Instruction: Generate impression based on findings.

Input: Reason: eval cuff, glenohumeral joint History: pain Exam is limited by motion artifact.ROTATOR CUFF: Moderate tendinosis of the supraspinatus tendon with full-thickness tear at the insertion. There is small amount of fluid in the subacromial bursa. There is moderate tendinosis of the infraspinatus muscle. There is severe tendinosis of the subscapularis tendon with some intact fibers.SUPRASPINATUS OUTLET: Note is made of an os acromiale, a normal variant, with associated edema and degenerative change.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is anatomic. There is serpiginous signal abnormality in the head of the humerus, compatible avascular necrosis. There are multiple degenerative cyst in the glenoid. The labrum appears degenerative. There is moderate joint effusion with debris suggestive of synovitis. There are bone marrow changes likely due to anemia secondary to renal failure. BICEPS TENDON: Long head of the biceps is not well seen intra-articularly. ADDITIONAL

Output: 1. Avascular necrosis of the humeral head.2. Full-thickness tear of the supraspinatus tendon at the insertion.3. Moderate glenohumeral joint effusion with debris suggestive of synovitis.4. Mild osteoarthritis with degenerative labrum.5. Poorly visualized intra-articular long head of the biceps tendon.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with heaviness in the legs, difficult walking, right more than left lower extremity numbness. Also complains of bilateral hand tingling. Cervical:Alignment is anatomic. Vertebral body height and morphology are within normal limits. Questionable mild edema is evident within the left C6 superior facet likely related to facet arthropathy. Otherwise no concerning marrow replacement or marrow edema is observed.The visualized cord demonstrates normal signal intensity and morphology throughout. No focal lesions are observed. No epidural abnormalities are suspected.C2-3: Facet arthropathy. No spinal canal stenosis or neuroforaminal narrowing. C3-4: Facet hypertrophy. No spinal canal stenosis. Moderate left and mild right foraminal narrowing. C4-5: Facet arthropathy. No spinal canal stenosis. Mild bilateral foraminal narrowing. C5-6: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Moderate left and mild right foraminal narrowing. C6-7: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. Mild bilateral foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Thoracic:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No focal lesions are seen. No epidural abnormalities are suspected.The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is seen.

Output: 1.Multilevel degenerative findings are seen in the cervical spine, more so affecting the facet joints than the intervertebral discs.2.Scattered variable foraminal narrowing is seen in the cervical region. No high-grade spinal canal stenosis is demonstrated.3.Evaluation of the thoracic spine is within normal limits.


Instruction: Generate impression based on findings.

Input: 39 year old male with a history of congenital VSD s/p repair in childhood, repaired residual LV to RA shunt, s/p TV repair in 2014, and SVT/atrial flutter ablation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 114 ml/m2 (normal range: 74+/-15), the LVEDV is 222 ml (normal range 142+/-34), the LV end systolic volume index is 62 ml/m2 (normal range 25+/-9), the LVESV is 121 ml (normal range 47+/-19), the LV mass index is 29 g/m2 (normal range 85+/-15), and the LV mass is 57 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is thinning with very small area of transmural LGE in the apical antero-lateral wall. This was seen on the last two MRIs (2011 and 2014) and is of unclear significance. It may represent presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of VSD. Site of VSD repair seen. Native T1 myocardial time = 1050 ms.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated and moderately reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 139 ml/m2 (normal range 82+/-16), the RVEDV is 222 ml (normal range 142+/-31), the RV end systolic volume index is 62 ml/m2 (normal range 31+/-9), and the RVESV is 121 ml (normal range 54+/-17). Some turbulence noted at the infundibulum on cine images of the RVOT. When compared with previous MRI (2014) the turbulence dose not appear as significant. MRA with main PA measurements not performed on this study. Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve is consistent with repair. There is an annuloplasty ring present. There is at least mild-moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size (35.7 mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (25.6 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with mildly reduced systolic function. (LVEF 46%).2. The right ventricle is moderately dilated with moderately reduced systolic function (RVEF 40%). The RV volume is smaller on this study when compared with the study performed in 2014.3. The tricuspid valve is consistent with repair. There is an annuloplasty ring present. There is at least mild-moderate tricuspid regurgitation. Suggest correlation with echocardiogram.4. There is a small area of transmural late gadolinium enhancement in the apical segment of unclear significance but may represent presence of an underlying fibrosing, infiltrative, or inflammatory process.5. No residual VSD. 6. Mildly dilated RA. This is a significant improvement from previous study which showed a significantly dilated RA.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 53 years old Reason: Please follow protocol IRB # 14-0288. Rectal cancer, please assess disease state post Chemo/RT, RECIST compare to previous MRI. History: as above Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: Rectal tumor abutment and mild invasion into the prostate gland has decreased.BLADDER: No significant abnormality noted.LYMPH NODES: Previously seen small, rounded lymph nodes within the mesorectal fascia have decreased in size. Reference largest lymph node measures 4 x 4 mm, previously 5 x 4 mm (series 1101/55). Mildly enlarged bilateral pelvic sidewall lymph nodes have also decreased in size. Reference right pelvic sidewall lymph node measures 10 x 6 mm, previously 10 x 9 mm (series 1101/67).BOWEL, MESENTERY: Lower third rectal tumor has decreased in size with no accurately measurable tumor on the current exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small left scrotal hydrocele.

Output: 1. Lower third rectal tumor with mild invasion into the prostate gland has decreased. 2. Prominent to mildly enlarged pelvic lymph nodes have decreased in size.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a left posterior parafalcine extra-axial enhancing mass situated along the left posterior frontal and parietal lobes. As before, there is evidence of invasion into the adjacent superior sagittal sinus, and the overlying calvarium. The lesion now appears more heterogeneous in enhancement, however this may be secondary to acquisition only with Stealth technique. Given this heterogeneous pattern, measurement is difficult, although it appears slightly larger. Associated vasogenic edema and mass effect have increased when compared to the prior MR, however essentially unchanged compared to the more recent CT. There are no other abnormal enhancing foci. Expected vascular flow voids are demonstrated.

Output: Redemonstrated is a left posterior parafalcine extra-axial enhancing mass situated along the left posterior frontal and parietal lobes.


Instruction: Generate impression based on findings.

Input: 28-year-old male with pain. Evaluate for scapholunate ligament tear. LIGAMENTS: There is disruption of the lunotriquetral ligament. The scapholunate angle appears increased with a slight dorsal tilt of the lunate bone. The scapholunate ligament appears intact. TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage appears intact. No intra articular contrast is identified within the distal radioulnar joint. TENDONS: The flexor and extensor tendons appear intact. BONES: There is increased bone marrow signal abnormality within the lunate and capitate bones which may represent contusions. There is no convincing negative or positive ulnar variance. ADDITIONAL

Output: Disruption of the lunotriquetral ligament and slight dorsal tilt of the lunate bone as described above.


Instruction: Generate impression based on findings.

Input: Epilepsy. Weekly convulsive seizures. There is severe artifact related to braces obscuring especially the inferior frontal lobes and anterior part of the temporal lobes. It also renders the diffusion weighted and gradient echo/susceptibility weighted sequences nondiagnostic.Accounting for the artifact, there is no signal abnormality in the brain to suggest seizure focus. There is no mass or mass effect. The CSF-containing spaces, accounting for lateral ventricular asymmetry, are normal in size. There are no findings to suggest cortical malformation or gray matter heterotopia. There is also no signal or morphologic abnormality in the hippocampi to suggest mesial temporal sclerosis. Following contrast injection, there is no abnormal parenchymal or leptomeningeal enhancement.

Output: Examination is significantly limited by artifact related to dental braces. No findings to suggest seizure focus are appreciated. No evidence of mesial temporal sclerosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 38 year old female with a known right breast IDC grade 3 with a metastatic right axillary lymph node presents for breast MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST and AXILLA:A known IDC is demonstrated as an irregularly shaped mass, measuring 50 x 39 x 42 mm (AP x LR x CC), at posterior 10:00 position. A marker clip is identified at lateral superior aspect within this mass. There are multiple satellites extending anteriorly from the index mass. Overall size of these lesions is 87 x 59 x 46 mm.Separately from the main cancer, there is an additional, suspicious non-mass enhancement at 8:00 position, measuring 40 x 11 x 15 mm.In the right axilla, a proven metastatic lymph node, measuring 11 mm, is present with a marker clip at superior aspect. There is another abnormally enlarged lymph node, measuring 14 mm, located interior-anterior from the proven lymph node.LEFT BREAST and AXILLA:No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in left axillary region.

Output: 1. Biopsy proven cancer at right posterior 10:00 position with anterior satellites.2. Suspicious non-mass enhancement in the right breast at 8:00 position. MRI-guided biopsy can be performed, if clinically indicated.3. No abnormal enhancement in left breast. No abnormal lymph nodes in left axillary region. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male; 37 years old. Reason: evaluate prostate for potential tumor to target on biopsy History: Elevated PSA history, negative prostate biopsy PELVIS:PROSTATE:Prostate Size: 3 x 4.7 x 4.6 cm.Peripheral Zone: No evidence of prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: Mild hemorrhage in the left inferior seminal vesicle.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of prostate cancer.


Instruction: Generate impression based on findings.

Input: 59-year-old female with right mastectomy for IDC in 2011, status post reconstruction and left breast reduction. History of benign left breast biopsy in 2014. Status post right mastectomy with autologous reconstruction.There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or right reconstructed breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Anesthesia of skinClinical question: stroke? TIA?Signs and Symptoms: r arm weakness MRI of the brainThere are several punctate foci of diffusion restriction present in the cortex of the right parietal lobe at the medial aspect of the right post-central gyrus, the right middle frontal gyrus, right posterior temporal lobe and the medial right parietal lobe.There is a punctate focus of susceptibility at the right middle frontal gyrus.There is a focus of T2 and FLAIR associated with volume loss located at the right cerebellar peduncle.The CSF spaces are appropriate for the patient's stated age with no midline shift. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacification of the right mastoid air cells. 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 fetal origin of the left posterior cerebral artery present. The right posterior communicating artery is medium-sized. The right P1 segment is similar in diameter to the right posterior communicating artery. The left P1 segment is hypoplastic.The anterior communicating artery is identified and is medium size. The left A1 segment is asymmetrically small. The vertebral arteries are asymmetric. The left vertebral artery is larger than the right vertebral artery.There is approximately 40% narrowing at the origin of the right middle cerebral artery and tandem 40% stenosis along the proximal portion of the superior division of the right middle cerebral artery..MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. There is mild narrowing at the origin of the left subclavian artery. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is irregular plaque present along the right carotid bifurcation associated with mild narrowing of the proximal right internal carotid artery. There is approximately 40% narrowing at the origin of the right internal carotid artery. There is approximately 30% narrowing at the origin of the left internal carotid artery. The vertebral arteries are irregular bilaterally with tortuous origins bilaterally. There appears to be a stenosis at the origin of the right vertebral artery and the right vertebral artery is irregular in diameter throughout its course

Output: 1.There are multiple foci of acute/subacute microinfarction along the right hemisphere. These include the right post central gyrus, right medial parietal lobe, right posterior temporal lobe and right middle frontal gyrus.2.There is a small focus of encephalomalacia along the right cerebellar hemisphere.3.There is a microhemorrhage along the right middle frontal gyrus. In isolation this is of little clinical significance.4.There is irregular plaque present at the origin of the right internal carotid artery. There is no significant stenosis at the origins of the internal carotid arteries on the basis of NASCET criteria.5.The right vertebral artery appears to be stenotic proximally and has multiple foci of irregular stenosis throughout its course in the neck..6.There is approximately 40% narrowing at the origin of the right middle cerebral artery and tandem 40% stenosis along the proximal portion of the superior division of the right middle cerebral artery.


Instruction: Generate impression based on findings.

Input: Cognitive decline and prior MRI with abnormal left hippocampal signal: memory loss. Redemonstrated are diffuse areas of high T2 signal in the left amygdala and hippocampus without appreciable mass effect. There is also a subcentimeter ovoid T2 hyperintense focus in the left temporal stem, which may represent a prominent perivascular space. The right hippocampus appears to be intact. Multiple scattered foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are retention cysts in the maxillary sinuses.

Output: Persistent signal abnormality in the left amygdala and hippocampus is incompletely characterized without intravenous contrast administration. Nevertheless, differential considerations include prior ischemia, dyplasia, or infection, for example.


Instruction: Generate impression based on findings.

Input: Left side weakness. There is diffuse high T2 signal swelling in the left inferior cerebellar hemisphere and left posterior medulla with numerous punctate areas of susceptibility effect. There is partial effacement of the inferior fourth ventricle, but no evidence of obstructive hydrocephalus. There are unchanged scattered areas of cerebral and pontine white matter T2 hyperintensity and a small area of encephalomalacia in the superior right frontal gyrus. There is no evidence of new infarcts. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is right osteomeatal unit complex pattern of secretions and mucosal disease, as well as secretions and mucosal thickening in the left sphenoid and left maxillary sinuses. There are bilateral mastoid air cell effusions.

Output: 1. Subacute left PICA territory infarct with associated petechial hemorrhage.2. Unchanged probable chronic small vessel ischemic disease involving the brain parenchyma and a small chronic right frontal lobe infarct.3. Scattered paranasal sinus inflammatory disease.


Instruction: Generate impression based on findings.

Input: Neoplasm of uncertain behavior of brain, unspecified [D43.2], Reason for Study: ^Reason: preop planning for craniotomy for tumor History: n/a- preop planning Multiple fiducial markers were attached on scalp.Re-demonstration of irregularly enhancing posterior fossa mixed solid and cystic mass which compresses 4th ventricle.The size, enhancing pattern and the degree of mass effects as well as the degree of ventriculomegaly do not show any significant interval change since prior scan.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Pre-operative MR imaging with fiducial markers were performed.No interval change in terms of posterior fossa mass size, MR characteristics, mass effects and the degree of ventriculomegaly since prior scan.


Instruction: Generate impression based on findings.

Input: Status post laser seizure focus ablation. There has been expected interval evolution of left medial temporal lobe laser ablation effects, where there is persistent T2 hyperintensity and linear enhancement. There is no evidence of territorial infarction. The ventricles are unchanged in size and configuration. There is no midline shift. There are small left maxillary and sphenoid sinus retention cyst and mild mucosal thickening in the right maxillary sinus.

Output: Expected interval evolution of left medial temporal lobe laser ablation effects.


Instruction: Generate impression based on findings.

Input: Reason: eval for ASA syndrome, spinal ischemia, cord impingement History: loss of bowel/bladder function and sensation to BLE, concern for ASA syndrome due to aortic occlusion / PVD No cord compression or evidence of high grade spinal canal stenosis in the cervical, thoracic or lumbar spine is identified.The vertebral bodies are appropriate in the overall alignment and height. The spinal cord appears grossly unremarkable.

Output: 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 or evidence of high grade spinal canal stenosis in the cervical, thoracic or lumbar spine is identified.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.Findings were discussed with Laura Gardener at 10 am on 3/20/2015 and complete spine MRI is pending.


Instruction: Generate impression based on findings.

Input: Large left flank/sacral mass in girl with NF1. There is a partly imaged large mass in the left paraspinal region with a bag of worms appearance, which extends from the L1 level to the sacrococcygeal region. The tumor protrudes into the left L1-2 through S2-3 neural foramina, but does not enter the spinal canal. There is also an infiltrative mass with partial bag of worms appearance in the posterior lower back subcutaneous tissues that measures up to approximately 11.5 cm. There is scalloping of multiple lumbar and sacral vertebral bodies with widening of the spinal canal. There is exaggerated lumbar lordosis, but no spondylolisthesis. The imaged cauda equina nerve roots and spinal cord appear to be grossly unremarkable.

Output: 1. A partly imaged large mass in the left paraspinal region with a bag of worms appearance, which extends from the L1 level to the sacrococcygeal region likely represents a plexiform neurofibroma, although assessment is limited by the lack of contrast. The tumor protrudes into the left L1-2 through S2-3 neural foramina, but does not enter the spinal canal. Please refer to the separate pelvis MRI report for additional details.2. An infiltrative mass in the posterior lower back subcutaneous tissues that measures up to approximately 11.5 cm may represent a superficial neurofibroma combine with features of a plexiform neurofibroma.3. Multilevel posterior vertebral scalloping related to neurofibromatosis 1.


Instruction: Generate impression based on findings.

Input: Reason: F/u compare to previous. given R frontal GBM, evaluate for progressive dz given gait difficulty and encephalopathy History: please see above The patient is status post right frontal lobe surgery involving right superior frontal gyrus some of the right middle frontal gyrus and some of the adjacent right cingulate gyrus. Cerebral blood volume map is not convincing for elevated cerebral blood volume.A previously noted right frontal horn of lateral ventricle nodule now measures 19 x 9 mm coronal dimensions and previously measured 13 x 7 mm coronal dimensions. It has some heterogeneous enhancement. There are serpiginous low signal foci on susceptibility imaging present within this lesion. Cerebral blood volume map is not convincing for elevated cerebral blood volume.There is a nonenhancing nodule present along the posterior and superior aspect of the right frontal lobe resection site measuring 27 x 19 mm and axial dimensions and previously measuring 27 x 19 mm axial dimensions. It is not associated with contrast enhancement but is associated with some susceptibility effect. Additional small nodules are redemonstrated at the borders of the resection site measuring up to 3 mm. These were not present in February.There is a focus of signal hyperintensity involving the medial aspect of the right frontal lobe and cingulate gyrus anterior to the frontal horn of the right lateral ventricle currently measuring 27 x 18 mm in axial dimensions and previously measuring similar dimensions. This is not associated with susceptibility effect. Cerebral blood volume map is not convincing for elevated cerebral blood volume.A right-sided cerebellar lesion adjacent to the fourth ventricle which deforms the fourth ventricle measures 9 x 13 mm axial dimensions and is unchanged when compared to the previous exam. This was not present on the exam from last February. Cerebral blood volume map is not convincing for elevated cerebral blood volume. This was not present in February.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.Incidental note is made of partial empty sella

Output: 1.Since the prior exam a subtle ependymal lesion in the right lateral ventricle has definitively enlarged. This suspicious for neoplastic process.2.A right subendymal lesion at the fourth ventricle and lesions at the surface of the tumor resection site remain stable when compared to the prior exam and were not present in February.3.A right anteromedial frontal lobe lesion is stable since February.


Instruction: Generate impression based on findings.

Input: 34-year-old female with increased breast cancer risk based on family history. Family history of breast cancer in maternal aunt, great aunt, grandmother and 2 cousins. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left upper inner quadrant, there is a faint focus of enhancement, unchanged from prior, with benign appearance. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary 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 ACDF C3-C4. Gunshot wound to lower back. Lower extremity pain. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Bone marrow signal is benign. There are postsurgical changes of ACDF at the C3-C4 level, hardware which can be better assessed with CT or radiographs.There is abnormal T2 signal within the cervical cord at the C3-C4 level consistent with myelomalacia and unchanged since 6/5/2013.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal. Mild neural foraminal narrowing bilaterally related to uncovertebral hypertrophy and mild facet arthropathy.C3-4: Abnormal signal involving the bilateral aspects of the cord with mild volume loss. There is mild spinal canal narrowing with partial effacement of the ventral and dorsal thecal sac. There is moderate to severe left and moderate right neural foraminal stenosis related to uncovertebral hypertrophy.C4-5: Mild disc bulge and bilateral uncovertebral hypertrophy. Mild narrowing of the spinal canal. There is moderate to severe right and mild-to-moderate left neural foraminal stenosis.C5-6: No significant compromise to the spinal canal. There is moderate right and mild to moderate left neural foraminal stenosis related to uncovertebral hypertrophy. C6-7: Left paracentral disc osteophyte complex with bilateral uncovertebral hypertrophy. There is mild narrowing of the left aspect of the spinal canal no significant spinal canal stenosis. There is moderate left greater than right neural foraminal stenosis.C7-T1: Small central disc protrusion without significant spinal canal stenosis. Mild left and minimal right neural foraminal narrowing.No abnormal enhancement. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures are unremarkable.THORACIC SPINE

Output: 1. Postsurgical changes of ACDF at C3-C4 with myelomalacia involving the cervical cord at the C3-C4 level presumably related to prior compressive myelopathy. No significant change since prior cervical spine MRI study from 6/5/2013. There is mild degree of spinal canal narrowing at C3-C4, C4-C5, and C6-C7. No high-grade spinal canal stenosis. Multilevel neural foraminal narrowing in the cervical spine as detailed above.2. Post surgical changes of laminectomy from T7 to T10. Spinal canal is well decompressed. Abnormal T2 signal is noted involving the dorsal thoracic cord at the T9-T10 level. No prior thoracic imaging is available for comparison, but finding is consistent with remote cord injury. Mild multilevel degenerative changes in the thoracic spine are seen including neural foraminal narrowing as detailed above.3. Postsurgical changes in the lumbar spine related to spinal canal decompression at the L3-L4 and L4-L5 levels. Spinal canal at these levels is well decompressed. There is mild narrowing of the lumbar spinal canal at the L2-L3 level which appears similar to prior from 4/10/2013. Multilevel relatively mild lumbar neural foraminal narrowing as detailed above.


Instruction: Generate impression based on findings.

Input: 16-year-old male with Chiari malformation and syrinx, annual evaluation for progression. Redemonstrated are postoperative findings related to Chiari surgery, stable in appearance. The cerebellar tonsils assume an unchanged configuration and morphology. Biphasic CSF flow is again noted at the level of the cerebellar tonsils, not significantly changed in appearance. A retroflexed odontoid tip somewhat narrows the adjacent subarachnoid space, however without cervicomedullary abutment or deformation, unchanged.There is no significant interval change in the size and extent of the syrinx that involves the cervical and thoracic spinal cord, as well as the conus medullaris. Maximal AP dimension at the C7/T1 level measures 3 mm, stable.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. The paravertebral soft tissues are unchanged.

Output: Postoperative findings related to Chiari decompression with unchanged syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: Altered mental status, concern for hypercoagulable state, hx of pericardial effusion s/p window and hypotension History: AMS Brain MRIThere are focal high signal intensity lesions on the left cerebellar hemisphere on 2 consecutive images (series 4, image 7 and 8). The inferior lesion shows restricted diffusion on ADC map but the superior one does not. The T2 images show slit like craniocaudal direction tissue defect on coronal scan. Therefore, this lesion is most likely T2 shine through artifact with subtle misregistration instead of acute ischemic infarction.  There is no evidence of acute hemorrhagic lesion on this scan.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. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Fluid collections on bilateral maxillary, ethmoid and frontal sinuses.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral P-comm arteries are patent and a common artery is patent.There is no evidence of intracranial arterial stenosis. There is no evidence of intracranial arterial aneurysm.Brain MRV3D Phase contrast MRV with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic leison.2. Normal brain MRA and MRV


Instruction: Generate impression based on findings.

Input: 31 year old with node positive triple negative left breast cancer. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.The known malignancy in the left upper outer breast at posterior depth is seen is an enhancing mass measuring 3.2 x 2.5 x 5.1 cm (AP x LM x CC). It is possible that in the CC dimension, an adjacent satellite lesion is present rather than a contiguous 5.1 cm mass. Additionally, located primarily anteriorly and inferiorly to the index malignancy are additional small masses and foci suspicious for satellite lesions. The largest of these measures about 1 cm. In total the inferior cluster of small masses and foci measures 3.3 x 2.9 x 2.7 cm. A 6 mm satellite mass is adjacent to the posterior/lateral aspect of the index lesion as well. Overall CC extent measures up to 8.8 cm, inclusive of the index cancer and satellite masses. The index mass abuts the pectoralis muscle posteriorly, though no definitive abnormal pectoralis enhancement is appreciated. The biopsy-proven metastatic lymph node with Hydromark biopsy clip artifact measures up to 2.2 cm. A subcentimeter lymph node inferior to the biopsied node is also somewhat suspicious based on it's lack of normal fatty hilum. No suspicious enhancement is seen in the right breast. A few enhancing foci of benign morphology and kinetics are noted. No suspicious right axillary lymph node. Right axillary nodes maintain normal fatty hila.

Output: Biopsy-proven malignancy in the left breast and axilla. Additional small masses and foci in the left breast are suspicious for satellite lesions, with total extent up to nearly 9 cm. MRI directed ultrasound with biopsy of a satellite mass could be performed to define extent of disease. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 84 year old female with mental status changes status post fall. Rule out subdural hematoma. There is no evidence of intracranial hemorrhage, mass or edema. Low-attenuation in the periventricular white matter is consistent with small vessel ischemic disease of indeterminant age. The ventricles and basal cisterns are normal in size and configuration.In the brainstem, there is a tortuous basilar artery partially obscuring the brainstem. This finding is unchanged. If there is a clinical suspicion of stroke, MRI may be considered.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of acute intracranial abnormality.2. Moderate small vessel ischemic disease of indeterminant age, unchanged.3. Unchanged tortuous basilar artery partially obscuring the brainstem. If there is a clinical suspicion of stroke, MRI may be considered.


Instruction: Generate impression based on findings.

Input: Pain, unilateral osteoarthritis MENISCI: The medial meniscus appears intact, however the lateral meniscus demonstrates diffuse globular signal within the body extending into the posterior horn with a complex defect largely horizontal linear defect extending to the inferior articular surface. An associated radial tear towards the posterior anchor is also suggested. Extensive fraying of the inner edge is also observedARTICULAR CARTILAGE AND BONE: Diffuse cartilaginous loss with thinning is observed in all 3 compartments with mild underlying edematous changes in the associated lateral femoral condyle and patella. Marrow signal is otherwise unremarkable underlying moderate osteoarthritic changes similar to the plain film.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex degenerative changes throughout the lateral meniscal body and posterior horn, as described2. Extensive cartilaginous loss with underlying moderate osteoarthritic changes 3. Large Baker's cyst


Instruction: Generate impression based on findings.

Input: Evaluate for progression of multiple sclerosis Numerous nonenhancing foci of T2 hyperintensity in the supratentorial, and to a lesser extent infratentorial, white matter are compatible with demyelinating disease and show no significant interval change in T2 signal characteristics. The majority of these foci have associated T1 hypointensity, also unchanged. CSF signal intensity foci in the basal ganglia are most consistent with prominent perivascular spaces. There is a prominent vessel coursing the right frontal lobe white matter perpendicular to the ventricles most consistent with a developmental venous anomaly. There is no abnormal enhancement within the brain. The ventricles and sulci are normal in size. Flow voids are present within the major vessels indicating patency. There is mucosal thickening of the right maxillary sinus.

Output: Grossly unchanged nonenhancing foci of white matter T2 hyperintensity compatible with demyelinating disease.


Instruction: Generate impression based on findings.

Input: 53 years, Male, increased pain in back of head, dizziness, diplopia. Evaluate Arnold-Chiari malformation.. Brain: Again seen is evidence of Chiari I malformation with ectopic cerebellar tonsils measuring up to 1 cm below the foramen magnum similar to prior. There is crowding with diminished CSF spaces ventrally and dorsally at the foramen magnum. Biphasic CSF flow is present but mildly diminished ventrally and severely diminished dorsally at the foramen magnum.Abnormal T1 hyperintensity involving the neurohypophysis previously described is not well assessed on the current study and can be better assessed on dedicated pituitary MRI if clinically indicated. Remainder of the brain parenchyma appears unremarkable for patient's age. No intracranial mass or mass effect. No evidence of infarct or hemorrhage. There is asymmetric size of the lateral ventricles which can be normal ventricle. No hydrocephalus. No extra-axial collections. Calvarium and extracranial soft tissues are unremarkable.Cervical Spine:No abnormal signal in the cervical cord or evidence of syrinx. Vertebral body heights in the cervical spine. There is mild retrolisthesis of C3 on C4 and C6 on C7. Bone marrow signal is benign. T1 hyperintense lesion involving the T1 bright device consistent with a hemangioma.C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and ligamentum flavum thickening with mild spinal canal stenosis. Minimal right neural foraminal stenosis. No significant left neural foraminal narrowing. C4-5: Minimal central disc protrusion. No significant spinal canal or neural foraminal stenosis.C5-6: Disc osteophyte complex and bilateral uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is moderate right and mild left neural foraminal stenosis.C6-7: Disc osteophyte complex and uncovertebral hypertrophy. There is moderate bilateral neural foraminal stenosis, slightly worse on the right. No significant spinal canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Findings of Chiari I malformation are similar to prior with tonsillar descent measuring up to 1 cm below the foramen magnum. There is associated diminished CSF spaces and CSF flow at the foramen magnum as described above.2. No evidence of cervical syrinx.3. Degenerative changes in the cervical spine, relatively worse at the C3-C4, C5-C6, and C6-C7 levels as above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine without aura, not intractable, without status migrainosusClinical question: Evaluate for etiology of increased frequency of migrainesSigns and Symptoms: as above with blurry vision The CSF spaces are appropriate for the patient's stated age with no midline shift. There several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for intracranial mass lesion. A few periventricular and subcortical punctate lesions are very commonly seen and likely of little clinical significance. They are nonspecific. They have been observed in association with migraines, however, they are nonspecific. They could also be vascular related or related to trauma but in general given their small number, they are likely of clinical significance


Instruction: Generate impression based on findings.

Input: Female, 18 years old, pregnant (16 weeks) with history of multiple sclerosis and continuing headaches, tremor, paresthesias. Left hemibody paresthesias and right hemibody weakness for two years. Left eye vision loss. Concern for demyelinating disease. Patchy hyperintensity seen within the pons on T2 weighted images is felt to be artifactual as it is not confirmed on the FLAIR or any other sequence.The cerebral and cerebellar hemispheres and brainstem are otherwise unremarkable. Diffusion-weighted images show are normal. No definite white matter lesions are seen.No intracranial hemorrhage, mass, edema or midline shift is noted. No abnormal extra-axial fluid collection is present. The ventricles and basal cisterns are patent and normal in size.

Output: No definite findings are seen which would account for the patient's symptoms. Patchy T2 hyperintensity within the pons is felt to be artifactual. If clinically warranted, however, repeat imaging with contrast can be considered after delivery.


Instruction: Generate impression based on findings.

Input: Male, 50 years old, with paresthesias and dysesthesias with new onset muscle cramps in the right leg, status post cervical fusion from C3 through C6 in 2009. Numerous scattered small foci of T2 hyperintensity are demonstrated within the periventricular and subcortical white matter. The overall size and number of these lesions do not appear to have changed significantly from the prior examination.No evidence of parenchymal edema or mass effect is detected. A focus of susceptibility is evident along the right caudate head which is unchanged and compatible with chronic blood products or mineralization.No abnormal extra axial fluid collections are detected. The ventricular system is patent and within normal limits including mild asymmetry at the level of the frontal horns.On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected.Bone marrow signal characteristics are within normal limits. Minimal mucosal thickening is evident within the ethmoid air cells. Artifact related to orthopedic instrumentation is partially visualized in the upper cervical spine.

Output: 1.Scattered small foci of T2 signal abnormality are redemonstrated in the subcortical and periventricular white matter. The size and number of these lesions have not significantly changed. They are nonspecific and could reflect the sequelae of prior inflammation, gliosis, demyelination or a vascular process.2.No new or acute intracranial abnormalities which would account for the patient's new symptoms.


Instruction: Generate impression based on findings.

Input: Knee pain and swelling, prior chondroplasty and microfracture of the patella MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is focal increased signal intensity extending through the articular cartilage of the lateral patellar facet that appears slightly less prominent on the current exam when compared to the prior. This may reflect further maturation of cartilage following chondroplasty/microfracture. The articular cartilage along the inferior portion of the medial facet and medial eminence appears thinned with surface irregularity representing degeneration. There is a small focus of signal abnormality within the underlying subchondral bone. Subjectively, the femoral trochlea appears shallow suggesting dysplasia. The articular cartilage of the medial and lateral compartments is preserved. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: The quadriceps and patellar tendons are normal. There is thickening of the lateral retinaculum at its patellar attachment that appears similar to prior exams. ADDITIONAL

Output: Signal abnormality of the lateral patellar facet appears less prominent than the prior examination suggesting some maturation of cartilage. There is thinning and surface irregularity of the medial patellar facet and patellar eminence suggesting some degeneration.


Instruction: Generate impression based on findings.

Input: 27-year-old male with history of squamous cell carcinoma of the right buccal mucosa with new right apical lung mass LUNGS AND PLEURA: Demonstration of a right apical pleural based heterogeneously enhancing mass (image 17 series 3) measuring 37 mm x 23 mm. Adjacent satellite irregularly marginated nodule (image 23, series 5) measures 9 mm x 8 mm.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy can be identified. Port-A-Cath with its tip in the SVCCHEST WALL: Soft tissue subcutaneous edema is identified within the visualized portions of the lower neck on the right.Right chest port.UPPER ABDOMEN: Hepatomegaly. Hypodense 24 mm x 23 mm mass in left kidney with CT numbers higher than expected for a simple cyst. Dedicated MRI or CT imaging of the kidneys is recommended.

Output: 1.Right apical pleural based mass with adjacent satellite nodule probably represents metastatic disease. However, location, is somewhat unusual for metastatic disease and raises the question of a second primary.2.Well-defined, hypodense lesion in the left kidney, with CT numbers higher than expected for simple cyst. Dedicated imaging of the kidney is recommended. 3.Hepatomegaly without evidence of an intrahepatic lesion.


Instruction: Generate impression based on findings.

Input: 71 years Female (DOB:8/9/1944)Reason: history of meningioma s/p surgery and RT. follow up imaging History: nonePROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA The patient is undergone left parietal craniotomy for removal of an extra-axial mass involving the superior sagittal sinus. The superior sagittal sinus is not present at the craniectomy site. There is redemonstration of a fluid collection at the craniectomy site.Since the prior exam the dural thickening at the posterior aspect of the falx has increased. On axial imaging and measures approximately 24 mm with x 35 mm AP dimension on sagittal imaging measures 35 mm x 25 mm it previously on axial imaging it measured 15 mm with and 24 mm AP dimension as well as 24 x 16 mm on sagittal imaging.Within the brain parenchyma adjacent to the craniotomy site there is signal change within the subcortical white matter in a contiguous fashion which has not changed substantially since the prior exam and has not changed since the preoperative exam.Incidental note is made of partial empty sella.There is mild anterior subluxation of C1 on C2.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.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacification of the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam an extra-axial dural based mass involving the falx cerebri has enlarged.2.There is mild anterior subluxation of C1 on C2 which appears unchanged since the prior exam


Instruction: Generate impression based on findings.

Input: Patient with stooped posture, memory decline. Concern for normal pressure hydrocephalus. No evidence of hemorrhage, edema, mass effect or midline shift is detected. Cortical sulci and ventricular system are proportionately enlarged and unchanged since prior MRI examination from 2007. Findings although may be at the upper limits of normal for age however they may represent underlying parenchymal volume loss. Calvarium is intact. Mastoid air cells and paranasal sinuses are unremarkable.

Output: No evidence of acute findings. Please see above comments.


Instruction: Generate impression based on findings.

Input: There is redemonstration of the expansile T2 hyperintense cystic appearance of the optic chiasm, without significant interval change. Asymmetric thickening extends from the chiasm anteriorly into the cisternal and intracanalicular segments of the left optic nerve. There continues to be asymmetric FLAIR hyperintensity within the left optic tract thinning posteriorly.There is again a stable 4 x 3 mm T2 hyperintense focus just lateral to the left hypothalamus (1201/5) with corresponding enhancement. Retrospectively, this lesion does appear present on the exam from 3/20/2014 on prior 1301/1 and 1501/1, although it now appears slightly more prominent compared to the more remote exam.Partially cystic and partially solid enhancing pineal lesion is unchanged compared to previous examination.The left mastoid air cells have essentially cleared, although there is now mild-moderate patchy fluid opacification of the inferior right mastoid air cells. There is mild mucosal thickening in the maxillary sinuses bilaterally.

Output: Continued stable appearance of left greater than right optic pathway glioma.Stable appearance of more recently recognized punctate enhancing lesion with T2 hyperintensity just lateral to the left hypothalamus, possibly more prominent than exam from March 2014 although only partially visualized at that time. Continued follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Female 48 years old with metastatic colon cancer to liver, asses left and right lobe involvement. ABDOMEN:LIVER, BILIARY TRACT: Multiple (see key images) T2 hyperintense, diffusion restricting hepatic metastatic lesions with peripheral enhancement are seen in both hepatic lobes. The largest metastasis is in segment 6 and measures 5.2 x 4.8 cm (series 501, image 19).The hepatic vessels are patent. The gallbladder is normally distended without cholelithiasis. There is no biliary ductal dilatation or ascites.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal and upper abdominal lymphadenopathy, submitted for reference metastatic left paraaortic lymph node measuring 1.6 x 1.6 cm (with suspected intralesional necrosis), image 126 series 803. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Multiple hepatic metastatic lesions as described above with the largest lesion in segment 6.2. Metastatic lymphadenopathy as above.


Instruction: Generate impression based on findings.

Input: 74-year-old male with severe dizziness with fall from standing. Evaluate for bleed. There is no evidence of intracranial hemorrhage, mass or edema. Recommend correlation with MRI if there is clinical concern for acute stroke.The ventricles and basal cisterns are normal in size and configuration.Multiple diffuse hypo-attenuating lesions in the deep white matter and basal ganglia, likely representing chronic lacunar infarcts. The calvaria and skull base are radiographically normal. Opacification of the right sphenoid sinus is noted. Otherwise, the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Chronic lacunar infarcts without evidence of acute intracranial abnormality. Recommend correlation with MRI if clinical concern for acute stroke persists.


Instruction: Generate impression based on findings.

Input: Clinical question: Low back pain L5. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI: There is normal anatomical alignment of vertebral column.The signal intensity of the vertebral column demonstrate changes related to degenerative disease and unremarkable otherwise.T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate no appreciable disc disease however moderate bilateral ligamentum flavum hypertrophy and mild (left greater than right) facet hypertrophic changes are present. Findings results in moderate central spinal stenosis however without neural foraminal compromise.L3-L4 demonstrate mild disc disease and loss of disc height, post operative changes of right laminectomy and resultant expansion of thecal sac without central spinal stenosis. No neural foraminal compromise is noted.L4-L5 demonstrate moderate disc disease and loss of disc height, significant bilateral ligamentum flavum hypertrophy, significant bilateral facet hypertrophic changes and including bilateral facet space widening and effusion. Constellation of findings results in significant central spinal stenosis and moderate to severe bilateral neural foraminal compromise. There is finding suggestive of prior bony fusion posteriorly at this level.L5-S1 demonstrate mild disc disease, without spinal stenosis however with moderate bilateral neural foraminal compromise. There is extensive bone formation contiguous with the articulating facets at this level suggestive of prior bony fusion.

Output: 1.Extensive hypertrophic changes of the ligamentum flavum at L2-L3 with resultant moderate central spinal stenosis without neural foraminal compromise.2.Postoperative changes of right laminectomy at L3-L4 without spinal stenosis and no neural foraminal compromise.3.Extensive degenerative changes at L4-L5 including facet effusion results in significant central spinal stenosis and moderate bilateral neural foraminal compromise.4.There is evidence of prior posterior bony fusion at L4-L5 and L5-S1 levels.


Instruction: Generate impression based on findings.

Input: There is reversal normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: There is a left paracentral disc protrusion which causes slight anterior left hemicord flattening as well as abutment of the adjacent transiting nerve roots.C5/6: UnremarkableC6/7: UnremarkableC7/T1: Unremarkable

Output: C4/5: There is a left paracentral disc protrusion which causes slight anterior left hemicord flattening as well as abutment of the adjacent transiting nerve roots.


Instruction: Generate impression based on findings.

Input: 93 year-old female status post fall. Initial head CT had a question of a subdural hematoma. Please evaluate for interval change. There is no evidence of intracranial hemorrhage, mass or edema. The previously described diffuse prominence of the cervical sulci and ventricles consistent with parenchymal volume loss is unchanged. Mild diffuse periventricular hypodensities consistent with small vessel disease, age indeterminate.The previously described mild prominence along the tentorium cerebelli raising a question of subdural hematoma is unchanged when compared to the prior exam. MRI is recommended for further evaluation if clinically warranted.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 definite acute intracranial process. Stable exam as described above.


Instruction: Generate impression based on findings.

Input: Reason: history of renal transplant concern for infection, previous MRI with findings concerning for left clavicle osteomyelitis, please include this in views to evaluate for osteomyelitis. LUNGS AND PLEURA: Moderate to large bilateral pleural effusions, not significantly changed compared 8/15/2016 PET with a small amount of associated compressive atelectasis. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal lymphadenopathy identified.CHEST WALL AND SOFT TISSUES: There is redemonstration of edema/fluid signal as well as increased enhancement within the fascial planes of the left upper chest wall surrounding the proximal and middle third of the left clavicle which is compatible with an inflammatory process such as cellulitis. There is also abnormal bone marrow signal, cortical indistinctness, and increased enhancement involving the proximal and to a lesser extent middle third of the left clavicle which is compatible with osteomyelitis which has progressed compared to the 8/15/2016 MRI neck. No associated discrete drainable abscess is identified.Degenerative changes affect the spine. There is a fat-containing structure within the T3 vertebral body which likely represents a benign hemangioma. There is redemonstration of a nonspecific T2 hyperintense nodule in the subcutaneous soft tissues of the left upper back.UPPER ABDOMEN: Cholelithiasis.

Output: 1.Signal abnormality and increased enhancement involving the proximal and middle third of the left clavicle compatible with osteomyelitis, progressed compared to 8/15/2016. Surrounding inflammatory changes compatible with cellulitis.2.Moderate to large bilateral pleural effusions.3.Please see recent dedicated MRIs of the soft tissues of the neck and left shoulder for additional details regarding those structures.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified abnormalities of gait and mobilityClinical question: vascular parkinsonism, gait instability MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Some enlarged perivascular spaces are present in the deep gray nuclei and left thalamus.On susceptibility imaging there are punctate subcortical white matter signal hypointense foci present located in the left inferior frontal gyrus, right precentral gyrus, right inferior parietal lobule, left inferior parietal lobule, left posterior temporal lobe, right middle frontal gyrus, periventricular white matter adjacent to the trigone of the right lateral ventricle, adjacent to the trigone of the left lateral ventricle and in the subcortical white matter of the cerebellum.There is a punctate focus at the trigone of the right lateral ventricle which is hyperintense on diffusion-weighted imaging but does not display any diffusion restriction on the ADC maps and appears represent T2 shine through.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present. Examination is somewhat degraded by patient motion.At C2-3 there is no significant compromise to the spinal canal. There is moderate left-sided facet hypertrophy present at this level. There is mild encroachment of the left-sided exiting nerve roots at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is marked left-sided facet hypertrophy present at this level. There is encroachment of left-sided exiting nerve roots at this levelAt C4-5 there is no significant compromise to the spinal canal. There is a moderate left-sided facet hypertrophy present at this level and mild right-sided facet hypertrophy. There is a small central disc protrusion present at this level. There is some encroachment of the left-sided exiting nerve roots within the left neural foramen at this level.At C5-6 there are endplate and uncovertebral osteophytes present associated with the effacement of spinal fluid ventral and posterior to the spinal cord and encroachment of the right-sided exiting nerve roots within the neural foramina. Overall there is a moderate degree of spinal stenosis at this level.At C6-7 there are endplate and uncovertebral osteophytes present associated with the effacement of spinal fluid ventral and posterior to the spinal cord and encroachment of the exiting nerve roots within the neural foramina. Overall there is a moderate degree of spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction. Please note that the exam is somewhat degraded by patient motion which may obscure more subtle abnormalities.3.Some enlarged perivascular spaces in the basal ganglia and left thalamus may be a result of prior ischemic events.4.There are multilevel degenerative changes present in the cervical spine worse at C5-6 and C6-7 where there is a moderate degree of spinal stenosis present. There is additional multilevel encroachment of exiting nerve roots within the neural foramina as detailed above. Please note however that the cervical spine exam is degraded by motion artifact which may obscure more subtle abnormalities.5.Multiple microhemorrhages present in the subcortical white matter. Etiology is nonspecific. One possibility is amyloid angiopathy.


Instruction: Generate impression based on findings.

Input: Other musculoskeletal symptoms referable to limbs(729.89) [729.89], Reason for Study: ^Reason: stroke History: left arm weakness Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Left ACA A1 segment is hypoplastic. No evidence of intracranial arterial aneurysm. No evidence of intracranial arterial luminal stenosis or occlusion.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. Normal brain MRA, normal neck MRA.


Instruction: Generate impression based on findings.

Input: Clinical question: stroke or mass work upSigns and Symptoms: right arm weakness MRI of the brainThere are punctate foci of diffusion restriction along the left centrum semiovale, the subcortical white matter of the posterior aspect of the left superior frontal gyrus, the right paramedian corpus callosum, the right cingulate gyrus, the left temporal lobe and the right occipital pole.There is a mild degree of periventricular, brainstem and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.Incidental note is made of a Thornwaldt cyst.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.The middle cerebral artery bifurcations are at the proximal M2 segments.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is barely visible. The posterior communicating arteries are medium sized The left vertebral artery is dominant. The left PICA is dominant. The right AICA is dominant.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the left vertebral artery. There is high grade stenosis at the origin of the right vertebral artery. The right vertebral artery has a tortuous origin. There is mild narrowing at the origin of the left vertebral artery which is tortuous. The left common carotid artery originates from the innominate artery.

Output: 1.A few minor punctate foci of cerebral microinfarcts are present in multiple vascular territories that can be potentially accounted for based only on anterior circulation.2.There is high grade stenosis at the origin of the right vertebral artery. 3.There is no evidence for intracranial cerebrovascular occlusive disease.4.There is no stenosis at the origin of the ICA bilaterally.5.No intracranial aneurysm is appreciated.6.Periventricular and subcortical white matter and brainstem lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 5-year-old male patient with hepatosplenomegaly grade 3 esophageal varices.EXAMINATION: MR abdomen without and with IV contrast 11/12/2015 ABDOMEN:LIVER, BILIARY TRACT: The liver measures 12 cm in craniocaudal dimension. Left lobe of the liver is scalloped in appearance. Tortuosity of the hepatic arterial and portal venous system predominantly in the left lobe of the liver with prominent peripheral vessels draining into the inferior vena cava at the hepatic dome. Extrahepatic portal vein is tortuous. No filling defect seen on postcontrast images. No intra or extrahepatic biliary ductal dilatation. No cholelithiasis.SPLEEN: Splenomegaly, measuring up to 13 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Tortuous appearance of the hepatic arterial and portal venous system in the left lobe of the liver as well as the extrahepatic portal vein. Given patient's history of prematurity (born at 24 weeks gestational age), patient probably had an umbilical venous catheter that may have caused portal vein thrombosis with resultant cavernous transformation and portal hypertension.2.Splenomegaly.


Instruction: Generate impression based on findings.

Input: 55 year old BRCA1 positive woman presents for screening breast MRI. No current breast complaints. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A few cysts are seen in both breasts similar to the prior exam.No suspicious 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 dilated pancreatic duct with question of main duct pancreatic mucinous neoplasm. History of ulcerative colitis. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis within a normally distended gallbladder without acute inflammatory changes.Mild steatosis.The liver is normal morphology and size without a focal suspicious lesion. No intra or extrahepatic biliary ductal dilatation. The vessels are patent.SPLEEN: The spleen is normal in size and signal intensity.PANCREAS: Demonstrated again is marked smooth main pancreatic ductal dilatation up to 11 mm. There is side branch ectasia.The main pancreatic duct appears to cross the common bile duct and drain into the minor papilla. There is no suspicious mural postcontrast enhancement.Following secretin administration there appears to be adequate exocrine response of the pancreas without significant caliber change of the main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal simple appearing cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild scoliosis.OTHER: No significant abnormality noted.

Output: Demonstrated again is significant smooth main pancreatic ductal dilatation without suspicious postcontrast enhancement, remaining suspicious for main duct IPMN. No obstructing masslesion or stone. Sequela of chronic pancreatitis felt to be less likely given absence of characteristic alternating pancreatic ductal stenosis/dilatation.Suspected pancreas divisum.


Instruction: Generate impression based on findings.

Input: Left eye blurry vision, NMO Orbits: There is mild T2 hyperintensity and enhancement involving the left optic nerve from the mid intraorbital level extending posteriorly to the prechiasmatic portion. Appearance is less extensive compared to 9/16/2013. The right prechiasmatic optic nerve and small portion of the intraorbital optic nerve demonstrate mild T2 hyperintensity and volume loss. The optic chiasm appears to be uninvolved. The globes and extraocular muscles are otherwise unremarkable. Brain: No brain abnormal parenchymal enhancement or signal abnormality to suggest demyelinating disease in the brain. There is no evidence of acute infarct. There is no midline shift or herniation. There is unchanged cavum septum pellucidum and vergae, but no evidence of hydrocephalus. The major cerebral flow voids are intact. The skull, paranasal sinuses, and mastoid air cells appear unremarkable.

Output: 1. T2 hyperintensity and enhancement involving the left optic nerve from the mid intraorbital level extending posteriorly to the prechiasmatic portion is less pronounced than 9/16/2013 but suggestive of recurrent optic neuritis. Otherwise, no evidence of brain parenchymal signal abnormality or enhancement.2. Mild right optic nerve atrophy is unchanged.


Instruction: Generate impression based on findings.

Input: History of hematuria. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Orthotopic kidneys are normal in size and morphology. No hydroureteronephrosis. No focal lesion. The kidneys enhance symmetrically and promptly excrete into normal bilateral collecting systems. The ureters are well seen, are normal in caliber and without a focal lesion or mural abnormality.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No findings to account for the patient's hematuria. Please note that MRI is inadequate for excluding urolithiasis.


Instruction: Generate impression based on findings.

Input: 26 year old woman with diagnosis of dermatomyositis, with tachycardia and chest pain in setting of troponin elevation. She was referred for cardiac MRI to evaluate for myocarditis. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 66 ml/m2 (normal range: 65+/-11), the LVEDV is 141 ml (normal range 109+/-23), the LV end systolic volume index is 18 ml/m2 (normal range 18+/-5), the LVESV is 40 ml (normal range 31+/-10), the LV mass index is 56 g/m2 (normal range 67+/-11), and the LV mass is 119 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a possible focus of mild epicardial late gadolinium enhancement in the mid anterolateral wall which is atypical for myocardial infarction, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of focal myocardial edema.The native T1 myocardial relaxation time is abnormal at 1200ms. These values are moderately elevated, suggestive of underlying diffuse fibrosis or infiltration.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 60%, the RV end diastolic volume index is 68 ml/m2 (normal range 69+/-14), the RVEDV is 145 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 58 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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 mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial effusion or inflammation.Extracardiac FindingsBilateral lower lobe consolidation. There is an metallic artifact in the stomach likely related to a feeding tube. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with hyperdynamic systolic function (EF 72%). While there is no focal myocardial edema, there is a possible focus of mild epicardial late gadolinium enhancement in the mid anterolateral wall which is atypical for myocardial infarction, and suggests an infiltrative, inflammatory or fibrotic process, including myocarditis. Additionally the native T1 myocardial relaxation time is moderately elevated (1200ms), which speaks to an underlying diffuse fibrotic or infiltrative process. 2. Normal size right ventricle with normal systolic function (EF 60%).3. Mild pulmonary artery dilation.4. Patchy areas of bilateral lower lobe consolidation which may represent pneumonia, aspiration, and/or organizing pneumonia.


Instruction: Generate impression based on findings.

Input: 24 year old female with knee pain and effusion, evaluate for meniscal or ligamentous injury. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: No articular cartilage defects are evident.LIGAMENTS: The anterior cruciate and posterior cruciate ligaments are intact, as are the medial collateral ligament and lateral collateral ligament complex.EXTENSOR MECHANISM: There is mild edema along and within the distal fibers of the vastus lateralis tendon at its insertion on the patella, suggesting strain injury. The remainder of the quadriceps tendon and patellar tendon appear normal. The retinacular structures are intact.ADDITIONAL

Output: 1.Ligament strain of the vastus lateralis tendon and other findings as above.2.We see no meniscal or ligamentous injury.


Instruction: Generate impression based on findings.

Input: Right hip and low back pain. Please note evaluation of SI joints is limited on this 2 views of the bilateral hips and one AP view of the pelvis.Osteophytes affect the bilateral hips indicative of mild to moderate osteoarthritis. Chondrocalcinosis of the bilateral hips indicates CPPD. No fracture or malalignment. Limited view of the SI joints appear within normal limits. Callus formation around the left medial ischium corresponds to prior area of abnormal signal on MRI 9/18/2015.

Output: Mild to moderate bilateral osteoarthritis affects the hips. CPPD of the bilateral hips. Healing fracture of the left ischium.


Instruction: Generate impression based on findings.

Input: Left inferior ramus lesion.IMAGE ACQUISITIONS: Noncontrast CT of the pelvis was performed with standard CT protocol. There is an irregular lucency measuring approximately 1.2 cm through the left inferior pubic ramus which demonstrates sclerotic margins and slight expansile remodeling however there is no associated soft tissue mass. There is no similar findings on the contralateral side. The remainder of the visualized osseous structures are within normal limits. The visualized lower lumbar spine and sacrum also are within normal limits. Sacroiliac joints are within normal limitsThe surrounding soft tissue structures including the musculature surrounding this lucency in the left inferior pubic ramus appears within normal limits. The edema seen on outside MRI study surrounding this lesion is not appreciated on CT examination which is expected.

Output: Irregular lucency with sclerotic margins in the left inferior pubic ramus with no associated soft tissue mass is most compatible with a benign lesion. The location and imaging appearance of this finding is highly suggestive of the ischiopubic synchondrosis which represents a normal ossification process however given the patient is symptomatic, it has been described to have stress reaction or swelling of the synchondrosis. Alternatively, this could be a fracture however it is an atypical place. Much less likely and still benign in etiology, this could represent an atypical appearing eosinophilic granuloma.Given the findings are most likely secondary to a swollen ischiopubic synchondrosis, short-term follow-up CT examination in 3 to 6 months is recommended to evaluate for change or resolution of findings.


Instruction: Generate impression based on findings.

Input: 68 year-old male history of peritoneal mesothelioma. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Scattered subcentimeter simple cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Peritoneal deposits are slightly decreased in size. Reference nodule adjacent to the left hepatic lobe measures 3.3 x 2.2 cm, previously 4.9 x 3.3 cm (image 33 of series 7). Nodule adjacent to the lesser curvature measures 2.9 x 1.4 cm, previously 3.2 x 1.9 cm (image 36 of series 7).PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Unchanged nodule between the seminal vesicles and rectum measuring 2.9 x 1.3 cm, previously 3.2 x 1.4 cm (image 23 of series 16).

Output: Improving peritoneal nodules. Stable nodule between rectum and seminal vesicles.


Instruction: Generate impression based on findings.

Input: 35-year-old male with liver lesion seen on CT. ABDOMEN: Study is limited due to lack of IV contrast.LIVER, BILIARY TRACT: There is a large caudate lobe lesion measuring 6.0 x 6.3 cm T2 hyperintense mass. There is mass effect on the IVC.There is a 19 x 18 mm T2 hyperintense lesion in segment five of the liver, favored to represent a hemangioma. Additional smaller subcentimeter T2 hyperintense lesions are too small to further characterize although are likely of benign etiology.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense foci in the kidneys likely reflect benign cysts. No hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large mass in the caudate lobe and smaller lesion in segment 5 are incompletely evaluated on a noncontrast study but are favored to represent hemangiomas. There is mass effect on the IVC by the caudate lobe lesion. 2.Small cysts in the liver are also present.3.The patient will be recalled to complete the post-contrast portion of the study.


Instruction: Generate impression based on findings.

Input: There are a few punctate areas of subcortical/periventricular white matter T2 hyperintensity. 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 or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. No evidence for intracranial metastatic disease.2. A few scattered foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease, but no evidence of acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 82-year-old female with cervical cancer. Radiation planning. PELVIS:The patient was unable to tolerate full instillation of vaginal gel, which partially limits the exam.UTERUS, ADNEXA: There is a faintly T2 hyperintense lesion that is anterior and left lateral to the endocervical canal. The lesion measures 2 cm in craniocaudal length (sagittal series 1001 image 23), 1.7 cm in AP, and 2 cm in transverse diameter (axial series 1203 image 398). This lesion demonstrates restricted diffusion and contrast enhancement. There is left parametrial invasion. The bladder wall and bilateral ureters are preserved.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Sigmoid diverticulosis without evidence for acute diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Enhancing anterolateral cervical lesion measuring 2 x 1.7 x 2 cm with left parametrial invasion.


Instruction: Generate impression based on findings.

Input: Subarachnoid hemorrhage. Gunshot wound to the right occipital region. Evaluate reabsorption. No evidence of hemorrhage this identified. Previously noted area of contusion has dramatically improved and only very minimal low-density at the site (right posterior temporal) is present. This may represent small area of encephalomalacia. This can be further and better evaluated with an MRI. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits.Multiple small metallic fragments in the soft tissues of the scalp in the right occipital, posterior temporal region.

Output: Minimal residual low-density at the site of prior contusion may represent minimal encephalomalacia. No residual clot.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:1/26/1960)Reason: preop planning for tumor biopsy History: preop planningPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI There is a ring-enhancing mass present in the right frontal lobe measuring 30 x 30 mm axial dimensions. This is centered in the right inferior frontal gyrus. Another several ring-enhancing lesions are present in the right superior frontal gyrus the largest one measuring 15 x 11 mm axial dimensions. Another lesion is present in the right temporal lobe measuring 20 x 18 mm axial dimensions. These lesions are surrounded by T2 signal hyperintensity compatible with vasogenic edema pattern.There is T2 signal hyperintensity present within the right middle cerebral peduncle extending to the pons.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Exam was performed for the purpose of stereotactic guidance during surgery. It is therefore limited. There are ring-enhancing right frontal lobe masses present and another mass in the right temporal lobe. These are suspicious for neoplasms, however, further characterization2.The lesion in the right midbrain and pons is nonspecific.


Instruction: Generate impression based on findings.

Input: 61-year-old man with history of testicular seminoma, evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mildly prominent right inguinal lymph node is unchanged (series 15, image 41).OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Pregnant with seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid in the right mastoid air cells.

Output: 1. No evidence of gross seizure foci.2. A small amount of fluid in the right mastoid air cells could be a manifestation of mastoiditis.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with facial droop. Assess for stroke, vascular stenosis. Brain MRI:No restricted diffusion is seen. There are, however, multiple patchy areas of periventricular T2 hyperintensity as well as several scattered discrete chronic lacunar infarcts in the basal ganglia and brainstem, the largest being in the right basal ganglia. Encephalomalacia of the left medial temporal-occipital junction is also seen. Small chronic infarcts of the cerebellar hemispheres are also noted.No evidence of parenchymal edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles and sulci are mildly prominent compatible with volume loss including ex vacuo dilatation of the left ventricular atrium.Brain MRA:Mild irregularity of the cavernous ICAs is seen. Otherwise, no significant intracranial vascular stenosis or occlusion is detected. No aneurysms are identified.Neck MRA:Due to technical limitations and artifact, the origins of the great vessels are not well visualized. There may be mild atherosclerotic narrowing at the level of the right carotid bifurcation. No significant stenosis is suspected within the left carotid vessels. Likewise, the vertebral vessels are free of significant stenosis in the neck.

Output: 1.No evidence of acute ischemia.2.Sequelae of extensive chronic territorial, microvascular and lacunar ischemic disease.3.No significant intracranial vascular stenosis.4.MRA of the neck is somewhat compromised by artifact. At most, a mild stenosis may be present at the right carotid bifurcation.


Instruction: Generate impression based on findings.

Input: There is redemonstration of multiple oval T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter as well as scattered along the corpus callosum which are similar in distribution, many perpendicular to the long axis of lateral ventricle. Many of the lesions also demonstrate corresponding T1 hypointensity. No definite new focus of abnormal signal is appreciated.The ventricles and sulci are normal in appearance. There is a CSF signal intensity lesion in the supracerebellar cistern resulting in flattening of the superior margin of the cerebellum. It currently measures 2.2 cm transverse x 2.8 cm AP x 2.4 cm CC, essentially unchanged.

Output: 1.Similar pattern of scattered foci of T2/FLAIR hyperintensity within the white matter consistent with known demyelinating disease, including a left brachium pontis lesion. Overall, there is mild to moderate T1 and moderate T2 burden of disease.2.Stable CSF signal intensity structure with mild mass effect upon the superior cerebellum, which is statistically most likely an arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Motion artifact degrades image quality. The ventricles and sulci are prominent, consistent with mild age-related volume loss. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. There are also subcentimeter defects in the bilateral basal ganglia, which likely represent chronic lacunar infarctions. There is no evidence of acute infarction. There are multiple foci of susceptibility artifact, within the bilateral thalami, and to a lesser extent the bilateral cerebral and cerebellar hemispheres and basal ganglia, consistent with chronic microhemorrhages. There is a partially empty sella. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Chronic basal ganglia lacunar infarcts and small vessel ischemic disease, but mo acute infarct, midline shift, or mass effect. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Disturbance of skin sensation [782.0], Reason for Study: ^Reason: Please evaluate for infarct or cerebral inflammation or vasculitis History: Worsening headache, new left arm paresthesia and numbness, chronic diffuse joint pains with high ANA Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.About 5.6mm tonsilar herniation through the foramen magnum.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No aneurysm. No arterial luminal stenosis.C-Spine MRINormal cervical lordosis has been lost. However, the cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable. There is no abnormal enhancement.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. 5.6mm tonsilar herniation through foramen magnum indicating possible Chiari malformation.3. Normal brain MRA4. Straightened cervical spine, otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Clinical question: Language disorder. Signs and symptoms: Progressive aphasia-PPA with the speech apraxia. Nonenhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrate mild primarily periventricular and to a lesser degree subcortical FLAIR hyperintensity (left greater than right) of bilateral hemispheric white matter and with normal signal intensity of brain parenchyma otherwise. There is mild enlargement of supratentorial ventricular system (left greater than right) with maintained midline which could represent ex vacuo dilatation. There is suggestion of mild interval progression of periventricular white matter findings however with disproportionate interval increased size of supratentorial ventricular system since prior exam. Largest transverse axis of the third ventricle measures at 12.5 mm compared to prior study measurement of 9.5 mm, the combined transverse measurement of the lateral ventricles at 40 mm compared to prior study measurements of 32 millimeter.Generalized prominence of cortical sulci more conspicuous in parietal lobes also with suggestion of interval progression since prior exam and concerning for parenchymal volume loss.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses remain within normal.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process.2.Subtle FLAIR hyperintensity only in the periventricular and minimally in the subcortical white matter of cerebral hemispheres with suggestion of mild interval progression since prior exam as detailed. Unremarkable signal intensity of brain parenchyma otherwise.3.Interval increased size of supratentorial ventricular system and highly suspected progression of generalized prominence of cortical sulci (more conspicuous in parietal lobes) since prior study as measured above.


Instruction: Generate impression based on findings.

Input: History of ependymoma status post craniotomy and radiation therapy, now off therapy evaluation. Some of the sequences are degraded by patient motion. There are stable findings related to left frontal craniotomy with a resection cavity in the inferior left frontal gyrus, with unchanged confluent T2 hyperintensity and mild susceptibility effect along the surgical margins. There is also an unchanged punctate focus of T2 hyperintensity in the left peritrigonal white matter. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues appear unchanged.

Output: No evidence of tumor recurrence.