Instruction: Generate impression based on findings.

Input: 29-year-old male with family and personal history of hypertrophic cardiomyopathy Left VentricleThe left ventricle is normal in size with normal systolic function. There is left ventricular hypertrophy, worse at the basal septum (16 mm). The overall LV ejection fraction is 65%, the LV end diastolic volume index is 111 ml/m2 (normal range: 74+/-15), the LVEDV is 222 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 77 ml (normal range 47+/-19), the LV mass index is 91 g/m2 (normal range 85+/-15), and the LV mass is 182 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no significant late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is a left ventricular crypt or diverticulum noted in the basal inferior wall. The native myocardial T1 relaxation time is within normal limits.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 125 ml/m2 (normal range 82+/-16), the RVEDV is 251 ml (normal range 142+/-31), the RV end systolic volume index is 55 ml/m2 (normal range 31+/-9), and the RVESV is 140 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. There is mild outflow obstruction in the LVOT related to SAM and septal hypertrophy. Mitral ValveThere is mild chordal and leaflet systolic anterior motion with mild mitral regurgitation. There is mild anterior leaflet bowing into the left atrium.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 (32 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Hypertrophic cardiomyopathy with maximum wall thickness of 16mm in the basal septum. No evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal left ventricular systolic function (LVEF 65%) with evidence of a left ventricular crypt or diverticulum involving the basal inferior wall. 3. Mild right ventricular dilation with normal systolic function (RVEF 56%). 4. Systolic anterior motion of the mitral leaflet with mild left ventricular outflow tract obstruction.5. Mild dilation of the main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Acute neck pain. Cervical spine shows minimal reversal of the normal lordosis. Vertebral body heights are preserved. Marrow signal shows mild heterogeneity but no suspicious focal lesion. Intervertebral discs show moderate height and severe T2 signal loss at all levels associated with endplate irregularity and osteophytesThe spinal cord shows normal signal. It is minimally indented by disc-osteophyte complexes as described below.C1-C2: Fluid signal posterior and superior to the dens is probably degenerative in nature and causes mild ventral indentation of the thecal sac.C2-C3: Disc osteophyte complexes along with left facet and right uncovertebral proliferative change results in moderate biforaminal stenosis. The central canal is preserved.C3-C4: The disc-osteophyte complex is slightly eccentric to the right. It is associated with right uncovertebral proliferative change. It results in mild-to-moderate canal narrowing and severe right and moderate left foraminal stenoses. There is also ligamenta flava thickening at this level.C4-C5: Disc osteophyte complex is eccentric to the right and contributes to mild to moderate canal narrowing as well as severe right and moderate left foraminal stenoses. Ligamenta flava thickening is also present.C5-C6: Disc osteophyte complex and right more than left uncovertebral productive changes result in severe right and moderate left foraminal stenoses. There is no significant canal stenosis. Ligamenta flava thickening is also present.C6-C7: Disc osteophyte complex and uncovertebral proliferative change cause mild-to-moderate right and moderate left foraminal stenoses. There is no significant central stenosis.C7-T1: Disc osteophyte complex causes severe right and moderate to severe left foraminal stenoses. There is no significant central stenosis.T1-T2: Facet proliferative change causes severe left and moderate right foraminal stenoses. There is also ligamenta flava thickening.Prominent central T2 hyperintensity in the pons may reflect small vessel ischemic change, of undetermined age.

Output: Multilevel degenerative disc/osteophyte disease as well as uncovertebral and facet proliferative change and ligamenta flava thickening cause variable (moderate to severe) foraminal stenoses that are worse on the right. They also cause central canal narrowing that is most pronounced at C3-C4 where it is mild-to-moderate.


Instruction: Generate impression based on findings.

Input: Thoracic spine compression fracture. There is mild thoracic scoliosis convex to the left. Compression deformities of various degrees are seen in thoracic spine, involving T4, T5, T6, T7, T8, T10, T11 and T12. The compression deformities are worst at T8 and T12 level. At T12 level, there are changes related to previous vertebroplasty. Small amount of vertebroplasty material is seen extravasated into the right paraspinal region, possibly involving a venous structure. At T11 - T12 there is disk bulging without significant compromise to spinal canal. Mild disk bulging is also seen throughtout the rest of the thoracic spine, without significant compromise of the spinal canal, although mild neuroforaminal narrowing is present.Abnormal opacity in the left upper lobe is partially visualized, suspicious for a neoplastic process as reported on prior CT chest of 9/15/2011. This is a lytic lesion involving the left pedicle L1, with no definite corresponding lesion seen on prior MRI study. Metastasis cannot be excluded.

Output: 1. Multi-level compression deformities in thoracic spine. Status post vertebroplasty at T12, with extravasated material in the right paraspinal region, probably through venous structure.2. Suspicious for left upper lobe neoplasm. Please correlate with CT chest.3. New lytic lesion at left L1 pedicle, suspicious for a lytic metastasis. Further correlation with MRI with contrast is recommended.


Instruction: Generate impression based on findings.

Input: Abnormal ultrasound, evaluate prominent common bile duct ABDOMEN: LIVER, BILIARY TRACT: No focal hepatic lesion. No intra or extrahepatic biliary ductal dilation. The common bile duct measures 7-8 mm in maximal diameter dimension without evidence of stones or mass. The gallbladder is normal.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes measuring up to 1.5 cm in the left iliac region (series 801, image 21).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Incompletely visualized 11 mm right axillary lymph node.

Output: No intra or extrahepatic biliary ductal dilation. The common bile duct measures 7-8 mm in maximal diameter. No evidence of stones or mass.


Instruction: Generate impression based on findings.

Input: 32 years, Female, migraines, confusion. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are again seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but may be related to migraines given history. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No evidence of intracranial mass or abnormal enhancement. Similar to prior, there are scattered foci of T2/FLAIR hyperintensity which primarily involve the subcortical white matter; these are nonspecific and may be related to patient's history of migraines. MRI of the brain is otherwise unremarkable for age.


Instruction: Generate impression based on findings.

Input: 36 year old male with worse headache of life No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. Images through posterior fossa demonstrate slight bony remodeled all foramina magnum with crowding of the cerebellar tonsils at the level of foramina magnum. This findings are suspected for ectopic cerebellar tonsils. This finding can be further evaluated with a dedicated MRI of brain.Calvarium, paranasal sinuses and mastoid air cells are unremarkable

Output: 1.No evidence of acute findings.2.Highly suspected Chiari malformation. Further evaluation with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: History of right nipple discharge. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.A small amount of high T1 signal fluid is seen within ducts in the immediate retroareolar region. There is minimal enhancement within the inverted right nipple that does not meet threshold for kinetic analysis, and no enhancing mass is seen within the nipple. No suspicious enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Ectatic ascending aorta measures up to 4.2 cm on this non-dedicated exam of that region. A few high T2 liver lesions are present, including an approximately 5 cm right hepatic lobe lesion that has previously been characterized on dedicated body MRI as a hemangioma.

Output: 1. Minimal enhancement in the inverted right nipple, not suspicious in appearance. No suspicious enhancing mass or non-mass like enhancement in either breast. 2. Ectatic ascending aorta measures up to 4.2 cm. Correlation with any previous cardiac imaging or, if performed, an outside institution chest CT to evaluate stability is suggested. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 68 years old, with gait imbalance. Assess for cerebellar etiology. The cerebellum is normally formed and shows preserved parenchymal volume. No abnormal signal or pathologic enhancement is demonstrated in the posterior fossa.Supratentorially, mild diffuse prominence of the sulci is seen compatible with parenchymal volume loss. A single nonspecific focus of T2 hyperintensity is evident within the right frontal white matter.No evidence of parenchymal edema, mass effect or pathologic enhancement is seen. No abnormal extra-axial fluid collections are detected. The ventricular system is within normal limits for size and morphology. The corpus callosum is rather undulating in contour as viewed in the sagittal plane and thins at the junction of the body and splenium, but this can be developmental and is of doubtful significance.

Output: 1.No specific findings are seen to account for the patient's gait abnormality. In particular, the cerebellum is within normal limits.2.Mild supratentorial parenchymal volume loss and a nonspecific focus of right frontal white matter signal abnormality are noted incidentally.


Instruction: Generate impression based on findings.

Input: Evaluate for gliosis: Headaches, memory and executive problems after 3 concussions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of gliosis. However, MR tractography may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Evaluate for mass, obstruction. History of cancer. Now with headaches. Nonenhanced MRI of brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal for patient stated age of 73.Calvarium is intact. Visualized orbits are unremarkable. Visualized paranasal sinuses and mastoid air cells are unremarkable.Prominence of right jugular fossa is believed to represent an anatomical variation and with no evidence of any destructive bony changes. This appears was noted on prior exam from 2003 and with no change.

Output: Negative nonenhanced CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: 60 year old male with non ischemic dilated cardiomyopathy with suspected LV non compaction (from outside hospital imaging), recurrent atrial fibrillation. MRI for assessment of possible LV non compaction. Left VentricleThe left ventricle is severely dilated with globally severely reduced systolic function. The overall LV ejection fraction is 19%. The LVEDV is 421 ml (normal range 142+/-34), the LV end diastolic volume index is 204 ml/m2 (normal range: 74+/-15), the LVESV is 339 ml (normal range 47+/-19) and the LV end systolic volume index is 164 ml/m2 (normal range 25+/-9). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no LV thrombus. LV morphology has the appearance of LV non-compaction.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal sized with mildly reduced systolic function. The overall RV ejection fraction is 45%. The RVEDV is 150 ml (normal range 142+/-31), RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVESV is 78 ml (normal range 54+/-17), and the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is trileaflet, 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 normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.Severely reduced LV EF without evidence for delayed enhancement.2.Severe left atrial enlargement3.LV morphology has the appearance of LV non-compaction.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 27 years old Reason: right knee pain and swelling. Cartilage damage? History: right knee pain and swelling. MENISCI: The menisci are unremarkable. We see no meniscal tear.ARTICULAR CARTILAGE AND BONE: There is partial-thickness degeneration of the articular cartilage of the medial facet of the patella. The articular cartilage of the lateral facet appears normal, as does the articular cartilage of the femoral trochlea. The articular cartilage of the medial and lateral compartments is normal. We see no fracture.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is thickening of the proximal fibers of the patellar tendon with focal increased signal intensity of the posterior fibers of the tendon at its patellar attachment, indicating a small undersurface tear. There is mild edema in the adjacent fat pad. There is mild edema within a small enthesophyte projecting from the inferior aspect of the patella. The distal patellar tendon appears normal. The quadriceps tendon appears normal. ADDITIONAL

Output: 1.Proximal patellar tendinosis with small undersurface tendon tear as described above.2.Partial-thickness degeneration of articular cartilage along the medial facet of the patella.


Instruction: Generate impression based on findings.

Input: Approximately 1.5 x 2.1 cm of predominant hypointensity is seen in the right occipital lobe adjacent to the calcarine sulcus. Centrally there is a more heterogeneous signal appearance. The pattern is consistent with cerebral cavernous malformation and is unchanged in appearance since the previous study dated 10/23/2014. In addition, there are numerous foci of susceptibility low signal in supratentorial region, infratentorial region, and the pons, representing numerous other cavernous malformations. There is no perilesional edema and there are no associated developmental venous anomalies.The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no extraaxial fluid collection. There is minimal right ethmoid mucosal thickening. Otherwise the visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.

Output: 1. Cavernous malformation seen in the right occipital lobe, unchanged in shape and size since the outside MRI dated 10/22/2014.2. Numerous foci of susceptibility low signal in supratentorial region, infratentorial region, and the pons, representing numerous other cavernous malformations. 3. There is no perilesional edema or associated developmental venous anomalies.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with altered mental status and new rigidity. Image quality is reduced by motion artifact. Within this limitation, the following observations are made.No restricted diffusion is seen. No evidence of significant parenchymal edema or mass effect is detected. An area of encephalomalacia and surrounding gliosis is seen within the left occipital lobe, unchanged. A small slitlike focus of encephalomalacia is also present in the right cerebellar hemisphere compatible with chronic ischemia. A chronic lacunar infarct in the right pons is unchanged as well.No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles and sulci are mildly and proportionately prominent compatible with moderate parenchymal volume loss.

Output: 1.No definite acute intracranial abnormality.2.Findings are seen compatible with chronic ischemia in the left occipital lobe, the right pons, and the right cerebellum.3.Moderate parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: 68-year-old female evaluate complex right renal cyst ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nonspecific subcentimeter hypodensity in the left lobe of the liver on image number 23, too small to accurately characterize but most likely benign.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The cyst incidentally discovered on previous MRI in the lower pole of the right kidney does not demonstrate any enhancement and measures 4-cm in diameter. Its consistent with a simple cyst. There are smaller cysts in the right kidney, some of which are too small to characterize. Largest cyst in the left kidney is in the lower pole and measures 11 x 19 mm image number 52, series number 7.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral benign-appearing cysts.


Instruction: Generate impression based on findings.

Input: Reason: eval for labral tear History: anterior hip pain and popping ACETABULAR LABRUM: Small, partial tear of the anterosuperior labrum.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Small partial tear of the anterosuperior labrum. Otherwise, unremarkable appearance of the right hip.


Instruction: Generate impression based on findings.

Input: Clinical question: persistent sciaticaSigns and Symptoms: back and leg pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge present at this level. There is mild facet and ligamentum flavum hypertrophy at this level. There is partial effacement of the fat surrounding the exiting nerve roots within the neural foramina at this level.At L4-5 there is a moderate degree of bilateral facet and ligamentum flavum hypertrophy associated with a disc bulge and disc desiccation. There is a couple millimeters anterior subluxation of L4 on L5 present. There is partial effacement of the fat surrounding the exiting nerve roots within the neural foramina at this level. There is mild triangulation of the thecal sac at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level.At L2-3 there is a right paramedian disc extrusion present with disc material tracking behind the L3 vertebral body. This extrusion is associated with encroachment at the right lateral recess at the L3 vertebral body level. Disc material extends towards the right neural foramen at L3-4.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are renal cysts present.

Output: 1.There is a disc extrusion present at L2-3 with disc material extending behind the L3 vertebral body and towards the right L3-4 neural foramen which encroaches on the nerve roots at the right lateral recess at L2-3 as the course into the right L3-4 neural foramen.2.There are multilevel degenerative changes present in the lumbar spine which are worse at L4-5 where there is a mild degree of spinal stenosis and some mild subluxation and mild encroachment of exiting nerve roots within the neural foramina.


Instruction: Generate impression based on findings.

Input: 67 year old female with history of left lumpectomy in 2000 for IDC followed by radiation, and right lumpectomy in 2011 for DCIS followed by radiation. Patient received Tamoxifen. No current breast complaints. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Intact bilateral retropectoral silicone implants.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: 40yo F w/ foot swelling pain and concern for deep tissue infection History: as above There is thickening of the distal fibers of the posterior tibialis tendon which may reflect a mild tendinosis. There are lobulated foci of fluid signal intensity within the tendon sheath of the posterior tibialis tendon which demonstrate enhancement on postcontrast sequences likely representing a tenosynovitis. The peroneal tendons appear intact. There may be a small amount of enhancement along the peroneal longus tendon also likely representing a mild tenosynovitis. The Achilles tendon appears intact. The extensor tendons are normal in appearance There is a small amount of fluid about the subtalar joint and talonavicular articulation which demonstrates enhancement on postcontrast sequences likely representing a synovitis. There is also fluid identified about the first MTP joint which is incompletely imaged but also likely represents a synovitis. Mild osteoarthritis affects the talonavicular articulation. There is no bone marrow signal abnormality to suggest osteomyelitis. There are no focal fluid collections to suggest abscess formation. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.

Output: Tendinosis and a mild tenosynovitis of the posterior tibialis tendon. Findings indicating a mild synovitis affecting the subtalar joint, talonavicular articulation, and first MTP joint. No evidence of osteomyelitis or focal fluid collection to suggest abscess formation.


Instruction: Generate impression based on findings.

Input: 76-year-old male with right knee pain. MENISCI: There is increased signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial articular surface consistent with a horizontal tear. The anterior horn appears intact.There is linear branching signal abnormality and deformity of the posterior horn of the medial meniscus with extension of the signal abnormality to the tibial and femoral articular surface consistent with complex degenerative tearing which extends into the body of the meniscus. There is medial extrusion of the body of the meniscus. There is globular increased signal abnormality within the anterior horn of the meniscus consistent with intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the anterior aspect of the lateral femoral condyle with underlying degenerative subchondral signal abnormality. There is a focal full-thickness articular cartilage defect along the anterior aspect of the medial femoral condyle with underlying subchondral signal abnormality. There is subjective thinning of the articular cartilage of the medial tibiofemoral compartment. There is near full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle and medial tibial plateau. There is full-thickness articular cartilage degeneration along the medial facet of the patella with underlying subchondral signal abnormality. There is near full-thickness articular cartilage degeneration affecting the lateral facet of the patella.LIGAMENTS: The cruciate ligaments appear intact. There is thickening and intermediate signal abnormality within the proximal fibers of the lateral collateral ligament proper which may reflect prior injury or sprain. The MCL appears intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial and lateral meniscus as described above. 2. Full-thickness articular cartilage degeneration. 3. Loose bodies within the joint and within a Baker's cyst as described above.


Instruction: Generate impression based on findings.

Input: Reason: headache History: headache. Intractable headache, pregnant, concern for venous sinus thrombosis. MRI Brain:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency.MRV Brain:There is normal venous flow demonstrated within the internal cerebral veins, vein of Galen, straight sinus, superior sagittal sinus and within the bilateral transverse and sigmoid sinuses. No dural venous sinus thromboses or occlusions are identified.

Output: Normal MRI brain. No evidence of dural sinus thrombosis.


Instruction: Generate impression based on findings.

Input: Evaluate for episodes of L-sided weakness and numbness. Also has new episodes of confusion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are small bilateral maxillary sinus retention cysts.

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


Instruction: Generate impression based on findings.

Input: 65-year-old man with painful left side Horner's syndrome. History of lung cancer status post surgery, chemotherapy and radiation. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged scattered punctate foci of white matter T2 hyperintensity. There is unchanged encephalomalacia in the left occipital lobe. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact.Neck: There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is an asymmetric appearance of the internal carotid artery flow voids, with areas of higher intraluminal signal. The osseous structures are unremarkable. The airways are patent. There is left apical scarring.

Output: 1.No evidence of metastatic disease in the head or neck, although portion of the neck are obscured by artifact on certain sequences.2.Unchanged minimal chronic small vessel ischemic disease and left occipital lobe cortical encephalomalacia.3. Asymmetric appearance of the internal carotid artery flow voids may be attributable to artifact or atherosclerotic plaque, although a dissection cannot be excluded. However, if there is persistent concern for dissection, dedicated vascular imaging is recommended.


Instruction: Generate impression based on findings.

Input: 25-year-old female with positive ulnar variance, ulnar abutment, and clinical concern for triangular fibrocartilage complex tear. LIGAMENTS: No contrast is present within the mid carpal joint, consistent with intact lunotriquetral and scapholunate ligaments.TRIANGULAR FIBROCARTILAGE COMPLEX: No contrast is evident within the distal radioulnar joint, consistent with an intact triangular fibrocartilage complex.TENDONS: Iatrogenic contrast is present within the extensor tendons. BONES: Cystic changes in the ulnar side of the lunate are consistent with ulnar abutment syndrome.ADDITIONAL

Output: 1.Intact triangular fibrocartilage complex as well as intact lunotriquetral and scapholunate ligaments.2.Cystic changes in the ulnar side of the lunate are consistent with ulnar abutment syndrome.


Instruction: Generate impression based on findings.

Input: Re-evaluate meningioma. Redemonstration of a enhancing extra-axial mass arising off the falx cerebri measuring 1.4 x 1.1 x 1.2 cm, which is unchanged in size. There is associated susceptibility artifact, which is unchanged. There is no surrounding increased T2 signal to suggest edema. There are no intraparenchymal areas of pathologic enhancement and the brain parenchyma is grossly unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. The major intracranial flow voids are intact. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Stable falx cerebri meningioma.


Instruction: Generate impression based on findings.

Input: MRI: The exam is performed without IV contrast. There is no acute infarct, mass, or cerebral edema. The ventricles and basal cisterns are prominent for patient age. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. MRV: The superior sagittal sinus, inferior sagittal sinus, proximal transverse sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. Both distal transverse and sigmoid sinuses are suboptimally visualized, especially on the right which is likely artifactual. The right internal jugular vein is markedly thinned which is likely due to anatomic variation.

Output: 1.Artifactual and anatomic variation in both distal transverse and sigmoid sinuses contributing to suboptimal visualization of these structures on the venogram portion of the exam. Diminutive right internal jugular vein which is likely anatomic variation. Given absence of findings in the brain parenchyma, an acute thrombosis is felt to be unlikely, however if there remains high clinical suspicion, confirmation with CT venogram with IV contrast and/or repeat MR venogram with IV contrast would be suggested.2.Stable noncontrast MRI of the brain with no acute infarct, hydrocephalus or mass effect.


Instruction: Generate impression based on findings.

Input: 37 years Male (DOB:5/15/1978)Reason: pre-op for craniotomy History: pituitary lesionPROVIDER/ATTENDING NAME: DOROTA K HAVLIN CHRISTOPHER L KRAMER There is a 28 mm AP dimension x 38 mm with x 47 mm height sellar and suprasellar nonenhancing mass present associated with expansion of the sella and scalloping of the clivus. Since the prior exam signal characteristics within the mass of changed. It is more heterogeneous on T2 with some hemorrhagic foci on the current exam which were not present on the prior. The optic chiasm is displaced superiorly in the third ventricle is compressed superiorly. The patient is status post transsphenoidal surgery. There is fat packing present within the sphenoid sinus and nasopharynx narrowing the nasopharynx.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 partially opacified. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Large sellar and suprasellar mass displacing the optic chiasm, hypothalamus and third ventricle with associated scalloping of the clivus and bony remodeling of the sella..2.Status post recent transsphenoidal surgery. 3.Narrowing of the nasopharynx.4.Examination was performed for stereotactic guidance.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:8/13/1959)Reason: Eval posterior stroke History: dizzinessPROVIDER/ATTENDING NAME: ROBERT A MULLIKEN JEANNE M DECARA MRI of the brainSeveral punctate foci of diffusion restriction are identified. One is located in the right periventricular white matter. One is located in the left centrum semiovale. One is located in the left occipital lobe.There are 4 or 5 periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images..Is a punctate focus of signal loss and susceptibility imaging in the left half of the splenium of the corpus callosum. Initial location this is of unknown clinical significance.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal left vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are there are small. The right vertebral artery is not readily identified. The right posterior inferior cerebellar artery territory and appears to be supplied via the right anterior inferior cerebellar artery. There is extracranial origin of the left posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. The right vertebral artery is small and ends just proximal to the level of the foramen magnum. The anterior spinal artery years to be supplied from the left vertebral artery. 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 vertebral arteries.

Output: 1.There are several acute microinfarcts identified in the periventricular and subcortical white matter in the multiple cerebral territories.2.Occlusion of the right vertebral artery distally. Radiology is not established on this exam.3.Anterior spinal artery is prominent but otherwise unremarkable. It is possible this represents a collateral supply to right vertebral artery territory to the brainstem.


Instruction: Generate impression based on findings.

Input: 52 years, Female, history of renal cell cancer and pancreatic cancer. Rule out metastasis. Lack of contrast limits evaluation for small metastatic lesions. Within this limitation however there is no intracranial mass, parenchymal edema, or mass effect to suggest metastatic disease. There are scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic disease. No evidence of infarct or hemorrhage. Ventricles and sulci are within normal limits for age. No extra-axial collections.Sella and orbits are grossly within normal limits. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastatic disease within the limits of noncontrast MRI.


Instruction: Generate impression based on findings.

Input: 49 years Male (DOB: 12/22/1966)Reason: cervical radiculopathy History: Right arm painPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE The cervical vertebral bodies are appropriate in overall alignment and height. There is reversal of the normal cervical curvature. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is left sided facet hypertrophy associated with mild narrowing of the left neural foramen at this level.At C4-5 there is no significant compromise to the spinal canal. There is right sided uncovertebral osteophyte formation. There is right sided facet hypertrophy. There is associated mild narrowing of the right neural foramen at this level.At C5-6 there is no significant compromise to the spinal canal. There is right sided uncovertebral osteophyte formation. There is right sided facet hypertrophy. There is associated narrowing of the right neural foramen and mild to moderate encroachment of the right sided exiting nerve roots at this level.At C6-7 there is no significant compromise to the spinal canal. There is bilateral uncovertebral osteophyte formation associated with narrowing of the right neural foramen and mild to moderate encroachment of the right sided exiting nerve roots 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.There are multilevel degenerative changes in the cervical spine as detailed above with mild to moderate encroachment of right sided exiting nerve roots at C5-6 and C6-7.2.Reversal of the normal cervical curvature is a non-specific finding on MRI. It could be positional or related to spasm or kyphosis.


Instruction: Generate impression based on findings.

Input: Chronic medial elbow pain, evaluate. LIGAMENTS: The radial and ulnar collateral ligaments are intact.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Normal MRI of the right elbow.


Instruction: Generate impression based on findings.

Input: Dedicated images through the sella demonstrate a normal height of the pituitary gland. Pituitary stalk is slightly to the left of the midline without evidence of mass effect. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.There is an area of hypoenhancement in the posterior aspect of the pituitary gland which measures up to 4 x 4 mm. Along the inferior aspect, there is a nonenhancing component possibly part of the same lesion which measures approximately 2 x 3 mm. Overall appearance of the pituitary gland is not changed since the prior exam, even dating back to 2/22/2014. There is no mass effect on the chiasm.Again seen is partially imaged periventricular white matter T2 signal abnormality related to known demyelinating disease and is better seen on prior brain MRI.

Output: Subcentimeter area of hypoenhancement involving the posterior pituitary gland may represent microadenoma and remains unchanged since 2/22/2014. No evidence of macroadenoma or mass effect.


Instruction: Generate impression based on findings.

Input: 17-year-old male with relapsed ALL with recent CNS relapse: MRI evaluation prior to CAR T-cell therapy. There is persistent diffuse high T1 and T2 signal along the folia of the superior cerebellum, without appreciable abnormal enhancement. There is unchanged linear high T2 signal along a prior right transfrontal catheter track. There is no evidence of acute infarct. The ventricles and sulci are unchanged in size and configuration. There is a mega cisterna magna and partially-empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There is mild maxillary sinus mucosal thickening.

Output: Persistent signal abnormality along the folia of the superior cerebellum likely represents treatment effects, without evidence of recurrent intracranial leukemia.


Instruction: Generate impression based on findings.

Input: 16 year old female with syndromic enchondroma. BONE MARROW: There are numerous low T1 and high T2 lesions especially medially along the proximal left femoral neck that appear similar to recent radiographs and increased when compared to prior MRI. One lesion extends from the femoral neck into the head, crossing the physis. Many similar lesions are noted in the femoral diaphysis, where they become confluent and expand the diaphysis and thin the cortical margin of the bone. These lesions also demonstrate a low T2 rim. No cortical disruption to suggest acute fracture or aggressive behavior.Please note that postcontrast characterization cannot be made as there are no precontrast T1 fat saturated imaging. SOFT TISSUES: There are a few prominent subcentimeter lymph nodes in the left inguinal region. No soft tissue masses. JOINTS: Joint spaces are well-maintained. No joint effusion present.ADDITIONAL

Output: Multiple areas of marrow replacement by a nonaggressive appearing lesions. Further characterization will be possible when the patient returns for precontrast imaging sequences. An addendum will be made at that time.


Instruction: Generate impression based on findings.

Input: Reason: history of NF1 and malignant peripheral nerve sheath tumor of the right pelvis/groin; concern for increasing soft tissue nodule in post-op bed in R groin; please evaluate History: R groin pain Again seen are postsurgical changes of a left lower extremity amputation with hip disarticulation. There is associated marked fatty muscle atrophy of the left hip musculature, appearing similar to the prior study. Again seen are innumerable cutaneous lesions the multiple masses within the pelvis compatible with neurofibromas. Sacral dural ectasia and scalloping of the posterior aspect of the vertebral bodies appear similar to prior. The reference right inguinal lesion has been resected, previously measuring 4.6 x 3.7 x 7.3 cm. This is increased signal abnormality on fluid sensitive sequences within the surrounding soft tissue and subcutaneous fat which enhances on postcontrast sequences and likely represents postsurgical changes/granulation tissue. However, some of this signal abnormality has a more nodular appearance (image 20; series 301). Close attention on follow-up examination is recommended to evaluate for interval change and to exclude the possibility of residual or recurrent disease.The reference left psoas muscle lesion measures 4.3 x 4.1 cm, previously 4.2 x 4.0 cm (series 301; image 34).The reference left posterior pelvic lesion measures 4.0 x 4.0 cm, previously 3.9 x 4.1 cm (series 301; image 19).The reference of tissue mass in the fundus of the uterus has been resected, previously measuring 7.6 x 5.8 cm. The patient is status post hysterectomy.

Output: Interval resection of the reference right inguinal and uterine masses consistent with the patient's known history of malignant peripheral nerve sheath tumor as well as uterine fibroids. There is enhancing signal abnormality in the right inguinal region which presumably represents postsurgical scarring/granulation tissue. However, some of this signal abnormality has a more nodular appearance and follow-up examination is recommended to exclude the possibility of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: 56-year-old male with elevated prostate specific antigen and multiple prior negative biopsies. Evaluate for evidence of disease.Free PSA of 1.83 ng/mL PELVIS:PROSTATE:Prostate Size: 4.7 x 5.5 x 5.1 cm.Peripheral Zone: The majority of the prostate is composed of transitional zone. No suspicious lesion within the thin sliver peripheral zone.Central Gland: Nodular central gland compatible with benign prostatic hypertrophy.Seminal Vesicles: No abnormality noted.Extracapsular Extension: No abnormality noted.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 suspicious lesions. Majority of the prostate is composed of transitional zone with only a thin sliver of the peripheral zone.


Instruction: Generate impression based on findings.

Input: Hyperprolactinemia. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, aside from minimal nonspecific patchy cerebral white matter T2 hyperintensity. 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.Pituitary: The pituitary gland appears to enhance slightly heterogeneously, although no discrete lesion is apparent. The pituitary gland is not particularly enlarged. The infundibulum and posterior pituitary bright spot are intact.

Output: The pituitary gland appears to enhance slightly heterogeneously, which is nonspecific, and no discrete lesion is apparent.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: There is mild increased signal of the distal fibers of the supraspinatus and infraspinatus tendon reflecting mild tendinopathy. Otherwise there is no evidence of full-thickness rotator cuff tear.SUPRASPINATUS OUTLET: There is mild acromioclavicular osteoarthritis. There is no significant fluid within the subacromial subdeltoid prior.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is severe osteoarthritis of the glenohumeral joint with extensive cartilage loss and cystic change. There is significant degeneration of the anterior superior labrum which appears to extend into the biceps tendon.BICEPS TENDON: There is increased signal within the proximal biceps tendon which may reflect extension of labral degeneration. The biceps tendon is otherwise intact. ADDITIONAL

Output: Osteoarthritis of the shoulder with severe degenerative changes of the glenoid. There is no evidence of a full-thickness rotator cuff tear or mass lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: 10-year-old male with seizure-like episodes with time alteration. Evaluate for structural abnormalities. Signs and symptoms: As above. Nonenhanced brain MRI:Negative diffusion weighted series.Examination is deteriorated secondary to motion artifact.In this limitation examination demonstrate normal anatomical development of brain without evidence of congenital malformation.The signal intensity of brain parenchymal remains within normal in all MRI sequences.The cerebral cortex, cortical sulci, ventricular system, CSF spaces myelination of the brain is within normal for age.Signal void the major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are within normal.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: Unremarkable nonenhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Check for ligamentous tear. Knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Mild thinning largely observed in the lateral femoral compartment with associated more moderate an irregular changes involving the undersurface of the patella. The patellar compartment also demonstrates associated subchondral cysts and focal full-thickness tear near the apex. Underlying patellar edema and more focal degenerative and edematous marrow changes are otherwise observed involving the tibial spines and mid plateau.LIGAMENTS: Collateral ligaments are intact as well as the PCL. The ACL however demonstrates diffuse increased signal and thickening representing a severe sprain given intact fibers are observed throughout (best appreciated on axial projection). Small immediately adjacent posterior periligamentous small cyst is observed (image 8 series 8). Retinaculum appears intact EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Severe ACL sprain with otherwise scattered focal cartilaginous degenerative changes, see details provided.


Instruction: Generate impression based on findings.

Input: Chiari malformation, esotropia, vision changes. There cerebellar tonsils extend up to 8 mm inferior and display pointed morphologies. In addition, posterior cranial fossa capacity appears to be relatively small. However, there is flow of cerebrospinal fluid across the foramen magnum, albeit perhaps slightly reduced posteriorly. The spinal cord displays normal signal and morphology. The conus medullaris is located at the L1-L2 level. The vertebral column alignment is within normal limits, without evidence of retroflexion of the dens. 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 unremarkable.

Output: Findings suggestive of Chiari type 1 malformation, without associated syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Parkinson's disease planning for DBS. There is no evidence of intracranial hemorrhage or mass. There is blurring of the susceptibility signal in the substantia nigra bilaterally. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is scattered fluid signal in the right mastoid air cells.

Output: Preoperative planning MRI with stigmata of Parkinson's disease.


Instruction: Generate impression based on findings.

Input: Reason: 6 year old with history of juvenile pilocytic astrocytoma s/p chemotherapy - change in mass? History: JPA. There is redemonstration of postoperative changes within the right posterior fossa. There is redemonstration of a predominantly extra-axial soft tissue mass at the right cerebellopontine angle measuring approximately 3.7 x 2.3 cm in greatest axial dimensions on 701/19, not significantly changed compared to multiple remeasurements dating back to 9/22/2015 as not all prior reference measurements are available. For example, on the 3/23/2016 exam, the mass remeasures 3.9 x 2.2 cm. There is redemonstration of encasement of the vertebro basilar arteries at this level, as well as extension into right Meckel's cave and internal auditory canal. Additional lobule of the tumor extends caudally along the dorsal lateral aspect of the cord, extending out of the axial field-of-view. Cystic components more inferiorly remain unchanged in size. There is no significant corresponding enhancement. There is persistent significant mass effect upon the caudal brainstem and upper cord.There is a right posterior parietal approach ventriculostomy catheter stable position, with the tip of the catheter near the right foramen of Monro. The lateral and third ventricles are stable and decompressed. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. There is prominent mucosal thickening in the sphenoid sinuses bilaterally. Both palatine tonsils are somewhat prominent, likely within normal limits for a patient this age.

Output: 1. Continued stable appearance of predominantly extra-axial right posterior fossa mass, with continued mass effect upon the caudal brainstem and upper cord.2. Interval significant bilateral sphenoid mucosal thickening which is nonspecific. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 58 years, Male, evaluate for progression of metastatic disease. Malignant neoplasm of right lung. There is no intracranial mass or abnormal parenchymal or meningeal enhancement. There is extensive T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter which is nonspecific but compatible with posttreatment-related and/or advanced chronic small vessel ischemic changes; this finding is similar to prior. There is moderate degree of global parenchymal volume loss. There are few scattered foci of susceptibility consistent with chronic microhemorrhages primarily in the left parietal lobe and also one in the right inferior cerebellar vermis; some of these are present on recent MRI from 8/23/2016 and not seen on earlier studies. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.There is a right maxillary mucus retention cyst. No gross destructive calvarial lesions are appreciated.

Output: 1. No evidence of progression of intracranial metastatic disease.2. No evidence of recurrence of a previously treated right frontal lesion.3. Extensive white matter signal abnormality is similar to prior and may represent treatment effect and/or chronic small vessel ischemic disease.4. Few punctate foci of susceptibility effect are nonspecific but compatible with chronic microhemorrhages or mineralization. These are primarily in the left parietal lobe and are new or more prominent than multiple prior studies. There is no associated enhancement but suggest attention on follow-up.


Instruction: Generate impression based on findings.

Input: Prostate cancer PELVIS:PROSTATE:Prostate Size: 3.2 x 4.9 x 3.5 cm (AP x TR x CC; series 801, image 15).Peripheral Zone: Nodular focus of T2 hypointensity involving the left peripheral zone at the apex with associated low ADC signal and is suspicious for carcinoma (series 801, image 13). Additional scattered foci of T2 signal abnormality are present.Central Gland: Benign prostatic hyperplasia.Seminal Vesicles: No significant abnormality noted. Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Nodular focus of T2 signal abnormality involving the left peripheral zone at the apex is suspicious for carcinoma.2.No evidence of extracapsular extension, seminal vesicle invasion, or lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female, 14 years old, with likely ovarian yolk sac tumor, baseline brain MRI evaluating for metastases. Image quality is reduced by mild motion artifact. Within this limitation, the following observations are made.No evidence of parenchymal edema or significant parenchymal signal abnormality is seen. No pathologic parenchymal or extra-axial enhancement is detected.Diffusion-weighted images are normal. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection are seen. The ventricular system is normal in size and morphology.

Output: Within the limitations of mild motion degradation, no evidence of intracranial metastasis is seen.


Instruction: Generate impression based on findings.

Input: Syrinx, tethered spinal cord and back pain. For the purposes of numbering, the most inferior well-defined disc space is labeled L5-S1. Low-lying conus near the lumbosacral junction and postoperative changes related to prior cord untetherings again seen. Distal thecal sac is ectatic and demonstrates septations, findings which are not appreciably changed. As before, the distal spinal cord abuts and may be adherent to the posterior thecal sac. Cauda equina nerve roots are also peripherally located as seen before which may also be reflective of adhesion/arachnoiditis. Prone images demonstrate no appreciable ventral motion of the distal cord again raising possibility of re-tethering in the appropriate clinical setting.No significant change in diameter or craniocaudal extent of visualized distal cord syrinx extending from approximately the L1 to the L3-L4 levels and measuring up to 2 x 4 mm in the axial plane. Syrinx is decreased in size when compared to earlier MRI from 3/30/2016.Alignment is anatomic. Vertebral body heights and intervertebral disc spaces are preserved. The bone marrow demonstrates a normal signal. No spinal canal or neural foraminal stenosis is seen at any level.

Output: 1. No significant change in examination compared to 7/14/2016 including the small distal cord syrinx. Syrinx is mildly decreased in size when compared to 3/30/2016. 2. There is no significant ventral motion of the distal cord in the prone position raising possibility of re-tethering, although this finding has been present on multiple prior studies.


Instruction: Generate impression based on findings.

Input: There is an enhancing dural-based mass centered on the planum sphenoidale with extension towards the partially empty sella, measuring 15 x 11 x 20 mm. This mass abuts the optic chiasm and is isointense to gray matter on unenhanced T1 and T2 weighted images. Two small additional lesions are again noted over the right frontal convexity, measuring up to 9 mm, which on the prior CT examination displayed calcification. There is mild prominence of the lateral and third ventricles, as well as the sulci due to diffuse cerebral volume loss. There is persistent moderate soft tissue crowding at the foramen magnum with a somewhat pointed morphology of the cerebellar tonsils, which extend up to 7 mm inferior to the foramen magnum. There is unchanged prominence of extra-axial space posterior to the cerebellum. There is minimal nonspecific scattered cerebral white matter T2 hyperintensity. There is no acute infarct or midline shift. There are bilateral lens implants. There is a posterior disc-osteophyte complex at C3-4, which appears to indent the spinal cord.

Output: 1.The planum sphenoidale mass and smaller dural-based extra-axial masses over the right frontal convexity are stable in size, accounting for difference in technique, and likely represent meningiomas.2.Findings consistent with Chiari I malformation.3.No evidence of acute infarction or intracranial hemorrhage. 4.A posterior disc-osteophyte complex at C3-4, which appears to indent the spinal cord. Dedicated cervical spine imaging may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. The conus medullaris ends at mid L2 level which is within normal limits. There is a 14 AP x 32 CC x 9 ML mm nonenhancing intradural extramedullary cystic mass extending from the tip of the conus medullaris inferiorly to the mid L5 level. It has a broad base along the posterior dural surface and follows CSF signal on all sequences. This mass causes mass effect with displacement of the cauda equina nerve roots ventrally which drape around the contour of the mass. There is no dysraphism. There is linear nonenhancing 2-mm thick intrinsic T1 shortening structure along the posterior midline aspect of the thecal sac inferior to the lower aspect of the cystic mass likely representing fatty filum. Lack of prone imaging limits evaluation.There are no vertebral body anomalies in the lumbar spine. There is no pathologic enhancement elsewhere. The vertebral body heights are intact. The osseous marrow signal is within normal limits. The intervertebral disks show normal height and signal intensity.

Output: 1.Large dorsal intradural extramedullary nonenhancing CSF signal cyst described above with displacement of the cauda equina nerve roots which are draped around the contour of the cyst. Differential considerations include arachnoid cyst versus epidermoid. Given absence of associated vertebral body anomalies in the lumbar spine at the levels of the cyst, neuroenteric cyst is felt to be unlikely.2.Conus medullaris terminates at L2 which is within normal limits. Likely incidental fatty filum, although sometimes it can be associated with a tethered cord. Prone imaging was not performed as this was an unexpected finding. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: Asymmetric hyperreflexia. Study is at least moderately limited by patient motion and body habitus.Straightening of the cervical spine may reflect patient positioning. The vertebral bodies are preserved in height. Marrow signal shows loss of the normal fatty signal which most likely reflect end-stage renal disease. Intervertebral discs are notable for partial loss of T2 signal at C2-C3 and C3-C4. Disc heights are fairly preserved. The spinal canal is fairly preserved. There is no gross compression on the thecal sac. The spinal cord also shows grossly normal morphology and signal. Included posterior fossa shows no gross abnormality. There is fluid in the mastoid air cells.C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: Small central disc-osteophyte complex but no significant spinal canal or foraminal stenosis.C4-C5: Shallow posterior disc-osteophyte complex indents the thecal sac. There is no significant spinal canal and only mild left foraminal stenosis. C5-C6: There is no significant spinal stenosis. There is left facet arthropathy but no significant foraminal stenosis.C6-C7 and C7-T1: There is no spinal canal or foraminal stenosis.

Output: 1.The examination is limited as described above.2.Mild multilevel degenerative spondylosis is present but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 54 year old female with hypertension, headaches, altered mental status. Please evaluate for evidence of acute bleed. There is a subcortical hypodense region in the right frontal lobe which likely represent ischemic changes of indeterminate age. MRI is recommended for further evaluation.Diffuse subcortical white matter hypodensities likely represent small vessel skin disease of indeterminate age.The ventricles and basal cisterns are normal in size and configuration.An old left zygomatic arch buckle fracture is noted. An old right zygomatic arch nonhealed fracture is noted. Additional fracture in the lateral wall of the orbits and bilateral surgical wires in the zygomatic arches are noted. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Right frontal lobe hypodensity may represent ischemic changes of indeterminate age with additional diffuse white matter hypodensities that may represent small vessel skin disease. MRI is recommended for further evaluation. No evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Type 2 diabetes mellitus, bacteremia with MRSA. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are multiple areas of abnormal fatty marrow replacement including T12, L1, L2 and L3. Especially L2 and L1 vertebral body were most extensive. There is minimal less than 5% compression fracture of L3 vertebral body.On contrast enhancement, those areas of low signal intensity on T1-weighted images show diffuse enhancement. On axial scan, post gadolinium enhancement images show ill-defined enhancement of soft tissues mesial aspect of bilateral psoas muscles and prevertebral space with some foci of non enhancing areas. Especially at the level of L2 vertebral body, the anterior epidural space shows slightly thicker enhancement than other level but does not particularly show mass formation. This finding could suggest possible inflammatory extension toward anterior epidural space but could also be engorged basivertebral vein due to surrounding inflammation.These findings are suggestive for multilevel vertebral osteomyelitis extends toward paravertebral space. The paravertebral space lesions are likely represent phlegmon type of lesion with some internal small abscess formation.There is no evidence of epidural abscess formation or hemorrhage.There is about 22.2 mm sized right renal cyst and 12.8 mm sized left renal cyst.On the right side external to back muscle group fascia, there is well circumscribed fat containing lesion within the subcutaneous tissue likely represent lipoma. The entire lesion was not imaged with this scan, thus if indicated, consider abdominal CT scan.There is normal lumbar lordosis. The spine alignment is anatomic. 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. The conus medullaris terminates at the L1 level.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: no neuroforaminal narrowing or spinal stenosis. L5-S1: disc dessication. no neuroforaminal narrowing or spinal stenosis.

Output: 1. Osteomyelitis involving T12, L1, L2 and L3 with main focus on the L2 and L1. Minimal compression fracture of L2 as described above.2. Evidence of paravertebral and pre vertebral inflammation with possible phlegmon with some internal abscess formation around L1 and L2 vertebral body level.3. Spinal canal and spinal cord appear to be normal.4. Disc dessication at the level of L5S1.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Stroke. Non-enhanced CT brain:Small left likely stroke is again identified. The corner infarct the left pons is again noted. Old likely hemorrhagic lacunar infarct of left basal ganglia is again identified. There is ex vacuo dilatation of left lateral ventricle secondary to this large stroke.There is no evidence of new hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The study is essentially stable since prior exam. If concern for new strokes persist follow-up with an MRI is recommended.

Output: Multiple old strokes and no evidence of acute new intracranial findings. Stable exam.


Instruction: Generate impression based on findings.

Input: 57-year-old man with history of SDHB mutation and predisposition to paragangliomas. NECK:No distinct mass or significant lymphadenopathy. Osseous structures unremarkable. The imaged intracranial structures unremarkable.CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.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: Sigmoid diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of tumor, specifically no paraganglioma or adrenal tumor seen.


Instruction: Generate impression based on findings.

Input: 52-year-old male. History prostate cancer. Patient scheduled for RALP. PELVIS:PROSTATE:Prostate Size: 3.5 x 3.9 x 4.5 cm. Peripheral Zone: In the apex, there is extension of tumor from the transitional zone into the medial left peripheral zone (series 801, image 11). 1.2 x 0.5 cm T2 hypointense lesion in the left base and a subcentimeter lesion in the medial right base, suspicious for additional tumor foci (series 801, image 16).Central Gland: Diffusion restricting, T2 hypointense lesion in the anterior and left transitional zone in the apex consistent with prostate cancer, measuring 1.9 x 1.1 cm (series 801, image 11). The anterior component of tumor measures 1.8 x 0.7 cm, with broad based extension to the fibromuscular stroma and is concerning for extracapsular extension (series 801, image 13).Seminal Vesicles: None.Extracapsular Extension: Findings suspicious for extracapsular extension at the anterior fibromuscular stroma, as described above.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multifocal prostate cancer with dominant lesion in the central to left TZ and medial left peripheral zone at the apex. Findings suspicious for extracapsular extension at the anterior fibromuscular stroma.


Instruction: Generate impression based on findings.

Input: 60 year-old male with history of lung cancer with new onset of seizure possible brain metastasis on outside hospital. Multiple intracranial enhancing tumors are consistent with multiple metastatic foci.The largest lesion measures 9.3-mm times 14-mm in height convexity left posterior parietal (axial image 22). Extensive surrounding edema causes effacement of the adjacent cortical sulci. No evidence of midline shift is detected. No evidence of hydrocephalus is present. There are 4 lesions identified however further evaluation with an MRI is highly recommended for precise evaluation.No evidence of hemorrhage is present.No definitive evidence of calvarial metastatic lesion is detected.

Output: Multiple non-hemorrhagic enhancing intracranial metastatic lesions of both cerebral hemispheres.


Instruction: Generate impression based on findings.

Input: 68-year-old female presents with right wrist pain after a fall, evaluate for tear of the triangular fibrocartilage complex. Some sequences are limited by patient motion artifact.TRIANGULAR FIBROCARTILAGE COMPLEX: Gadolinium extends from the radiocarpal joint into the distal radioulnar joint through a large tear of the articular disc of the triangular fibrocartilage complex near its radial attachment. There is also undulation and increased signal intensity within the volar radioulnar ligament which is suspicious for a tear of this structure. LIGAMENTS: Contrast is also noted within the mid-carpal joint, perhaps from a tear of the membranous portion of the lunotriquetral ligament, however, the actual defect is not well defined. No definite tear of the scapholunate ligament is identified.TENDONS: There is a small amount of fluid along the extensor pollicis longus tendon as it courses over the second compartment tendons, of questionable significance. The remaining tendons appear intact. BONES: There is a fracture through the hook of the hamate best seen on image 10 of series 9 with edema in the adjacent medullary bone. Bone marrow signal intensity is otherwise normal.ADDITIONAL

Output: Tear of the triangular fibrocartilage complex and fracture of the hook of the hamate. These findings were relayed to the patient following the procedure. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 63-year-old male with generalized weakness, questionable aspiration pneumonia, and partial left facial droop. Evaluate for left-sided stroke. Questionable loss of gray-white differentiation in the right frontal region raises the possibility of acute stroke, though this may be further characterized by MRI. Encephalomalacia in the left MCA territories compatible with prior stroke. There is no intracranial hemorrhage or abnormal extra-axial fluid collections. The ventricles are midline, with normal volume and morphology.The calvaria and other osseous structures are intact. Visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Loss of gray-white differentiation in the right frontal lobe may represent acute stroke, with no evidence of acute intracranial hemorrhage. Further evaluation by MRI is recommended.2. Evidence of old stroke in the left MCA territory.


Instruction: Generate impression based on findings.

Input: Diagnosis: LumbagoClinical question: follow up study. Lesion in lumbar vertebraSigns and Symptoms: painful lower back Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is redemonstration of a 9mm lesion along the inferior aspect and inferior endplate of the L1 vertebral body which was previously associated with T2 signal hyperintensity. This T2 signal hyperintensity has resolved since the prior exam.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.A lesion at the inferior aspect of L1 has the appearance of a large Schmorl's node. Previously seen inflammatory change associated with this have resolved and it is now in a more chronic stage.


Instruction: Generate impression based on findings.

Input: 37 year old female with strong family history of breast cancer (sister diagnosed with breast cancer at age 38) presents for screening MRI. Per EPIC, the patient is currently breast-feeding. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.Due to marked parenchymal enhancement, an evaluation of the breast is limited.With this limitation, no abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: Limited study due to marked parenchymal enhancement.Follow up MRI in 6 months is recommended.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3A - Followup at Short Interval (Within 6 Months).


Instruction: Generate impression based on findings.

Input: 79-year-old woman with history of endometrioid adenocarcinoma with sarcomatoid transformation status post radiation. PELVIS:UTERUS, ADNEXA: Previously seen enhancing, lobulated endometrial mass involving the lower uterine segment has now significantly increased in size measuring up to 82 x 50 mm (601/22), previously 71 mm. Of note, the tumor now extends into the upper vagina (601/21) and extends around the anterior mucosal surface of the uterine body (601/22). The tumor also extends through the wall of the uterus and abuts the serosal surface. The amount of endometrial fluid has increased with fluid fluid layer suggestive of hemorrhagic contents.Multiple fibroids of varying size are noted in the uterine fundus and body.BLADDER: The bladder does not appear involved by the endometrial tumor.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Significant increase in size of endometrial tumor with extension into the upper vagina and to the anterior uterine body.2.No definite evidence of extraserosal extension or regional lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Male, 83 years old, with neck and arm pain, altered gait. Spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are heterogeneous but benign. Endplate marrow signal change is seen related to disc degeneration. No evidence of significant marrow edema is detected.C2-3: Unremarkable. C3-4: Right greater than left facet hypertrophy. Ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis. Slight cord deformation but no cord signal abnormality. Moderate to severe bilateral foraminal narrowing. C4-5: Left greater than right facet hypertrophy. Ligamentum flavum thickening. Posterior disc osteophyte complex formation. Severe generalized spinal canal stenosis. Spinal cord deformation but no cord signal abnormality. Moderate left and mild right foraminal narrowing. C5-6: Left facet hypertrophy. Ligamentum flavum thickening. Posterior disc-osteophyte complex formation asymmetric to the right. Severe generalized spinal canal stenosis. Cord deformation but no cord signal abnormality. Moderate to severe right and minimal left foraminal narrowing. C6-7: Bilateral facet hypertrophy. Mild posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. No mass effect upon the cord. Moderate bilateral foraminal narrowing. C7-T1: Facet hypertrophy. No significant spinal canal or foraminal stenosis.

Output: Multilevel cervical spondylosis with moderate spinal canal stenosis at C3-4, and severe spinal canal stenosis at C4-5 and C5-6. The spinal cord is deformed at these levels but there is no evidence of cord signal abnormality. Scattered foraminal narrowing is also noted as discussed above.


Instruction: Generate impression based on findings.

Input: Chronic diarrhea. Evaluate for chronic pancreatitis. Status post orthotopic liver transplant. ABDOMEN:LIVER, BILIARY TRACT: The patient is status post liver transplant. No focal hepatic lesions are seen. No biliary ductal dilation is present. SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is normal in signal and enhancement. There is no focal pancreatic lesion evident. The pancreatic duct is normal in caliber. No peripancreatic fluid collections are present.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal appearing bowel loops in the imaged upper abdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No intra-abdominal fluid collections.

Output: 1. Normal MR appearance of the pancreas.2. No specific findings to account for the patient's chronic diarrhea.


Instruction: Generate impression based on findings.

Input: Elevated PSA. PELVIS:PROSTATE:Prostate Size: IsPeripheral Zone: In the left paramedian region, there is a 1.5 x 0.5 cm T2 hypointense focus (axial series 401 image 82). The margins have a more linear appearance rather than convex.A faintly T2 hypointense focus in the left apex (axial series 601 image 9) is felt to be artifactual due to its linear appearance in the corresponding coronal location (series 501 image 14).Central Gland: Nodular appearance compatible with BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: There is nonspecific T2 hyperintense signal within the left pectineus muscle (axial series 1301 image 52).OTHER: Small fat-containing left inguinal hernia.

Output: 1.Despite the absence of the convex margins, a 1.5 x 0.5 cm T2 hypointense focus in the left paramedian region is concerning for malignancy in the context of elevated PSA.2.Benign prostatic hypertrophy.3.Nonspecific increased T2 signal intensity within the right pectineus muscle could represent strain/injury versus tendinopathy. Correlate with patient's clinical history and symptoms.


Instruction: Generate impression based on findings.

Input: 51-year-old male with radicular pain in the left lower extremity, assess for left lumbar radiculopathy. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. There is mild fibrofatty infiltration of the filum terminale measuring 1-2 mm in thickness which can be a normal variant. Paraspinous soft tissues are within normal limits.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. Mild facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. Mild facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge and bilateral facet arthropathy. There is mild spinal stenosis which appears slightly worse related to increased prominence of the epidural fat when compared to the prior exam. There is mild left and minimal right neural stenosis.L4-L5: Moderate degree of fatty endplate marrow signal changes is similar to prior. There is mild disc bulge, facet arthropathy, ligamentum flavum thickening, and prominence of the epidural fat. There is mild to moderate spinal canal stenosis, minimally worse since prior. There is partial effacement of the lateral recesses. There is mild to moderate left greater than right neural foraminal stenosis similar to prior without clear evidence of nerve impingement.L5-S1: There is a mild disc bulge without significant interval change. There appears to be moderate spinal canal stenosis related to increased prominence of the epidural fat as well as the epidural venous plexus which narrows the thecal sac compared to the prior exam. No significant neural foraminal stenosis.

Output: 1. Multilevel degenerative changes in the lumbar spine. Compared to 12/22/2010, there is worsening of spinal canal stenosis in the lower lumbar spine primarily related to increased prominence of the epidural fat which circumferentially narrows the thecal sac; from L4-5 to L5-S1 there is up to moderate spinal canal stenosis.2. At L4-L5 there is mild to moderate left relatively greater than right neural foraminal stenosis, which is similar to prior. No high grade neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Head trauma with passing out episodes precipitated by laughter, assess for thalamic hamartomas or other abnormalities History: h/o head trauma with passing out episodes precipitated by laughter, assess for hamartomas or other abnormalities. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few mild scattered The brain parenchyma otherwise appears unremarkable. In particular, the hippocampi are intact and there is no evidence of hamartomas. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. However, there is flattening of the pituitary gland. 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 a few scattered retention cysts in the paranasal sinuses.

Output: No evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: 54 male with right knee pain and swelling. Evaluate for chondral injury. MENISCI: No meniscal tear is identified.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the lateral patellar cartilage. The cartilage otherwise appears intact. Small subchondral cyst/mild bone marrow edema is seen in the lateral tibial plateau and medial facet of the patella. Note is also made of a benign enchondroma in the distal femoral metaphysis.LIGAMENTS: No evidence of ligamentous injury.EXTENSOR MECHANISM: No evidence of injury to the extensor mechanism.ADDITIONAL

Output: Degenerative changes without evidence of acute injury.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for artifact. Lesion/tumor or other causes of anosmia. Signs and symptoms: Anosmia for 6 months. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates no detectable abnormality of the skull base, bilateral frontal regions or the olfactory bulbs. Very minimal opacification of right ethmoid air cells is noted suggestive of minute sinusitis and unremarkable other paranasal sinuses.There is a focus of encephalomalacia in the right occipital and medial aspect of right temporal lobe posteriorly as well as a tiny focus in the right thalamus all suggestive of small foci of ischemic stroke in the distribution of right PCA.There is normal anatomic cord morphology of the brain parenchyma and with normal signal intensity on all MRI sequences otherwise.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of all major intracranial arterial branches are identified.Post contrast images demonstrate no abnormal parenchymal, leptomeningeal or calvarial enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Normal signal intensity of intracranial venous sinuses with normal pattern of enhancement.

Output: 1.No diffusion-weighted abnormality.2.No evidence of pathology to explain patient's anosmia. Unremarkable calvarium and skull base.3.Foci of FLAIR hyperintensity in the right occipital, medial aspect of right posterior temporal and right thalamus suggestive of chronic ischemic changes of PCA territory.4.Unremarkable pre and post enhanced brain MRI otherwise and without abnormal enhancement.5.Minute right ethmoid sinus disease and unremarkable paranasal sinuses otherwise.6.Images through the nasal passage demonstrate moderate leftward nasal septum deviation.


Instruction: Generate impression based on findings.

Input: NECK: There are extensive postoperative findings related to right orbital and sinonasal exenteration with myocutaneous flap reconstruction. The lesion in the roof of the left posterior nasopharynx along the surgical margin is no longer measurable. The previously demonstrated punctate right temporal scalp subcutaneous tissues nodule is not apparent. The right temporal fossa enhancing lesion with an adjacent underlying calvarial defect, right squamosal temporal bone calvarial lesion with extension into the overlying scalp has decreased in size, and right mandibular body lesion are not significantly changed. There is unchanged asymmetric enhancement in the right foramen rotundum. There are persistent obstructed secretions in the frontal and sphenoid sinuses and mucosal thickening and fluid in the left maxillary sinus. There is nonspecific high T2 signal in the bilateral mastoid air cells. There is no evidence of significant lymphadenopathy in the neck. The thyroid and salivary glands appear unchanged.BRAIN: There is no abnormal intraparenchymal enhancement, acute infarct, mass, herniation, or midline shift. There are unchanged scattered T2 hyperintensities in the subcortical and periventricular white matter, which are nonspecific. The ventricles and sulci are unchanged.

Output: 1.Unchanged metastases in the skull and mandible, but no measurable residual tumor in the left posterior nasopharynx along the surgical margin and in the right scalp.2.Persistent mild asymmetric enhancement in the right foramen rotundum may be post-treatment in nature.3.No evidence of brain metastases.4. Findings suggestive of acute left maxillary sinusitis with otherwise persistent obstructed secretions associated with the exenteration flap.


Instruction: Generate impression based on findings.

Input: cT4N1M0 squamous cell carcinoma of the left maxillary sinus. There is a bulky heterogeneous and infiltrative mass centered in the left sinonasal region, completely obliterating the left maxillary sinus and much of the left nasal cavity and ethmoid sinuses, with extension into the inferior and medial extraconal orbit, abutting the left inferior rectus muscle and globe, and into the overlying left facial subcutaneous tissues with surrounding fat stranding and into the retromaxillary space. There is also compression of the left nasolacrimal duct, with dilatation of the lacrimal sac. Overall, the mass measures up to approximately 7 cm. There are secretions and mucosal thickening in the left frontal sinus and portions of the bilateral ethmoid sinuses. The left optic nerve is intact. The right orbit is unremarkable. There is no significant upper cervical lymphadenopathy. The salivary glands appear to be intact. There is no evidence of gross intracranial tumor. There is no evidence of acute cerebral infarction, hemorrhage, or ventriculomegaly. There is minimal nonspecific periventricular T2 hyperintensity.

Output: A large, aggressive mass centered in the left sinonasal region with extension into the left extraconal orbit, the overlying left facial subcutaneous tissues, and the retromaxillary space is compatible with a squamous cell carcinoma.


Instruction: Generate impression based on findings.

Input: History of migraine. Comment a history of cerebral aneurysm. Nonenhanced CT of brain:A there is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. Considering multiple normal prior CT examinations recommend an MRI examination to exclude possibility of pathology not appreciated on an not infused head CT.Calvarium, limited field paranasal sinuses and mastoid air cells are also within normal limits. No change since prior examinations.CTA of intracranial circulation:There is normal visualization of bilateral intracranial vertebral arteries, bilateral pica branches, basilar artery, posterior cerebrals and superior cerebellar arteries.Normal appearing bilateral cavernous internal carotid arteries and their supraclinoid components. There is no visualization of posterior communicating arteries. This is a normal anatomical variation. Bilateral anterior cerebral arteries and including anterior communicating artery remains within normal. Both middle cerebral arteries and their branches are within normal.

Output: 1.Normal nonenhanced CT brain and calvarium. Stable since prior study from 2009.2.Negative CTA of intracranial vasculature.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, scalp soft tissues, and orbits are unremarkable. There is a mucous retention cyst in the right maxillary sinus and minimal opacification of the anterior ethmoid air cells.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The right A1 segment is hypoplastic which is a normal variant. The middle and anterior cerebral arteries are otherwise unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: Unremarkable noncontrast MRI brain and MRA head.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient with a T12 bone lesion and left paraspinous lesion previous confined by an and the aspiration. Differential is infection and tumor. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion and the paraspinous soft tissue collection.

Output: T12 vertebral bone biopsy under CT guidance. A total of three samples were delivered to pathology for analysis and 5 bone samples and a 2mL aspirate from a paraspinous collection were sent to microbiology for analysis.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: S/p SRS for brain metastasis. Surveillance exam. History: S/p SRS for brain metastasis. Surveillance exam. Previously seen right side the enhancing lesion at the junction of right post central sulcus and intraparietal sulcus shows interval decrease in size (which measures about 5.6 mm which was about 8 mm).There is no evidence of another abnormal enhancing lesion.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1.Interval decrease of the size of previously seen right postcentral surface and right intraparietal sulcus junctional enhancing lesion since prior scan.2. No other abnormal enhancing lesion is seen.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 38 year-old male status post MVC with loss of consciousness and head and neck pain. Rule out bleed. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Examination of the neck reveals normal alignment no acute fracture. Soft tissue density is seen at C4/C5 that may represent a disc protrusion. MRI is recommended for further evaluation.Degenerative disc disease also at C5/C6 with mild narrowing of the neural foramina bilaterally.

Output: Normal brain CT.Focal soft tissue density at C4/C5 that may represent disc protrusion. An MRI is recommended for further characterization. No fractures or malalignment is identified.


Instruction: Generate impression based on findings.

Input: Diagnosis: Thoracic or lumbosacral neuritis or radiculitis, unspecifiedClinical question: assess stenosisSigns and Symptoms: radiculopathy Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is some loss of disc space height as well as a disc bulge at this level and a disc desiccation.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level. There is mild loss of disc space height and a mild disc desiccation at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is an incompletely included cystic lesion present in the left side of the pelvis measuring approximately 50 x 44 mm in sagittal dimensions . It is bright on T2 and dark on T1-weighted imaging.

Output: 1.There are some mild degenerative changes present in the lower lumbar spine without significant compromise to spinal canal or exiting nerve roots.2.There is a left pelvic cystic lesion present which is not completely included on this exam. Please correlate with clinical exam findings. If clinically appropriate an ultrasound of the pelvis may be of benefit to further evaluate this. One possibility is that this is related to the left ovary.3.At the time of this dictation alphanumeric page was sent to Dr. James Mok with the above unusual finding and callback number. In addition an email was sent to Dr Mok as well.