Generate impression based on findings.

Input: BRAIN: There are stable patchy foci of T2 hyperintensity within the thalami, anterolaterally on the left and posterior medially on the right. There are also symmetric rounded foci of T2 hyperintensity within the medullary olives which are slightly more prominent, although this apparent change could reflect technical differences. There is no associated decreased diffusion or enhancement. Punctate symmetric foci of T2 hyperintensity are seen on the FLAIR sequences within the bilateral insula that were not seen on the prior exam. These are present on axial, coronal and sagittal FLAIR acquisitions, but are not confirmed on other sequences. Questioned signal abnormality in the caudate nuclei and corticospinal tracts on the prior exam is not duplicated and may have been artifactual. There is a right frontal lobe developmental venous anomaly. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Sphenoid sinus inflammatory disease is seen.PITUITARY: There is a normal pituitary height for age. The posterior pituitary bright spot is present. The infundibulum is slightly deviated to the left, although, there is no evidence for pituitary or suprasellar mass. The optic chiasm, cavernous sinuses and intracranial portions of the optic nerves are normal in appearance.MR SPECTROSCOPY: A spectrum obtained over the medullary olives demonstrates markedly diminished NAA and perhaps trace lactate. Spectra obtained over both thalami demonstrate modest reductions in NAA but no significant lipid or lactate. Spectra obtained over normal appearing grey and white matter show moderate reductions in NAA (particularly in grey matter), but again no significant lipid or lactate.

Output: 1. Signal abnormality involving the bilateral thalami and medullary olives persists, and is unchanged in the thalami and unchanged or at most mildly progressed in the olives. The spectroscopic pattern of these lesions indicates neuronal injury or loss, and in addition, there may be trace lactate in the olives. Of note, normal appearing grey and white matter also show reduced levels of NAA, which would suggest a global or systemic phenomenon. While not diagnostic of any particular entity, the spectroscopic pattern, along with conventional imaging findings, would be compatible with an inherited metabolic deficiency, perhaps mitochondrial in nature.2. Normal pituitary MRI.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: There is a tiny focus of signal abnormality within the distal clavicle which may represent early cyst formation, but this is equivocal and not necessarily of clinical significance. Otherwise no abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Essentially normal MR arthrogram of the shoulder. Specifically, there is no evidence of labral tear or Bankart lesion.


Instruction: Generate impression based on findings.

Input: A 60 year old female with history of transverse myelopathy suspected to be secondary to neurosarcoidosis, deep vein thrombosis, bilateral legs edema. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 49 ml/m2 (normal range: 65+/-11), the LVEDV is 97 ml (normal range 109+/-23), the LV end systolic volume index is 21 ml/m2 (normal range 18+/-5), the LVESV is 42 ml (normal range 31+/-10), the LV mass index is 26 g/m2 (normal range 67+/-11), and the LV mass is 52 g (normal range 114+/-24). There are no regional wall motion abnormalities present. No enhancement is present.No intracavitary thrombus was noted.No iron overload was noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 39 ml/m2 (normal range 69+/-14), the RVEDV is 78 ml (normal range 110+/-24), the RV end systolic volume index is 17 ml/m2 (normal range 22+/-8), and the RVESV is 34 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is 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.Extracardiac FindingsBilateral apical high signal foci in the lungs correlate to fibrosis, better characterized on the recent CT thorax, compatible with patient's sarcoidosis. There is gastroduodenal lymph node that is enlarged, 2.0 x 2.6 mm (501/8), which is unchanged from recent CT

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 57%. 2. No enhancement is present to suggest myocardial sarcoid. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 56%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Possible cavernous sinus process on the right: right eye droop and anisocoria. Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions. The infraorbital nerve canals appear to be intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is nonspecific scattered mild patchy cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemia. The brainstem and cerebellum and unremarkable. The cavernous sinuses are intact bilaterally. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are partly imaged findings related to right parotidectomy.

Output: No evidence of orbital or cavernous sinus lesions.


Instruction: Generate impression based on findings.

Input: 74 years, Male, postop craniotomy for tumor resection.. There are expected postsurgical changes of left parieto-occipital craniotomy for tumor resection including small amount of pneumocephalus, blood products within and immediately surrounding the resection cavity as well as a thin extra-axial fluid collection beneath the craniotomy. There has been near total resection of the previously seen heterogeneously enhancing mass. There are areas of intrinsic T1 shortening with suspected thin residual enhancing tissue along the medial aspect of the resection cavity in the left parietal lobe as well as in the left posterior medial temporal lobe, suspected to represent minimal residual enhancing tumor. Enhancement again noted to extend to the ependymal surface of the left lateral ventricle. There is minimal rim of restricted diffusion surrounding the resection cavity margin related to blood products and cytotoxic edema. Again seen is extensive FLAIR hyperintensity in the left parietal, temporal, and occipital lobes. Effacement of the left lateral ventricle is also again noted as well as mild asymmetric dilatation of the right lateral ventricle. There is mild rightward midline shift similar to prior. No uncal herniation.Remainder of the brain demonstrates minimal foci of T2/FLAIR hyperintensity related to mild chronic small vessel ischemic changes but is otherwise unremarkable. Major flow-voids are preserved.

Output: Expected postsurgical changes of resection of known GBM. There appears to be near total resection with minimal residual enhancing tumor suspected along the resection cavity margins in the parietal lobe and extending into the left posterior medial temporal lobe.


Instruction: Generate impression based on findings.

Input: Dizziness. There is no evidence of intracranial hemorrhage or midline shift. An ill-defined region of low density in the right occipital lobe (images 14 and 15/28, series 2) may represent volume averaging. However, an MRI is recommended for further evaluation.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Area of low-attenuation in the right occipital lobe may represent volume averaging. However, an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Clinical question: Newly diagnosed germinoma. Signs and symptoms: Evaluate disease status. Pre- and post enhanced cervical MRI:Examination demonstrates no detectable metastatic lesion to the cervical spine, cord or developed meninges.There is normal anatomical alignment of the vertebral column however mild reversal of cervical lordosis centered at C4-C5 level.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 is unremarkable.C4-C5 demonstrate mild bulging disc and unremarkable otherwise.C5-C6 demonstrate a tiny linear enhancement within the annulus of the disc highly suggestive of an annular fissure. No spinal stenosis or neural foraminal compromise.C6-C7 is unremarkable.C7-T1 is unremarkable.Incidental note is made of a tiny cystlike lesion in the superior aspect of nasopharynx in the midline measuring approximately at 5 mm in size and highly suggestive of a Thornwaldt cyst.Pre and post enhanced thoracic MRI:There is normal signal intensity and alignment of vertebral column.There is normal signal intensity and caliber of the thoracic cord.There is no evidence of spinal stenosis or neural foraminal compromise at any level.There is no detectable abnormal enhancement of the cord, leptomeninges or the vertebral column.Pre- and post enhanced lumbar MRI:There is normal signal intensity and caliber of the lower most visualized thoracic cord, conus and the cauda equina without detectable abnormal enhancement.There is normal signal intensity and alignment of vertebral column without abnormal enhancement.No evidence of a spinal stenosis or neural foraminal compromise at any level.

Output: 1.Pre- and post enhanced MRI of cervical spine demonstrate no detectable metastatic lesions. There is a small midline enhancing annular fissure at C5-C6, mild reversal of cervical lordosis at C4-C5. Incidental note is made of a 5 mm Thornwaldt cyst.2.Unremarkable pre and post enhanced thoracic MRI.3.Unremarkable pre and post enhanced lumbar MRI.


Instruction: Generate impression based on findings.

Input: Clinical question: 35- week old infant with apnea. Evaluate for intracranial abnormality. Signs and symptoms: Apnea. Unenhanced head CT:There is no evidence of intracranial hemorrhage, mass-effect, midline shift or hydrocephalus. Although there is no suggestion of any edematous changes of brain parenchymal immature brain parenchymal can obscure subtle edema brain parenchyma. If clinical concern for ischemic change is high recommend an MRI examination. The cortical sulci, ventricular system and CSF cisterns are unremarkable for patient's stated age. No definitive abnormality in the posterior fossa is detected. Calvarium is intact.

Output: 1.No definitive evidence of acute intracranial abnormality.2.Immature brain parenchymal can obscure subtle edematous changes of brain on head CT. If clinical concern persist recommend an MRI examination.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate 1st MTP/toe for fracture History: pain and swelling s/p trauma We see no acute fracture or malalignment. There is a mild deformity of the fourth metatarsal neck which may represent an old healed fracture. There is mild soft tissue swelling about the great toe. A nodular soft tissue density seen on the lateral view dorsal to the metatarsals may represent a prominent vascular structure but if there is a palpable mass in this location it could be further evaluated with MRI. Incidental note is made of an os trigonum, a normal anatomic variant.

Output: Mild soft tissue swelling and other findings as described above. We see no acute fracture.


Instruction: Generate impression based on findings.

Input: Migraine with aura, with intractable migraine, so stated, without mention of status migrainosus [346.01], Reason for Study: ^Reason: structural abnormality? Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. 2. No abnormal enhancement.3. Normal brain MRA and Neck MRA


Instruction: Generate impression based on findings.

Input: Left hip pain Moderate to severe osteoarthritis of the left hip has progressed compared with prior radiographs from 2013. Suspected acetabular stress fracture seen on prior MRI is not clearly evident on these radiographs.

Output: Osteoarthritis.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with left-sided weakness. Evaluate for stroke. A band-like area of restricted diffusion is seen along the right lateral ventricular atrium with a few scattered adjacent satellite foci. These lesions are associated with T2 signal abnormality and minimal local edema. No significant generalized mass effect is detected.The background brain demonstrates numerous scattered foci of periventricular and pontine T2 hyperintensity. No large parenchymal defects are seen. No evidence of acute intracranial hemorrhage is detected. A focus of susceptibility is evident in the central pons compatible with chronic microhemorrhage. Apart from slight mass effect on the right lateral ventricular atrium, the ventricles are within normal limits.

Output: Acute ischemia involving the periventricular tissues along the right lateral ventricular atrium with no evidence of hemorrhagic conversion and only minimal local edema.


Instruction: Generate impression based on findings.

Input: AMS x 2 weeks. There is a punctate, T2 hyperintense, extra-axial lesion adjacent to the posterior right temporal lobe. There is no evidence of intracranial hemorrhage or acute infarct. There are scattered punctate and confluent areas of periventricular and subcortical white matter T2 abnormality, most compatible with chronic small vessel ischemic disease. There is diffuse mild cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mucosal thickening in the right sphenoid sinus, with sclerosis of the surrounding sinus walls. There is fluid in the left mastoid air cells. There are bilateral lens implants.

Output: 1.No evidence of acute infarct.2.Moderate chronic small vessel ischemic changes and mild cerebral volume loss.3.A small extra-axial lesion adjacent to the right temporal lobe likely represent a meningioma, but is incompletely characterized.4.Fluid in the left mastoid air cells may represent mastoiditis.5.Chronic right sphenoid sinusitis.


Instruction: Generate impression based on findings.

Input: Right knee pain following injury MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is cortical irregularity involving the epiphysis of the lateral femoral condyle posteriorly. The overlying cartilage is normal and this is favored to represent normal ossification.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Small joint effusion.2. Cortical irregularity of the epiphysis of the lateral femoral condyle posteriorly favored to represent normal ossification.


Instruction: Generate impression based on findings.

Input: 16 years, Female, year post Chiari decompression, new headaches. Brain: Interval postsurgical changes of posterior fossa surgical decompression are seen including suboccipital craniectomy and resection of the posterior arch of C1. Posterior fossa structures at the foramen magnum are well decompressed with increase in size of the CSF spaces. There is preserved biphasic ventral and dorsal CSF flow, which is likely improved compared to prior although outside comparison CSF study is technically limited. Remainder of the brain appears unremarkable. No intracranial mass or mass-effect. Pituitary gland is within normal limits for age. The ventricles are within normal limits in size and configuration. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Major flow-voids are preserved. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits aside from the above-mentioned postsurgical changes. Cervical spine: The cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. No cord signal abnormality is definitively appreciated within the limits of motion degradation. No evidence of syrinx.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis at any level within the cervical spine.

Output: 1. Interval postsurgical changes of posterior fossa decompression. The CSF spaces at the foramen magnum are well decompressed, and CSF flow is preserved.2. Brain and cervical spine MRI are otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Again demonstrated is dilatation of the right temporal horn, similar to previous, with volume loss involving the adjacent right parahippocampal gyrus suggesting that right temporal horn enlargement is likely on an ex vacuo basis. There is increased T2 signal in the medial right temporal lobe including hippocampus as well as anterior to the hippocampus. There is increased T2 signal involving the mesial left temporal lobe as well but to a lesser extent. There is some volume loss involving the bilateral hippocampi, but does not appear disproportional to the remainder of the brain.There is a 4 x 5 mm small aneurysm of right anterior communicating artery at A1/A2 junction There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with chronic small vessel ischemic changes. Incidental note is made of a persistent cavum septa pellucidum and vergae. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.There is mucous retention cyst in the right maxillary sinus. Remaining paranasal sinuses and mastoid air cells are clear.

Output: 1. Stable ex vacuo dilatation of the right temporal horn, as well as increased T2 hyperintensity involving the mesial temporal lobes right more than the left. Findings are consistent with gliosis which may be related to prior inflammation, ischemia, trauma, or other injury. No significant change since prior. No intracranial mass or mass effect. No abnormal enhancement.2. 5 x 4 mm right anterior communicating artery aneurysm incidentally noted.3. Periventricular and subcortical T2 hyperintensities likely related to chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History significant for 5 or 6 sports related concussions with worsening headaches over past year and a prior head CT that showed an intracranial cyst. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild asymmetry of the lateral ventricles, left larger than right, and a cystic defect that measures up to 18 mm in the left frontal lobe that communicates with the left lateral ventricle. Otherwise, the brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Small left frontal lobe porencephalic cyst. Otherwise, no evidence of acute intracranial hemorrhage, mass lesions, or acute infarcts.