Instruction: Generate impression based on findings.

Input: 49 years Female (DOB:3/18/1967)Reason: eval for cord compression History: known metastatic renal cell carcinomaPROVIDER/ATTENDING NAME: IRA J BLUMEN IRA J BLUMEN The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.There are some anterior osteophytes present at C6-7 and C7-T1 which are fairly large.Overall the marrow signal is relatively lowThere are degenerative changes present in the lower lumbar spine with disc bulges at L2-3, L3-4, L4-5 and L5-S1Sagittal T1 images of the lumbar spine are partially degraded due to patient motion artifact.The localizer image demonstrates multiple foci of edema within the frontal lobes and left occipital lobe.The right kidney appears to be markedly enlarged and irregular but incompletely evaluated on this exam. Multiple lesions are identified within the lung parenchyma and possibly at the sternal notch.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.3.There are degenerative changes present in the lumbar spine and in the cervical spine there is not appear to be any spinal stenosis.4.There is some marrow replacement present which is rather diffuse. This could be related to anemia or chronic disease.5.Multiple intracranial lesions are present. Please refer to CT of the head from the same date for further comments.6.Enlarged right kidney and multiple pulmonary lesions are present but incompletely imaged on this exam. These are compatible with the patient's known neoplasms. Please refer to CT of the abdomen from April further comments.


Instruction: Generate impression based on findings.

Input: Cognitive decline with prior strokes and Parkinson disease: please assess for burden of cerebrovascular disease. There are small areas of encephalomalacia in the bilateral deep grey matter structures and anterior right frontal lobe superimposed upon a background of diffuse bilateral cerebral hemisphere white matter T2 hyperintensity, primarily in a periventricular distribution. There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse cerebral volume loss. There is an unchanged subcentimeter extra-axial lesion with susceptibility effect along the anterior right frontal convexity. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and mastoid air cells are grossly unremarkable. There is a subcentimeter nodule in the left occipital scalp, which may represent an inclusion cyst, but has gradually increased in size.

Output: 1. Small chronic infarcts in the bilateral deep grey matter structures and anterior right frontal lobe superimposed upon a background of chronic small vessel ischemic disease, but no evidence of acute acute infarct.2. An unchanged subcentimeter extra-axial lesion with susceptibility effect along the anterior right frontal convexity may represent a calcified meningioma.3. A subcentimeter nodule in the left occipital scalp, which may represent an inclusion cyst, but has gradually increased in size and is incompletely characterized.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of chronic back pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. A peripherally enhancing Schmorl's node is present along the inferior endplate of L4. The conus medullaris is normal in position terminating at the level of L1. No abnormal enhancement to suggest infection.Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No significant spinal canal or neuroforaminal stenosis.L1-L2: No significant disc disease. No significant spinal canal or neuroforaminal stenosis.L2-L3: Minimal disc bulge and facet arthropathy. No significant spinal canal stenosis. Minimal bilateral neuroforaminal stenosis.L3-L4: Mild disc bulge and small left annular fissure. There is facet hypertrophy. Mild to moderate left neuroforaminal narrowing. No significant right neural foraminal narrowing.L4-L5: There is a left paracentral extrusion with slight superior migration, mild facet and ligamentum flavum hypertrophy resulting in moderate left and mild right neuroforaminal narrowing. No significant spinal canal stenosis. Minimal T2 hyperintensity in the disc is compatible with degenerative change. L5-S1: Advanced bilateral facet arthropathy. Mild disc bulge with facet and ligamentum flavum hypertrophy resulting in mild to moderate bilateral neural foraminal stenosis. Possible pars defect on the right. There are bilateral facet effusions.The paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes of the lumbar spine as above, relatively worse at the L4-5 level where there is disc extrusion and moderate left neuroforaminal narrowing. No significant spinal canal stenosis at any level.2. Advanced bilateral facet arthropathy at L5-S1 which may be contributing to patient's low back pain. 3. No evidence of discitis-osteomyelitis or epidural abscess.


Instruction: Generate impression based on findings.

Input: 81 years, Female, repeat of FLAIR sequence. Memory loss. Several foci of FLAIR hyperintensity are again noted in the bilateral subcortical and periventricular white matter as well as more confluent areas of FLAIR signal abnormality in the pons, which are nonspecific, but compatible with chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age.

Output: Patient returned for repeat FLAIR sequence which demonstrates no new findings. There are findings which likely represent chronic small vessel ischemic disease, particularly involving the pons.


Instruction: Generate impression based on findings.

Input: Male, 20 years old, with epilepsy, pre-laser fiber planning examination. No definite focal parenchymal lesions are seen. Brain morphology is within normal limits on this limited examination. No pathologic intracranial enhancement is seen. No abnormal fluid collections are detected. The ventricles are normal in size and morphology.

Output: No significant abnormalities are detected on this limited examination for surgical planning purposes.


Instruction: Generate impression based on findings.

Input: Female, 91 years old. Reason: right ankle/heel wound eval for osteo History: ankle/heel wound Several sequences are limited by patient motion artifact. The patient refused further imaging, and no contrast-enhanced sequences were performed.Markers were placed along the posterior aspect of the heel and lower leg, presumably denoting the extent of the patient's wound. There is a soft tissue defect measuring at least 3 cm in diameter situated above the level of the calcaneus posteriorly and extending to the Achilles tendon. There is thickening and increased signal intensity of the underlying Achilles tendon, indicating tendinopathy, but we see no fluid collection to suggest soft tissue abscess.There is a second soft tissue defect posterior to the calcaneus that does not appear to extend to the bone. Minimal increased signal intensity within the posterior aspect of the calcaneus on fat suppressed T2W images (series 1001) likely represents osteitis rather than osteomyelitis as the signal intensity on T1W images appears relatively normal.Mild osteoarthritis affects the ankle and midfoot. There is a small amount of fluid in the subtalar joint which is not necessarily of any true clinical significance. We see no specific findings to suggest septic arthritis. There is moderate to severe fatty atrophy of the musculature of the ankle.There appears to be a focal longitudinal split tear of the peroneus brevis tendon as it courses beneath the fibular tip. The medial tendons and anterior tendons appear normal for age. Evaluation of the ligaments is limited on this study.

Output: Soft tissue ulceration and other findings as above without findings to suggest osteomyelitis.


Instruction: Generate impression based on findings.

Input: Clinical question: History of left acoustic neuroma status post radiosurgery; please evaluate for response. Signs and symptoms: As above. Pre- and post enhanced brain MRI:Examination is performed utilizing the standard pre and post enhanced brain MRI and without dedicated by IAC images.Negative diffusion weighted series.Examination demonstrates an enhancing left-sided acoustic neuroma occupying the entire left internal auditory canal and the slight bulge into the cerebellopontine angle cistern. The lesion measures 13.3 mm in transverse axis which is identical to prior study. It measures approximately 7.7 mm in AP axis at the level of the left internal auditory meatus is similar to prior exam.Examination otherwise demonstrate normal anatomical morphology of the brain and with normal signal intensity on all MRI sequences. No detectable abnormal parenchymal or leptomeningeal enhancement. Unremarkable calvarium and soft tissues of the scalp. Unremarkable images through the orbits including axial fat sat post enhanced series. Normal signal intensity of bilateral mastoid air cells, middle ear cavities and visualized paranasal sinuses.

Output: 1.No appreciable interval change in the size, morphology or enhancement of a 13.3 x 7.7 mm left acoustic neuroma since prior exam.2.Unremarkable pre and post enhanced brain MRI otherwise. Please see above comments.


Instruction: Generate impression based on findings.

Input: 64-year-old male with respiratory failure pre-lumbar puncture evaluation. Provided further history of vascular malformation. There is no evidence of intracranial hemorrhage or edema. Right frontal mass-like lesion overlying right frontal cortex with internal coarse popcorn calcifications measuring approximately 3.4 x 2 .4 cm (series 3 image 21). This lesion exerts a mass effect on underlying right precentral and postcentral gyri with minimal sulcal effacement and an about one to 2 mm of midline shift to the left. This is unchanged compared to prior MRI. The right ventricle appear slightly asymmetrically thinner than the left likely from minimal mass effect of the extra-axial mass.The basal cisterns, third and fourth ventricles are normal in size and configuration. The calvaria and skull base unremarkable. The orbits are unremarkable. The visualized paranasal sinuses are well pneumatized. There is partial opacification of bilateral mastoid air cells.

Output: 1. No acute intracranial hemorrhage. 2. Right frontal mass like lesion is compatible with vascular malformation seen on an outside MRI. The associated minimal mass-effect and midline shift have been stable. Further evaluation with brain MRA and MRI is recommended.


Instruction: Generate impression based on findings.

Input: 3 year-old female with seizure. Redemonstrated are several foci of T2 hyperintensity in the bilateral frontal and left parietal cortical and subcortical region as well as along radial glial lines. As before, there are several small subependymal nodules in the subependymal bilateral lateral ventricles. None obstruct the foramen of Monroe. There appears mild thinning of the posterior body of the corpus callosum, unchanged. The midline structures and cranial-cervical junction are otherwise normal. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1.Redemonstrated are intracranial manifestations of tuberous sclerosis without significant interval change.2.If future MR imaging is contemplated, gadolinium enhancement would be recommended to better assess for subependymal giant cell astrocytomas, although on the current exam no subependymal nodule approaches the foramen of Monroe.


Instruction: Generate impression based on findings.

Input: Compression of brain [G93.5] / Syringomyelia and syringobulbia [G95.0], Reason for Study: ^Reason: chiari malformation decompression, thoracic syrinx, please do with csf flow study History: worsening symptoms, neck pain , arm History: neck and arm pain MRI C-SPINECervical spine alignment is normal.There is evidence of C1 to C3 laminectomies, suboccipital craniectomy and cauterization of bilateral cerebellar tonsils for Chiari decompression.Small syrinx in cervical spine about 1mm diameter on axial scan and slightly more prominent at the level of C5, unchanged since prior scan.No evidence of spinal canal stenosis.Cervical CSF flow studyBiphasic CSF flow through the foramen magnum anterior to the brainstem and through the posterior aspect of the cerebellar tonsil.Comparing to prior study, no definitive interval change is seen.Thoracic MRIThoracic vertebral alignment is normal.Again syrinx is seen to the level of T10, unchanged in terms of diameter and extent since prior scan.No evidence of spinal canal stenosis.

Output: 1. Stable cervical and thoracic syrinx in terms of size and extent since prior scan.2. Unchanged maintained biphasic CSF flow anterior to the brainstem and posterior to the cerebellar tonsil since prior scan.


Instruction: Generate impression based on findings.

Input: Prostate cancer staging. Biopsy dated 1/26/2016 demonstrated left base lateral 3+3 1.5 mm 10%. PELVIS:PROSTATE:Prostate Size: 4.1 x 6.7 x 6.2 cmPeripheral Zone: Minimal hemorrhage/proteinaceous signal intensity. Mild wedge shaped T2 weighted hypointensity of the right mid gland/base peripheral zone without a discrete measurable lesion. Central Gland: Changes of BPH without a suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.Contrast extravasation description:Supervising radiologist: Dr. O'BrienMinor or major extravasation: MinorContrast type:16 cc of Multihance were administered. Amount extravasated: 8 ccLocation of extravasation: Right AC fossaSigns and symptoms: Patient reports mild swelling but no pain. Intact neurovascular function.Treatment given: Warm compress and elevation. No pain at discharge. Discharge instructions given: Yes

Output: Mild signal abnormality in the right mid-gland/base without a discrete dominant lesion. No evidence of extraprostatic extension or enlarged pelvic lymphadenopathy. Please note that this was a nonenhanced MR due to contrast extravasation.


Instruction: Generate impression based on findings.

Input: Diagnosis: DysarthriaClinical question: STROKESigns and Symptoms: SLURRED SPEECH MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of encephalomalacia present in the right gyrus rectus.There are periventricular white matter lesions which are bright on T2 and FLAIR MRI present of moderate degree.There are T2 and FLAIR hyperintense lesions in the basal ganglia and brainstem associated with some volume loss.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minor opacities in the left mastoid air cells. The visualized portions of the orbits are intact.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.The right transverse sinus and sigmoid sinus are larger than the left transverse sinus and sigmoid sinus.

Output: 1.There are numerous small lesions in the brainstem and basal ganglia which are suspicious for old lacunar infarcts. There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.No evidence for dural venous sinus thrombosis


Instruction: Generate impression based on findings.

Input: 6-year-old girl with history of right forearm desmoid tumor. Follow-up examination. Again seen is a heterogeneous mass on the radial aspect of the forearm. Thismass demonstrates predominately low T1 signal intensity, with heterogeneous T2 signalintensity. There is minimal enhancement.The superficial portion of the mass is located on the radial aspect of the forearm andinvolves the superficial forearm extensors, including the brachioradialis and extensorcarpi radialis longus. This superficial portion of the tumor (series 1101, image 26)measures 4.5 x 2.6 x 7.1 cm (previously 4.1 x 2.4 x 6.8 cm).The deep portion of the mass extends into the interosseous region and partially encasesthe radius. This deep portion of the mass (series 2001, image 18) measures 2.0 x 1.1 cmon axial images (previously 1.9 x 1.4 cm).

Output: Minimal increase in size of right forearm desmoid tumor.


Instruction: Generate impression based on findings.

Input: There is flow within the bilateral vertebral arteries. The right vertebral artery is dominant. The post PICA left V4 segment appears diminutive, though this is likely congenital in etiology. There is irregularity of the left PICA just distal to its origin.Further, there is also appropriate flow within the basilar artery, distal bilateral internal carotid arteries. The right A1 segment appears diminutive, and the A2 segment is not visualized shortly after its origin. There is redemonstration of occlusion of the left MCA within the mid M1 segment with distal perfusion likely provided by collateral branches. This correlates with prior loss of flow void seen on old imaging. No arterial arteriovenous malformations or aneurysms are identified.

Output: 1. Persistent complete occlusion of the left MCA at the mid M1 segment.2. Redemonstration of occluded of right A2 segment.3. Partially visualized left PICA atherosclerotic irregularity.


Instruction: Generate impression based on findings.

Input: 69 years Female (DOB:6/3/1947)Reason: ?mass or lesion of posterior circulation History: headachePROVIDER/ATTENDING NAME: NAOUM P ISSA NAOUM P ISSA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are largely unchanged since the prior exam. Additionally there are punctate foci of T2 and FLAIR signal hyperintensity within the brainstem which are also largely unchanged since prior exam.Some punctate foci of signal loss and susceptibility imaging are present in the cerebellum predominantly within the vermis..No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.An 8 mm nodule in the right parotid space at the anterior aspect of the superficial portion of the right parotid gland was also present on the prior exam and remains unchanged. It is hyperintense on T2 and hypointense on T1 and FLAIR suggesting that it is cystic

Output: 1.Periventricular and subcortical white matter lesions of a mild to moderate degree and punctate lesions within the brainstem are nonspecific. At this age they are most likely vascular related. 2.Microhemorrhages identified within the cerebellum are nonspecific.3.Subcentimeter cystic lesion in the right parotid gland remains stable.


Instruction: Generate impression based on findings.

Input: New onset optic disc edema: bilateral optic disc edema. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered foci of cerebral white matter T2 hyperintensity, which are nonspecific. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is diffuse paranasal sinus mucosal thickening and secretions.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Pansinusitis.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. Mild pseudosubluxation at C2-C3 is incidentally noted. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: MRI of the cervical, thoracic, and lumbar spine appears within normal limits. No cord signal abnormality, abnormal enhancement, or evidence of spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: There are unchanged postoperative findings related to remote transsphenoidal pituitary mass resection with stable appearance of homogeneously enhancing residual pituitary gland within the right aspect of the sella and slight thickening with enhancement of pituitary stalk. The pituitary stalk remains deviated to the right. The cavernous sinuses are symmetric and normal in signal and enhancement. There is no significant abnormality in the hypothalamus or suspicious enhancement. There is no mass effect on the optic chiasm.Limited evaluation of the remainder of the brain demonstrates no mass or mass-effect or abnormal enhancement.

Output: Unchanged postoperative findings of pituitary adenoma resection. No new or enlarging lesion to suggest tumor recurrence.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chiari malformation and syrinx: worsening symptoms. Brain: There are postoperative findings related to Chiari decompression surgery. There appears to be intact cerebrospinal fluid flow across the posterior neo-foramen magnum, but it is reduced anteriorly in association with a small pannus posterior to the dens. The supratentorial brain is unremarkable. The ventricles are not enlarged. There is no evidence of acute infarct or intracranial mass. The orbits and paranasal sinuses are unremarkable.Spine: The discontinuous syrinx that extends from C4-C5 through L1-L2 is unchanged in caliber, measuring up to 6 mm at the midthoracic level. The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unchanged.

Output: 1. Persistent diffuse syringohydromyelia.2. Findings related to Chiari decompression surgery with reduced cerebrospinal fluid flow across the anterior neo-foramen magnum in association with a small pannus.


Instruction: Generate impression based on findings.

Input: Patchy hypodensity is present within the pons without associated restricted diffusion consistent with chronic small vessel ischemic disease. There is loss of normal flow void within the distal right vertebral artery, with some retrograde reconstitution of the distalmost segment. Fluid is present within a few left mastoid air cells.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.Patchy hypodensity is present within the pons without associated restricted diffusion consistent with chronic small vessel ischemic disease. 2.There is loss of normal flow void within the distal right vertebral artery, with some retrograde reconstitution of the distalmost segment.3.Fluid is present within a few left mastoid air cells.4.Otherwise negative MRI of the internal auditory canals.


Instruction: Generate impression based on findings.

Input: History of thoracic fusion. Follow-up bone fusion and hardware. Osteomyelitis. There are posterior rods with screws entering T7, T8, T11, and T12. The T7 screws overlie the superior endplates of the vertebral body, but I see no acute hardware complications. Deformity of the T9 and T10 vertebral bodies with loss of height and endplate irregularity is compatible with known discitis/osteomyelitis. Orthopedic fixation of the cervical spine is noted on the AP view. Note is made of a stent in the right innominate vein, as well as a catheter with its tips in the superior vena cava. An orphaned catheter cuff is noted above the right clavicle. Arterial calcifications are noted.

Output: Orthopedic fixation of the thoracic spine with other findings as described above.


Instruction: Generate impression based on findings.

Input: 61 year old female with a family history of breast cancer in her mother diagnosed at age 60 and ovarian cancer at 86, maternal grandmother diagnosed at age 60, and paternal aunt diagnosed at age 60. Personal history of skin cancer diagnosed at age of 52. No current breast complaints. There is scattered fibroglandular tissue in both breasts.Moderate nodular parenchymal enhancement is noted bilaterally. Symmetric bilateral enhancing foci are present in both breasts, however none are dominant or uniquely enhancing.Bilateral subcentimeter, T2 hyperintense nonenhancing cysts are identified. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of HCV cirrhosis. Presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Iron deposition. Cirrhotic liver morphology with predominantly central fibrosis. Cholelithiasis without evidence of acute cholecystitis. Trace perihepatic ascites.Miliary hypointense lesions throughout the liver parenchyma compatible with siderotic nodules. No suspicious focal lesion is identified. Due to the patient's chronic portal vein obliteration evaluation is slightly limited.Chronic obliteration of the portal vein with innumerable small periportal collateral vessels. The hepatic artery is patent.SPLEEN: The spleen measures 11.3 cm in craniocaudal dimension without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Splenorenal shunt. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Portosystemic collateral vessel formation including a recanalized periumbilical vein and perigastric cardia collateral vessels.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis with periportal fibrosis. No suspicious focal hepatic lesion. Please note that evaluation is slightly limited due to chronic portal vein obliteration.2.Chronic portal vein obliteration with innumerable small periportal collateral vessels. Previously described portosystemic vessel nonocclusive thrombus is no longer visualized.


Instruction: Generate impression based on findings.

Input: Left hip pain Mild osteoarthritis affects the hip. There is linear low signal intensity within the anterior superior articular cartilage of the hip which may reflect degeneration and possibly delamination but there is no discrete fluid-filled articular cartilage defect. There is minimal increased signal intensity of the anterior labrum suggesting degeneration but there is no discrete fluid-filled tear. There is no gross CAM deformity. There is no joint effusion and the bone marrow signal intensity is normal.There is minimal increased signal intensity of the distal fibers of the gluteus medius tendon at its insertion suggesting tendinosis or chronic insertional tearing however this is not necessarily of any current clinical significance. Similar findings are noted are seen on the right as demonstrated on the large field-of-view images.Evaluation of the lower lumbar spine is limited secondary to metallic susceptibility artifact from lumbar fixation. There is mild osteoarthritis of the pubic symphysis. A collection of near fluid signal intensity measuring 1.5 cm is seen immediately anterior to the pubic symphysis and deep to the pre-pubic aponeurotic complex. This was not present on the prior MRI images and it is uncertain whether this represents a synovial cyst arising from the symphysis or is secondary to chronic injury of the aponeurotic complex itself.

Output: 1. Mild osteoarthritis of the left hip and pubic symphysis.2. Mild increased signal intensity within the insertional fibers of the left gluteus medius on the greater tuberosity which may reflect tendinosis or chronic tearing. A similar finding is noted on the right but is not necessarily of any current clinical significance.3. Small collection of near fluid signal intensity anterior to the pubic symphysis which may represent a synovial cyst or chronic injury to the pre-pubic aponeurotic complex.


Instruction: Generate impression based on findings.

Input: 38 year-old female with cerebral cavernous malformations, annual evaluation for change in size/number of lesions The CSF spaces are appropriate for the patient's stated age with no midline shift. Redemonstrated is a right frontal lobe lesion with a heterogeneous appearance on T1/T2 with a blooming effect on susceptibility imaging. The lesional nidus appears slightly retracted, with resolution of previously demonstrated fluid/heme levels. The lesion as measured between hemosiderin stained borders is unchanged. There is no perilesional edema.There are a few foci of T2 hyperintensity, the most prominent of which is within the left superior frontal gyrus subcortical white matter. Smaller findings are also noted in the right posterior lateral frontal lobe. At the time, these lesions do not demonstrate discrete susceptibility abnormality, and are stable in appearance.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.Other than a few scattered mucus retention cysts, the visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Stable right frontal cavernous malformation without perilesional edema.2.Stable foci of T2 hyperintensity.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with newly diagnosed thyroid cancer. Evaluate extent of disease. A very large, heterogeneous mass is identified arising from the region of the right thyroid lobe measuring 87 mm (TV) by 75 mm (AP) by 83 mm (CC). In the CC dimension, this lesion extends from the level of the submandibular space down to the level of the manubrium. In the AP dimension, it extends from the anterior margins of the C5 through T1 vertebral bodies nearly to the skin surface. In the TV dimension, the lesion extends from the strap muscles and sternocleidomastoid to the level of the trachea with marked leftward deviation of the trachea. Despite the marked deviation of the airway, the airway does remain patent.The carotid and jugular vessels pass along the posterior lateral aspect of this tumor. The carotid artery seems to remain patent and, although it closely abuts the lesion, is not clearly engulfed by the lesion. The internal jugular vein is deviated and narrowed. There remains the appearance of a very thin fat plane between this lesion and the trachea itself. The tumor closely approaches the right aspect of the thyroid and cricoid cartilages but without definite evidence of invasion.A clustering of right level 2, 3 and 4 lymph nodes are seen along the margin of the tumor which, although not pathologically enlarged by size criteria, are suspicious by virtue of their number. No pathologic adenopathy is detected on the left side of the neck. The salivary glands are unremarkable. Marrow signal characteristics are within normal limits.

Output: Very large tumor arising from the right thyroid bed compatible with the history of thyroid cancer.


Instruction: Generate impression based on findings.

Input: Male, 18 years old, with sickle cell disease and small aneurysm seen on MRI/MRA one year ago. Assess for changes, stenosis, moyamoya. Cerebral morphology and signal characteristics are within normal limits. No tissue defects are seen. No evidence of restricted diffusion, focal signal abnormality, edema or mass effect is detected. There are no findings to suggest intracranial hemorrhage. The ventricles are normal in size and morphology. The pattern of enhancement on postcontrast images is within normal limits. No significant deficit or asymmetry is noted on perfusion imaging.MRA images are degraded by motion and are of lesser quality than those obtained on the prior examination. Nevertheless, the appearance of the ophthalmic segment of the right ICA is similar to prior in that there appear to be at least one and potentially two areas of vascular outpouching directed laterally which probably measure about 4 mm in length. No additional lesions are identified. The terminal ICAs and MCAs are both symmetric and of normal caliber with no areas of stenosis or occlusion. The left vertebral artery is dominant.

Output: 1.No evidence of acute or chronic ischemia or any other significant parenchymal brain abnormalities are noted.2.Stable appearance of the ophthalmic segment of the right ICA with one or possibly two areas of vascular outpouching which may represent aneurysms. CTA can be considered for a more detailed evaluation of these findings if clinically warranted.3.Elsewhere, no significant vascular abnormalities are detected, and in particular there is no evidence of moyamoya.4.No deficit or asymmetry is noted on perfusion imaging.


Instruction: Generate impression based on findings.

Input: Male, 75 years old, with neurogenic claudication. Spinal alignment is anatomic. Marrow signal characteristics are somewhat heterogeneous which may represent the presence of asymmetric fat or benign hemangiomas. Scattered Schmorl's node deformities are also demonstrated appearing similar to the prior examination. Vertebral body height and morphology are otherwise unremarkable. No worrisome marrow replacement or evidence of marrow edema is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected. Cystlike renal lesions are redemonstrated bilaterally. The right psoas muscle is smaller than the left.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Facet arthropathy is similar to prior, with a lobular cystic structure projecting dorsally from the left facet joint likely representing a synovial cyst. Disc bulging slightly asymmetric to the right is unchanged. No significant generalized spinal canal stenosis is seen. Mild bilateral foraminal narrowing is unchanged. L3-4: Facet arthropathy and ligamentum flavum thickening. Disc bulging. Mild narrowing of the spinal canal. Moderate right and mild left foraminal narrowing. Findings are unchanged. L4-5: Facet arthropathy and ligamentum flavum thickening. Disc bulging with a right foraminal protrusion. Moderate generalized spinal canal narrowing. Severe right foraminal narrowing with probable nerve root impingement. Mild left foraminal narrowing. Findings are unchanged. L5-S1: Facet arthropathy. Disc bulging asymmetric to the right foraminal zone. Mild generalized spinal canal narrowing. Moderate to severe right foraminal narrowing. A previously seen cystic structure in the right neural foramen is no longer identified. Findings are otherwise unchanged.

Output: No significant interval change is seen in multilevel disc and posterior element degeneration. Most notably, there remains severe foraminal narrowing on the right at L4-5 with possible nerve root impingement.


Instruction: Generate impression based on findings.

Input: 55-year-old female with CAM deformity and mild osteoarthritis of the left hip on recent radiographs. ACETABULAR LABRUM: Note is made of linear increased signal abnormality traversing the anterior superior acetabular labrum from the 1 o'clock to 3 o'clock position indicating a tear.ARTICULAR CARTILAGE AND BONE: Mild osteoarthritis affects the left hip. We see no full-thickness articular cartilage defects. There is a CAM deformity anteriorly along the femoral head/neck junction, with an alpha angle of approximately 60 degrees. Small cysts are noted within the anterior aspect of the femoral head/neck junction. The ligamentum teres appears intact.SOFT TISSUES: There is mild peritrochanteric inflammatory changes identified bilaterally, more pronounced on the left. ADDITIONAL

Output: 1. Mild osteoarthritis of the left hip with CAM deformity and labral tear.2. Mild peritrochanteric inflammatory changes. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 72-year-old female with a right thigh mass status post radiation therapy. There is a large mass within the anterior compartment of the right thigh measuring 14.5 x 12.3 x 23.6 cm (TR x AP x CC) which results in medial displacement of the rectus femoris and vastus medialis muscles (41; series 601). The mass also displaces the femoral vessels medially, but does not definitively contact the vessels themselves. The mass is largely isointense to muscle with a few hyperintense foci likely representing subacute blood products. The mass demonstrates predominantly fluid signal intensity on T2-weighted images with low signal intensity septations. The majority of the mass does not enhance following administration of contrast although there is a peripheral rind of enhancement. There is also edema type signal intensity and enhancement of the vastus lateralis muscle belly posteriorly and distally which may reflect denervation, although we cannot entirely exclude tumor extension. The signal abnormality and enhancement within the vastus lateralis muscle contacts the femur, as does enhancing tissue arising from the posteromedial aspect of the mass, but we see no signal abnormality within the cortex or medullary cavity of the femur itself to suggest tumor invasion. There is mild edema and enhancement within the anterior musculature of the hip. There is a small knee joint effusion with enhancement suggestive of a mild synovitis which is nonspecific.

Output: Large soft tissue mass as described above.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: Abnormal signal intensity replaces the posterior horn of the medial meniscus at/near the root, indicating possible radial tear or root avulsion with resultant medial extrusion of the medial meniscus. There is intrasubstance degeneration of the remaining portions of the medial meniscus. There is mild intrasubstance degeneration of the lateral meniscus, but no discrete tear is appreciated.ARTICULAR CARTILAGE AND BONE: There is severe degenerative chondral thinning within the medial tibiofemoral compartment, with full thickness loss of cartilage along the weightbearing femoral condyle and tibial plateau. There is adjacent degenerative signal abnormality in the underlying subchondral bone. There is partial thickness chondral loss in the lateral tibiofemoral compartment. There is moderate chondral loss in the patellofemoral compartment, particularly along the medial patellar facet. There is also full-thickness chondral loss of the trochlea, inferiorly, with underlying reactive subchondral cyst formation.LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The medial collateral ligament is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is within normal limits.ADDITIONAL

Output: 1.Edema and focal fluid collection with the medial head of the gastrocnemius muscle, suggesting high-grade strain on this nonenhanced study. An abscess with surrounding edema is considered less likely.2.Tricompartmental osteoarthritis, worst in the medial tibiofemoral compartment.3.Radial tear/root avulsion of the posterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Chronic medial ankle pain TENDONS: The Achilles tendon is normal. There is a small amount of fluid within the sheaths of the medial tendons which can be a normal finding and are not necessarily of any clinical significance. The peroneal and anterior tendons also appear normal.LIGAMENTS: The anterior and posterior talofibular ligaments are intact although there is a 1.7 cm lobulated fluid signal intensity focus lateral to the anterior talofibular ligament which likely represents a ganglion. The calcaneofibular ligament is intact. The anterior and posterior tibiofibular ligaments are intact. There is loss of the normal fatty striation of the deep fibers of the deltoid ligament which may reflect prior sprain but this is equivocal and there is no evidence of an acute abnormality. The plantar fascia and sinus tarsi are unremarkable.ARTICULAR SURFACES AND BONE: The bone marrow signal of the ankle is normal with no evidence of an osteochondral defect.ADDITIONAL

Output: Loss of the normal fatty striations of the deep fibers of the deltoid which may reflect prior sprain but this is equivocal. There are otherwise no specific findings to account for the patient's pain. Additional findings are detailed above.


Instruction: Generate impression based on findings.

Input: Reason: evaluation of posterior knee soft tissue mass History: same, present, The medial and lateral meniscus appear intact. The cruciate and collateral ligaments appear intact. No bone marrow signal abnormality is identified. The extensor mechanism appears intact. There is linear decreased signal abnormality within the articular cartilage along the lateral facet of the patella, centrally, that may represent a partial-thickness articular cartilage cleft. There is a small amount of fluid within the joint which extends posteromedially into a lobulated Baker's cyst which measures approximately 4 cm in the craniocaudal dimension. There are foci of increased signal abnormality on T1-weighted images internally which may represent blood products/hemorrhage. There is thin peripheral and septal enhancement on postcontrast sequences. There is a skin marker in the overlying area presumably corresponding to the patient's palpable area of concern. There is edema within the quadriceps fat pad which is nonspecific and may be of no clinical significance, but can be seen in patient's with fat pad impingement. The imaged musculature of the left knee normal appearance. The tibial tubercle trochlear groove distance is normal. No evidence of patella alta.

Output: 1. Lobulated Baker's cyst corresponding to the patient's area of concern.2. Probable partial-thickness articular cartilage cleft along the lateral facet of the patella.3. Edema within the quadriceps fat pad is nonspecific and may be of no clinical significance, however, this can be seen in patient's with fat pad impingement.


Instruction: Generate impression based on findings.

Input: 21year old healthy male with history of acute pericarditis presenting for evaluation of cardiac function. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 195 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 85 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is pericardial enhancement with Gadolinium, in addition in the postero-lateral wall there is mild epicardial myocardial enhancement. No evidence of constriction seen. 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 53%, the RV end diastolic volume index is 111 ml/m2 (normal range 82+/-16), the RVEDV is 218 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 103 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 no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no evidence of pericardial effusion or pericardial masses seen. 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 left ventricular size and systolic function (LVEF 56%)2. Normal right ventricular size and systolic function (RVEF 53%)3. There is pericardial enhancement with Gadolinium, in addition in the postero-lateral wall there is mild epicardial myocardial enhancement.


Instruction: Generate impression based on findings.

Input: Other general symptoms(780.99) [780.99], Reason for Study: ^Reason: etiology for altered mental status History: AAO x2 There is no evidence of acute ischemic or hemorrhagic lesion on the scan.On FLAIR images, there are multifocal bihemispheric scattered white matter lesions indicating nonspecific small vessel 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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Minimal scattered nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 63 year old man referred for evaluation of thoracic aorta. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 84 ml/m2 (normal range: 74+/-15), the LVEDV is 151 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 58 ml (normal range 47+/-19), the LV mass index is 54 g/m2 (normal range 85+/-15), and the LV mass is 98 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 170 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 85 ml (normal range 54+/-17).Right AtriumThe right atrium is mild to moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root dimensions are as follows:SOV: 41mm x 40mm x 39mmSTJ: 35mm x 36mmAscending aorta: 40mm x 40mmMid aortic arch: 25mm x 25mmDescending thoracic aorta: 23mm x 23mmPulmonary 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. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%.3. Mild aortic root dilation, dimensions as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female; 43 years old. Reason: Patient with high liver enzymes and alkaline phosphatase. Suspected choledocholithiasis. HAS A POWER PORT History: High liver enzymes and alkaline phosphatase ABDOMEN:Lack of IV contrast limits sensitivity for solid organ pathology.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted. Subcentimeter T2 hyperintense lesion in the inferior spleen is most likely benign in etiology.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild nonspecific porta hepatis lymphadenopathy.BOWEL, MESENTERY: Right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No choledocholithiasis or other significant hepatobiliary abnormality.2. Mild nonspecific porta hepatis lymphadenopathy.


Instruction: Generate impression based on findings.

Input: An 80 year old male with history oh hypertension, stroke, end stage renal disease and systemic amyloidosis. A recent echocardiography showed good left ventricular function with hypertrophy. Referred to cardiac MRI (without contrast due to low kidney function) to evaluate cardiac amyloidosis Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 177 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 54 ml (normal range 47+/-19). There is concentric LVH. There are no regional wall motion abnormalities present. T1-mapping showed normal values suggesting that there is no presence of an underlying fibrosing, infiltrative, or inflammatory process.No LV thrombus was seen. No evidence of iron overload was notedLeft AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 178 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 84 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is moderate to severe aortic regurgitation (regurgitant fraction of 42%). The number of AV leaflets could not be determined.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium. The SVC is normal in size while the IVC is dilated.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with hyperdynamic systolic function, the LVEF is 70%. There is concentric LVH.2. T1-mapping showed normal values suggesting that there is no presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with normal systolic function, the RVEF is 53%. 4. There is moderate to severe aortic regurgitation (regurgitant fraction of 42%).


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsions Apnea, not elsewhere classifiedClinical question: Eval for AVMSigns and Symptoms: New Seizures, xanthochromia in CSF, Macrophage w hemosiderin MRI of the brainNo diffusion weighted abnormalities are appreciated.The posterior limbs of internal capsules demonstrate some myelination. Otherwise there is little myelination.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The right A1 segment is small. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial arteriovenous malformation or aneurysm.3.No evidence for acute ischemic cerebral infarction.4.Myelination pattern is neonatal.


Instruction: Generate impression based on findings.

Input: Altered mental status, left hemispheric intracerebral hemorrhage. There is a 32 mm x 20 mm sized left frontal intra-axial lesion. The lesions show high signal intensity on T1 as well as T2 weighted image with relatively thin rim of signal voids indicating chronic intra-axial hematoma with hemosiderin ring.There is a another lesion on the left parietal lobe precuneus sized about 4 mm x 19 mm with the surrounding edema. The lesion shows high signal intensity on T1 and low signal intensity on T2-weighted images indicating subacute hematoma.On gradient echo images, there are multifocal gyriform susceptibility lesions on bilateral frontal parietal lobes indicating chronic subarachnoid hemorrhage. In addition, there are small scattered nodular signal voids lesions on bilateral cerebral hemisphere as well as bilateral cerebellar hemisphere indicating chronic petechial hemorrhagic lesions.On gadolinium enhancement, there is no evidence of abnormal enhancing lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, left transverse sinuses, left sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus. Right transverse and sigmoid sinus appear to be hypoplastic. There is no evidence of major dural sinus occlusion.

Output: 1. Multifocal multi-age intracerebral as well as subarachnoid hemorrhages as described above. In particular, there is a 32 mm x 20 mm sized organize hematoma on the left frontal lobe and 4 mm x 19 mm sized subacute hematoma on the left precuneus.2. No evidence of abnormal enhancement.3. Hypoplastic right transverse and sigmoid sinus as well as right jugular bulb which most likely represent congenital normal variation, otherwise unremarkable MR venogram of the brain.


Instruction: Generate impression based on findings.

Input: 51 years Male (DOB:5/6/1964)Reason: For Research: GBM s/p resection with Ziopharm trial. eval changes in tumor History: surveillancePROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI The patient status post left-sided craniotomy and left temporal lobe surgery. There is redemonstration of an enhancing mass centered in the left temporal lobe and surrounding the temporal horn of the left lateral ventricle. It is irregularly shaped enhances heterogeneously and has heterogeneous signal on T2 imaging. It is associated vasogenic edema extending to the left parietal lobe and occipital lobe and multiple foci of susceptibility within the enhancing component of the lesion which are compatible with microhemorrhages. The enhancing component measures 46 x 29 mm axial dimensions and previously measured 29 x 46 mm axial dimensions. There is an enhancing tract extending from the surface of the left temporal lobe into the lesion which was also present on the prior exam. Overall this has not significantly changed compared to prior exam.There is redemonstration of mild uncal herniationNormal 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 mucosal thickening and status post paranasal sinus surgery.. The visualized portions of the mastoid air cells demonstrate minor opacities The visualized portions of the orbits are intact.

Output: Since the prior exam from 4/20/2016 there has been no significant interval change in the patients left temporal lobe mass surrounding the temporal horn of the left lateral ventricle.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke workup. HIV-positive patient. Signs and symptoms: Slowed speech, right arm weakness, gait instability. Pre- and post enhanced brain MRI:Diffusion weighted images demonstrate a tiny focus of subcortical restricted diffusion (6 mm) in the subcortical white matter of left postcentral gyrus and a larger focus (14.5 x 6.5 mm) in the left paramedian lower pons consistent with acute ischemic strokes without evidence of susceptibility signal changes.Additionally examination demonstrates fairly extensive confluent FLAIR and T2 hyperintensity involving the white matter of bilateral cerebral hemispheres. Lesser degree of similar signal changes are present in bilateral basal ganglia and left pons. Susceptibility signal changes demonstrate multiple tiny foci of microhemorrhages in bilateral subcortical periventricular white matter as well as bilateral basal ganglia and right thalamus. Constellation of above findings are suggestive of advanced chronic minimally hemorrhagic small vessel ischemic strokes. Considering patient's HIV positive status the above detailed findings also could at least partially be secondary to chronic changes of HIV infection. Mild prominence of cortical sulci and supratentorial ventricular system for patient's stated age is suggestive of underlying parenchymal volume loss. Examination also demonstrated evidence of bilateral ovarian degeneration.There is no detectable abnormal enhancement of brain parenchyma or the meninges.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium and soft tissues of the scalp. There is evidence of extensive opacification of left maxillary sinus and well-pneumatized paranasal sinuses otherwise.Findings and concerns on this study were discussed by phone (45901) with the emergency room physician (Dr. Padera) at the time of review of the study.

Output: 1.There is a 6 mm left postcentral gyrus and a 14.5 x 6.5 mm eft paramedian pons restricted diffusion consistent with acute strokes.2.Extensive periventricular and subcortical as well as bilateral basal ganglia and pontine FLAIR hyperintensity with internal foci of hemorrhage suggestive of chronic minimally hemorrhagic small vessel ischemic strokes. Possibility of overlapping chronic changes of HIV infection cannot be entirely excluded.3.There is no detectable abnormal enhancement on post infused series.4.Prominence of cortical sulci and ventricular system for stated age consistent with underlying parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: 26-year-old male. Pain and catching. Evaluate for meniscus injury. MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits without evidence of contusion or fracture. Marked cartilage thinning of the weight-bearing surface of the medial aspect of the lateral femoral condyle; no full thickness defect is evident. Medial tibiofemoral compartment and patellofemoral compartment cartilage is intact.LIGAMENTS: ACL, PCL, MCL, and lateral collateral ligamentous complex are intact.EXTENSOR MECHANISM: Fluid signal intensity septated cystic foci in the soft tissues posterior to the medial femoral condyle consistent with ganglion cysts.ADDITIONAL

Output: 1. Diffuse marked cartilage thinning of the medial aspect of the lateral femoral condyle without a full thickness defect. 2. No evidence of a meniscal tear or ligamentous injury.


Instruction: Generate impression based on findings.

Input: Pain. Rotator cuff tear? Impingement syndrome. Evaluation of several sequences is limited by patient motion artifact.ROTATOR CUFF: The rotator cuff tendons and muscles appear normal for age.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is prominent edema within the distal clavicle associated with a curvilinear band of subchondral low signal intensity. This may be degenerative in etiology, although could represent a stress reaction in the correct clinical context. There is trace fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint is within normal limits. There is a small amount of fluid within the joint but no large effusion. Intermediate signal intensity within the superior labrum likely represents degenerative tearing that extends into the anterior labrum as well.BICEPS TENDON: Given the limitations of a non-arthrogram study, the tendon of the long head of the biceps appears normal.

Output: 1.The rotator cuff appears normal for age.2.Mild osteoarthritis of the acromioclavicular joint. Edema within the distal end of the clavicle may be degenerative in etiology, but could also represent a stress reaction ("posttraumatic edema/osteolysis of the distal clavicle") in the correct clinical context.3.Degeneration of the glenoid labrum.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: acute stroke on ct History: hemiparesis Brain MRIThere are multifocal scattered restricted diffusion lesions involving bilateral cerebellar hemispheres, pons, left thalamus and right occipital lobe indicating acute ischemic infarctions. There is no evidence of hemorrhagic transformation.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 occluded right ICA but patent and normal appearing left ICA, bilateral MCAs and bilateral ACAs. Bilateral PCAs are fetal origin.Vertebrobasilar system appears to be normal.

Output: 1. Multifocal acute ischemic infarctions involving bilateral cerebellar hemispheres, pons, left thalamus and right occipital lobe.2. Bilateral fetal PCAs. Otherwise no evidence of intracranial arterial stenosis or occlusion. No aneurysm was seen.


Instruction: Generate impression based on findings.

Input: Diagnosis: Syncope and collapseClinical question: mass or atrophy causing memory problemsSigns and Symptoms: dementia The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate air-fluid level and mucosal thickening in the left maxillary sinus and a minor opacity in the right maxillary sinus as well as partial opacification of the left ethmoid air cells.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Some images are degraded by motion artifact

Output: No obvious explanation for the patient's and dementia can be ascertained on the basis of this exam.Pattern of low opacification of paranasal sinuses may suggest obstruction at the level of the left hiatus semilunaris.Exam is degraded by patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 49-year-old female presents for follow-up of a possible right nipple papilloma. A targeted right nipple ultrasound was performed. Stable oval hyperechoic lesion measuring 3 x 2 mm is redemonstrated without increased vascularity most likely corresponding to the lesion seen on MRI.

Output: No sonographic evidence for malignancy. Stable right nipple 3 mm lesion most likely a papilloma. Patient is due for a bilateral diagnostic mammogram in October 2015.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Male, 12 years old, with history of epidural abscess and periorbital abscess status post I&D. A left orbital/periorbital abscess is again seen centered on the superolateral aspect of the bony orbit. As before, there are components of this abscess which extend medially and superiorly along the supraorbital ridge, and posteriorly into the extraconal space of the orbit.In comparison to the prior examination, the overall size of the abscess has decreased slightly. One component for example now measures 25 x 12 mm and previously measured 25 x 15 mm. The component which extends along the supraorbital ridge has substantially decreased in thickness.A thick rind of solid enhancing tissue is evident surrounding the abscess cavity. This involves nearly the entirety of the extra orbital soft tissues including the upper eyelid with extension into the left frontal and temporal scalp. Within the orbit, this thick enhancing tissue extends posteriorly along the superolateral orbital margin and is in contiguity with the lateral rectus muscle and superior rectus muscle. This abnormal solid enhancement extends nearly to the level of the orbital apex.Although the globe remains relatively round, the presence of this intraorbital enhancing tissue does result in a mild degree of proptosis. The optic nerve does not appear to be in immediate proximity to this tissue and is not frankly impinged at any point. The remaining extraocular muscles are within normal limits.The dura overlying the adjacent left frontal lobe remains smoothly thickened and enhancing. There is only a small focus of restricted diffusion which questionably correlates to a portion of this enhancing dura. Otherwise, no restricted diffusion is seen and no frank epidural collection is detected. There may be minimal leptomeningeal enhancement subjacent to the enhancing dura, but this is not as well-demonstrated as on the prior examination.No evidence of pathologic parenchymal enhancement or frank parenchymal signal abnormality is seen. The morphology of the brain is within normal limits. The ventricles are normal in size and shape.Again seen is extensive paranasal sinus inflammation with thickened enhancing mucosa and accumulated secretions in the left frontal sinus, left ethmoid air cells, and left maxillary sinus.

Output: 1.The left orbital/periorbital abscess has decreased in size slightly from the prior examination, though it does persist in approximately the same configuration as that seen previously.2.A rind of thick enhancing tissue is evident surrounding the abscess cavity extending to the adjacent scalp, and also into the superolateral extraconal orbit. This enhancing tissue is contiguous with both the lateral and superior rectus muscles and extends nearly to the level of the orbital apex. There is a mild associated left globe proptosis. The left optic nerve does not appear to be immediately affected by any of these abnormalities.3.Intracranial, smooth dural thickening persists along the left frontal lobe. This is of uncertain etiology and could represent a reactive phenomenon, though there are findings on the diffusion weighted images to suggest perhaps a small amount of infectious material intracranially. The possibility of a meningitis or very small developing extra-axial collection cannot be excluded. Findings have not significantly changed from the prior exam.4.Extensive left-sided paranasal sinus inflammation/infection is redemonstrated.


Instruction: Generate impression based on findings.

Input: Diagnosis: Thoracic or lumbosacral neuritis or radiculitis, unspecifiedClinical question: assess for progression of lumbar stenosisSigns and Symptoms: claudication Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. The patient is status post laminectomies at L1, L2, L3, L4 and L5. There is mild left lateral translation of L3 on L4. There is redemonstration of a 22 x 17 mm T1 hyperintense well-circumscribed lesion within the T12 vertebral body along its right posterior aspect. The signal intensity suppresses on the fat suppressed images. Most likely this represents a vertebral body hemangioma and remains stable.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level. There is some mild enhancement adjacent to the nerve root at the left lateral recess at this level. This is stable compared to the prior exam.At L4-5 there is no significant compromise to spinal canal. There is loss of disc space height present at this level associated with Schmorl's node and a disc bulge as well as some chronic endplate reactive changes. The exiting nerve roots within the right neural foramen are surrounded by fat whereas the fat surrounding exiting nerve roots within the left neural foramen is effaced. There is facet hypertrophy present on the left side at this level and some ligamentum flavum hypertrophy bilaterally. This is stable compared to the prior exam.At L3-4 there is no significant compromise to spinal canal. There is loss of disc space height, disc desiccation and a mild disc bulge associated with endplate reactive changes at this level. The fat surrounding the exiting nerve roots within the neural foramina bilaterally isn't effaced. There is left lateral translation of L3 on L4. This is stable compared to the prior exam.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and disc bulge at this level associated with some endplate osteophytes and some mild narrowing of the neural foramina. There is a right far lateral disc protrusion present this level which displaces the right-sided exiting nerve root after it exits the neural foramen. This is stable compared to the prior exam.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation, endplate reactive changes and a disc bulge at this level.There are disc bulges also present at T12-L1, T11-T12 and T10-T11 which are also stable.

Output: 1.The patient is status post multilevel laminectomies in the lumbar spine since the 2006 exam. There is neural foramina encroachment of the exiting nerve roots due to degenerative changes present on the left side at L4-5 and bilaterally at L3-4. This neural foramina encroachment is stable.


Instruction: Generate impression based on findings.

Input: Pain. Evaluate for internal derangement. Due to the patient's body habitus an alternative coil was used resulting in suboptimal image quality.MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is an approximately 1 cm focus of increased signal intensity of the articular cartilage of the lateral facet of the patella suggesting full-thickness degeneration. The remainder of the articular cartilage is normal and we see no discrete fluid filled defect.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: There is flattening of the superior aspect of the trochlea indicating dysplasia. The TT-TG distance and Insall-Salvati ratio are within normal limits. ADDITIONAL

Output: Femoral trochlear dysplasia and mild degeneration of the articular cartilage of the patella.


Instruction: Generate impression based on findings.

Input: Right optic nerve sheath atypical meningioma f/u exam, status post radiation therapy and three debulking surgeries. Orbits: Postoperative findings related to right optic nerve sheath meningioma subtotal resection are redemonstrated. What appears to be residual tumor in the posteronasal aspect of the right orbit, measuring up to 15 mm in the craniocaudal dimension and 14 x 14 mm in the axial dimension, is best seen on the coronal STIR sequence (series 1101, images 21 and 22). Artifact from hardware around the right orbit significantly limits evaluation. There is otherwise soft tissue deficiency in the right orbit with associated enophthalmos with diffuse enhancement of the intraorbital structures, which may represent post-treatment inflammation and/or scar tissue. The right optic nerve is deformed with diffusely increased T2 signal as before. The right globe is intact. The left orbital structures are normal. Brain: Remaining of the brain parenchyma is within normal limits. There are a few scattered nonspecific cerebral white matter T2 hyperintense foci. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact.

Output: No significant interval change in findings related to right optic nerve sheath meningioma subtotal resection with what appears to be residual tumor that measures up to 15 mm in the posteronasal aspect of the right orbit and enophthalmos.


Instruction: Generate impression based on findings.

Input: Female, 61 years old. Anterior and Posterior facet stress fractures left calcaneous with split tear of peroneus brevis, s/p 4 weeks NWB in cast The previously seen stress fractures within the anterior process and posterior to the posterior facet of the calcaneus are less conspicuous compared to the prior study, with markedly decreased surrounding bone marrow edema, compatible with healing.No new fractures or osteochondral defects are identified. Degenerative marrow changes and subchondral cyst formation within the navicular and medial cuneiform appear similar to the prior study. There is a small amount of fluid within the subtalar joint.The flexor and extensor tendons appear intact. There is a persistent split tear of the peroneus brevis tendon, appearing similar to the prior study. Minimal intermediate signal within the distal fibers of the Achilles tendon, suggesting mild tendinosis or interstitial tearing, is unchanged. The imaged ligaments of the ankle appear intact.

Output: 1.Healing stress fractures of the calcaneus as above. No new fractures identified.2.Split tear of the peroneus brevis, similar to prior.


Instruction: Generate impression based on findings.

Input: 8-year-old male status post DNET tumor resection. Redemonstrated are changes from recent right pterional craniotomy consistent with resection of the right anterior temporal lobe lesion. Fluid with air and minimal blood products are present intracranially without hematoma. There is residual T2 hyperintense parenchyma along the posteromedial aspect of the resection cavity. Linear T2 hyperintensity with some susceptibility is present along the previous location of 2 depth electrodes. Overlying smooth dural enhancement is felt to be postprocedural. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. Again noted is minimal fluid signal within the bilateral mastoid air cells.

Output: 1.There is residual T2 hyperintense parenchyma along the posteromedial aspect of the left temporal lobe resection cavity. 2.Linear T2 hyperintensity with some susceptibility is present along the previous location of 2 depth electrodes. 3.Overlying smooth dural enhancement is felt to be postprocedural.


Instruction: Generate impression based on findings.

Input: 44-year-old female patient with left knee pain. MENISCI: There is attenuation of the body and posterior horn of the medial meniscus with increased signal intensity. There is also branching increased signal intensity extending to both the tibial and femoral articular surfaces, indicative of extensive complex tearing. There is abnormal signal intensity adjacent to the complex tear and underlying the medial collateral ligament that likely represents synovitis. Slight medial extrusion of the body of the medial meniscus is noted. The anterior horn of the medial meniscus is relatively intact. There is no lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: There is severe osteoarthritis at the patellofemoral joint with much of the lateral patellar facet devoid of articular cartilage and prominent subchondral cysts in the patella with associated edema-like signal. There is also full-thickness degeneration of the cartilage of the lateral facet of the femoral trochlea. There is slight lateral subluxation of the patella relative to the center of the trochlea. Flattening of the trochlear groove is suggestive of underlying trochlear dysplasia.In the medial compartment there is near full-thickness chondral loss along the femoral condyle just anterior to the posterior horn of the medial meniscus. There is heterogeneity of the articular cartilage of the tibial plateau, suggesting mild degeneration with subchondral cyst formation along the periphery of the tibial plateau.In the lateral compartment there is mild heterogeneity of the articular cartilage of the femoral condyle and tibial plateau, suggesting mild degeneration.There are tricompartmental osteophytes.LIGAMENTS: There is medial bowing of the medial collateral ligament related to underlying degenerative changes and is otherwise intact. Anterior cruciate ligament, posterior cruciate ligament, and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: 1.Severe osteoarthritis, particularly affecting the patellofemoral joint, with findings suggesting underlying femoral trochlear dysplasia and elevated tibial tubercle-trochlear groove distance.2.Extensive tearing of the medial meniscus.


Instruction: Generate impression based on findings.

Input: FLAIR/T2 hyperintensity with susceptibility abnormality is consistent with the previously demonstrated bifrontal hemorrhagic contusions. Additionally, there is a much smaller focus of FLAIR/T2hyperintensity with susceptibility abnormality involving the lateral right temporal lobe, as well as subtle FLAIR/T2hyperintensity involving the anterior temporal lobes without susceptibility abnormality, also consistent with contusions. These latter lesions are not w readily apparent with previous CT technique.Expected evolution is noted involving small foci of subdural hemorrhage overlying the right frontal lobe as well as the left parietal lobe, with the latter propagating along the left tentorium. These do not have significant associated mass effect.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no midline shift. There is no evidence for acute cerebral, brainstem or cerebellar infarction. Flow voids are present within the major vessels indicating patency. Fluid is again noted within left mastoid air cells. Scalp swelling is again evident over left and right calvarium posteriorly. Previously identified calvarial changes are not appreciated with MRI technique.Sagittal T1 fat saturation technique demonstrates a normal-appearing posterior pituitary lobe. The pituitary stalk appears intact without transection. The pituitary gland proper is normal in height.

Output: 1.FLAIR/T2 hyperintensity with susceptibility abnormality is consistent with the previously demonstrated bifrontal hemorrhagic contusions. Additionally, there is a much smaller focus of FLAIR/T2hyperintensity with susceptibility abnormality involving the lateral right temporal lobe, as well as subtle FLAIR/T2hyperintensity involving the anterior temporal lobes without susceptibility abnormality, also consistent with contusions. 2.Expected evolution is noted involving small foci of subdural hemorrhage overlying the right frontal lobe as well as the left parietal lobe, with the latter propagating along the left tentorium. These do not have significant associated mass effect.3.Fluid is again noted within left mastoid air cells.4.Sagittal T1 fat saturation technique demonstrates a normal-appearing posterior pituitary lobe. The pituitary stalk appears intact without transection.


Instruction: Generate impression based on findings.

Input: Recent reexploration of lumbar laminectomy for untethering of spinal cord and history of tethered cord previously released in 2011. There is partial sacralization of the L5 vertebra. There are postoperative findings related to reexploration of lumbar laminectomy for untethering of spinal cord, with fluid in the posterior paraspinal soft tissues along the incision plane. There is no significant interval change in the lipomatous lesion associated with the conus terminalis, which displays a blunted morphology and is situated at the L2 level. There is mild diffuse enhancement along the conus medullaris and portions of the cauda equina nerve roots. Patchy low T1 and T2 signal posterior to the conus likely represents CSF flow artifact versus less likely hemorrhage. There is no appreciable translation of the conus medullaris with prone imaging. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: Recent postoperative findings related to reexploration of lumbar laminectomy for untethering of spinal cord without appreciable translation of the abnormal conus with associated lipomatous malformation. The presence of mild diffuse enhancement along the conus medullaris and portions of the cauda equina nerve roots is likely within the expected limits of recent surgical effects, although superimposed infection cannot be entirely excluded on the basis of imaging alone.


Instruction: Generate impression based on findings.

Input: Evaluate tumor size and ventricular size: optic glioma with hyponatremia. There has been interval increase in size of the lobular mass centered in the suprasellar cistern, now measuring 6.6 x 5.1 cm, previously 5.1 x 3.8 cm. There is also new susceptibility abnormality in the center of the lesion suggestive of hemorrhage. There is increased mass effect on the adjacent bifrontal and bitemporal lobes, as well as left cerebral peduncles, brainstem, and pituitary stalk. The mass encases and displaces portions of the bilateral internal carotid, middle cerebral, and anterior cerebral arteries. There is new encephalomalacia in the anterolateral right frontal lobe, which may be related to right frontal craniotomy for tumor biopsy. There is no evidence of acute infarction. There is bilateral tympanomastoid fluid.

Output: Interval increase in size of the bulky suprasellar region low-grade astrocytoma with areas of intratumor hemorrhage. In addition, the lateral ventricles are now slightly dilatated due to mass effect upon the third ventricle.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of inflammatory bowel disease on treatment presents with disease flare and rectal pain. Evaluate for perianal disease. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple prominent mesorectal lymph nodes are likely reactive given the colonic inflammation.BOWEL, MESENTERY: The visualized rectosigmoid and rectum is featureless and has diffuse mild circumferential wall thickening and mucosal hyperenhancement compatible with acute inflammation. Intrinsic T1-weighted submucosal signal also reflects submucosal fat deposition related to chronic inflammation as well. The inflammation is most severe near the anterior anorectal region where there is a fistulous tract originating from approximately the 11:00 position of the anus (series 501/29). The tract extends inferiorly within the right intersphincteric space and communicates with a right ischioanal fossa fluid collection measuring 1.9 x 1.3 x 2.4 cm. Extensive adjacent subcutaneous inflammation and skin thickening. The inflammation extends superiorly superficial to the external sphincter without a discrete fluid-filled tract.Small volume of right lower quadrant ascites. Possible inflammation of additional bowel loops which are partially imaged.BONES, SOFT TISSUES: Diffuse low T1 weighted signal intensity of the bone marrow likely reflects anemia.OTHER: No significant abnormality noted.

Output: 1.Intersphincteric fistula with an abscess in the right ischioanal fossa near the right gluteal cleft measuring up to 2.4 cm.2.Severe active inflammation of the visualized rectosigmoid colon.


Instruction: Generate impression based on findings.

Input: 37 year old female with a personal history of left breast IDC and DCIS status post lumpectomy in 2007 followed by radiation, chemotherapy, and hormonal therapy. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Expected volume loss and lower inner quadrant post surgical architectural distortion are present in the left breast. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.A small area of enhancement on the skin of the right at 12 o'clock position is present. Clinical correlation is recommended.

Output: 1. No MRI evidence for malignancy in either breast. 2. A small area of enhancement on the skin of the right at 12 o'clock position. Clinical correlation is recommended. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 72 years, Female, Reason: eval liver lesion in R dome History: cirrhosis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cirrhotic liver morphology. There is a lesion in segment 8 which is ill-defined with a large necrotic component as well as a minimally enhancing component with multifocal areas of diffusion restriction. No fat is associated with this lesion. There is complete thrombosis of the portal vein which enhances in portions, likely representing tumor thrombus. The SMV and splenic veins are patent.Common bile duct is dilated to 15 mm and there is abrupt transition at the ampulla. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: The distal pancreatic duct is normal in caliber. There are multiple cysts within the pancreatic tail which appear to communicate with the main pancreatic duct which is dilated at portions, compatible with a main duct IPMN.ADRENAL GLANDS: Left adrenal nodule measuring 1.7 x 2.0 cm (601/18).KIDNEYS, URETERS: Multiple bilateral simple renal cysts, some of which are too small to characterize.RETROPERITONEUM, LYMPH NODES: Large necrotic portacaval lymph node measuring 2.4 x 2.4 cm (601/23). Additional large aortocaval lymph node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of perihepatic ascites. There is a dilated vessel in the right mid abdomen as well as multiple peri-splenic collaterals.

Output: 1.Large necrotic mass the pancreatic dome is suspicious for diffuse hepatocellular carcinoma.2.Tumor thrombus within the portal vein.3.Necrotic retroperitoneal lymph nodes suspicious for metastases.4.Left adrenal nodule is indeterminate but suspicious for metastases given other findings.


Instruction: Generate impression based on findings.

Input: 60-year-old male patient with history of head trauma and loss of consciousness. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: VP shunt, evaluate ventricles: yearly follow up. Paralytic strabismus, sixth or abducens nerve palsy. There is no appreciable change in the size of mildly dilated supratentorial ventricular system with a right transparietal ventricular catheter in position, which projects into the right anterior corpus callosum. There is partial absence of the septum pellucidum. There is also persistent dilatation of the fourth ventricle with a catheter in position that indents the posterior aspect of the right pons. There is unchanged T2 hyperintensity along the catheter tracts, periventricular white matter, and right cerebellar hemisphere. There is no evidence of intracranial hemorrhage, mass, or acute infarct, although reservoir artifact obscures the right posterior brain. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No appreciable change in the size of mildly dilated supratentorial ventricular system with a right transparietal ventricular catheter in position.2. Persistent dilatation of the fourth ventricle with a catheter in position that indents the posterior aspect of the right pons. 3. Areas of gliosis and/or encephalomalacia along the catheter tracts, periventricular white matter, and right cerebellar hemisphere.4. No evidence of acute intracranial hemorrhage, mass, or acute infarct, although reservoir artifact obscures the right posterior brain.


Instruction: Generate impression based on findings.

Input: Reason: Patient with posterior knee pain and swelling. Unstable knee. Please evaluate for meniscal tear, ligament tear. History: Posterior right knee pain. MENISCI: There is increased signal in the posterior horn of the medial meniscus, likely representing degeneration, which may extend to the tibial articular surface.ARTICULAR CARTILAGE AND BONE: There is marked loss of cartilage in the lateral facet of the patella with underlying cyst formation consistent with severe degenerative changes in the patellofemoral compartment.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Increased signal in the posterior horn of the medial meniscus likely representing degeneration; it is equivocal whether this extends to the tibial articular surface. 2.Severe degenerative changes affect the patellofemoral compartment.


Instruction: Generate impression based on findings.

Input: 14-year-old male, evaluate for piriformis syndrome or hypertrophy of the piriformis muscle The piriformis muscles are symmetric in size with normal signal intensity. The sciatic nerves coursing anterior to the muscles appear normal.Note is made of a cystic structure to the right of the midline in the prostate, which may represent a prostatic utricle or Mullerian duct cyst. The BMI is elevated.

Output: Normal symmetric appearing piriformis muscles without evidence of piriformis syndrome.


Instruction: Generate impression based on findings.

Input: Two days of right shoulder/neck and upper arm pain with uncontrollable spasm of first and second digits. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Small nodules are noted involving the bilateral thyroid lobes.

Output: 1. MRI of the cervical spine is essentially within normal limits. No spinal canal or neural foraminal stenosis at any level. No cord signal abnormality.2. Multiple small bilateral thyroid nodules.


Instruction: Generate impression based on findings.

Input: 52-year-old female with right knee popping/pain for one and a half years with standing. Evaluate right knee for lateral meniscus tear. MENISCI: There is blunting of the free edge of the body of the lateral meniscus corresponding to a small radial tear. There is also increased signal intensity within the peripheral half of the anterior horn of the lateral meniscus indicating intrasubstance degeneration and degenerative tearing with several small adjacent parameniscal cysts. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage along the medial facet of the patella indicating moderate degeneration with what appears to be delamination. There is a small cleft of low signal intensity within the articular cartilage of the femoral trochlea, centrally, which likely represents a non fluid filled defect. There is also a focus of low signal intensity within the articular cartilage of the medial facet of the femoral trochlea, more inferiorly, that likely represents an additional focus of degeneration with underlying subchondral cysts. There is heterogeneity of the articular cartilage of the lateral tibial plateau with foci of increased signal intensity suggesting full-thickness cartilage degeneration. There is a focus of low signal intensity along the posterior cortex of the distal femoral metaphysis medially, that may reflect a former cortical desmoid of doubtful clinical significance.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Small radial tear of the body of the lateral meniscus along with degeneration and degenerative tearing of the anterior horn of the lateral meniscus with tiny adjacent parameniscal cysts.2. Cartilage degeneration as described above.