Instruction: Generate impression based on findings.

Input: Male, 11 years old, with cough, potentially representing a tic. A T2 hyperintense, cystic-appearing lesion is evident arising from or protruding into the left medial thalamus. The lesion measures approximately 10 x 9 x 6 mm. Along the posterior margin of the lesion there is a 4 mm enhancing nodule which, although it resembles the pineal gland, is situated well above the typical location of the pineal. The native pineal gland is otherwise not discretely visualized, which could be technical. The lesion appears to indent the posterior aspect of the third ventricle. However, there is no associated mass effect on the cerebral aqueduct, and no evidence of ventricular obstruction.The cerebral hemispheres otherwise demonstrate normal morphology and signal characteristics. No evidence of significant edema or mass effect is seen. No diffusion restricting lesions are seen. No other pathologic parenchymal or extra-axial enhancement is observed. Ventricular size and morphology are within normal limits. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid is seen. No susceptibility inducing lesions are detected.

Output: A cyst-like lesion measuring up to 1 cm is demonstrated arising from or projecting into the medial surface of the left thalamus. An adjacent small enhancing nodule is favored to be related to the cyst as it is positioned above the typical location of the pineal gland.The differential diagnosis for this finding is broad and would include inflammatory lesions including atypical or parasitic infection. Cysticercosis would be a consideration in the context of the appropriate travel or exposure history. An early neoplastic process would be in the differential as well, particularly if the enhancing nodule is indeed associated with the cyst. A congenital lesion is considered somewhat less likely but not entirely excluded. For example, this could represent an atypical pineal cystic lesion with ectopic positioning of the pineal gland, or perhaps an ependymal cyst.On subsequent imaging, it is recommended to obtain high-resolution imaging centered on the midline, as would be provided in the dedicated pineal protocol. This would allow better characterization of the lesion and its relationship to the actual pineal gland.


Instruction: Generate impression based on findings.

Input: Aphasia [R47.01], Reason for Study: ^Reason: stroke History: slurred speech and left sided weakness Brain MRI:Motion artifact degraded image qualityNo evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. No evidence of intracranial arterial aneurysm, no significant (more than 50%) arterial luminal stenosis.


Instruction: Generate impression based on findings.

Input: Ms. Hamilton is a 62 year old female with a strong family history of breast cancer in her sister (diagnosed at the age of 59), paternal grandmother (diagnosed in her 70's) and paternal cousin (diagnosed at the age of 50). Personal history of benign left breast MR-guided biopsy in 08/2010 for atypical lobular hyperplasia. There is scattered fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.Multiple foci of scattered enhancement are seen bilaterally, all of which appear stable in distribution and appearance when compared to prior exams. No one focus appears more suspicious than the rest. Susceptibility artifact from the benign MR guided biopsy in the left central breast is unchanged. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Female, 82 years old, with radiculopathy and low back pain. Assess for progression of spinal stenosis. Mild levoscoliosis is again seen centered at L2-3. Sagittal alignment is otherwise unremarkable. Vertebral body heights are preserved. Extensive endplate degenerative marrow signal is seen, similar to prior. Mild marrow edema within the left L5 pedicle and facet complex, likely degenerative in nature, is similar to prior. No other evidence of marrow edema or concerning marrow replacement is observed.T12-L1: Facet hypertrophy and ligamentum flavum thickening. Bulging disc, slightly progressed, with a small inferiorly directed central disc extrusion. Moderate spinal canal stenosis, progressed from prior. Moderate bilateral foraminal narrowing, unchanged.L1-2: Moderate to severe facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate to severe spinal canal stenosis with crowding of the cauda equina, similar to prior. Moderate bilateral foraminal narrowing, unchanged. L2-3: Severe facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate spinal canal stenosis with slight crowding of the cauda equina, unchanged. Moderate to severe bilateral foraminal narrowing, unchanged. L3-4: Severe facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate to severe spinal canal stenosis, unchanged. Mild to moderate bilateral foraminal narrowing, unchanged. L4-5: Severe facet hypertrophy and ligamentum flavum thickening. Bulging disc with a small central annular fissure and protrusion. Moderate to severe spinal canal stenosis, unchanged. Mild right and moderate left foraminal narrowing, unchanged. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Minimal disc bulge asymmetric to the right. No significant spinal canal stenosis. No significant foraminal narrowing. No interval changes.

Output: 1.Moderate spinal canal stenosis at T12-L1 has mildly progressed.2.Moderate to severe spinal canal stenosis from L1-2 through L4-5 is unchanged.3.Variable foraminal narrowing is unchanged as above.


Instruction: Generate impression based on findings.

Input: Tingling and numbness in third and fourth digits bilaterally Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild retrolisthesis of C5 on C6. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is mild retrolisthesis and small disc osteophyte complex which contribute to mild spinal canal narrowing. There is also uncovertebral hypertrophy on the right. There is resulting moderate right and mild left neural foraminal stenosis. There is abnormal low T2 signal dorsal to the C6 vertebral body which is suspected to represent subacute ligamentous disc extrusion and contributes to partial effacement of the ventral thecal sac centrally.C6-7: There is a disc osteophyte complex with bilateral uncovertebral hypertrophy and mild ligamentum flavum thickening. There is resulting mild spinal canal stenosis. There is uncovertebral hypertrophy which contributes to mild right and moderate left neural foraminal stenosis. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Degenerative changes at the C5-C6 and C6-C7 levels with mild spinal canal stenosis at these levels. There is abnormal signal dorsal to the C6 vertebral body which may reflect subligamentous extruded disc material and contributes to the mild spinal canal stenosis at this level. 2. There is moderate right C5-C6 and moderate left C6-C7 neural foraminal stenosis. There is also mild left C5-C6 and mild right C6-C7 neural foraminal stenosis. These findings may be contributing to patient's radiculopathy.


Instruction: Generate impression based on findings.

Input: Female, 77 years old, with cognitive decline, forgetfulness, language problems. No true restricted diffusion is seen. A focus of diffusion hyperintense signal in the right parietal white matter shows no ADC correlate compatible with T2 shine through artifact.Patchy T2 hyperintensity is seen within the periventricular white matter and the pons. No significant parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The sulci and ventricles are mildly prominent but not beyond what is typically seen for age.On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected.

Output: 1.No acute intracranial abnormality and no specific findings to account for the patient's symptoms.2.Moderate chronic small vessel ischemic disease is seen.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:11/15/1961)Reason: stage IV uveal melanoma assess for dse status prior to study enrollment. History: uveal melanomaPROVIDER/ATTENDING NAME: JASON JOHN LUKE JASON JOHN LUKE The right eye appears circumferentially distortedThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a minor opacity in the left ethmoid air cells.. The visualized portions of the mastoid air cells are clear.

Output: 1.Please note that ophthalmoscopy may be more sensitive in evaluation of uveal melanoma a relative to MRI of the brain. The patient is status post right eye treatment.2.There is no evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: Lumbar pain. Fracture versus disc bulge. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. No evidence of fracture within the limits of MRI. Alignment is within normal limits aside from mild straightening. Bone marrow signal is benign. There is a small nonspecific focus of fat attenuation involving the anterior superior L3 vertebral body. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: Disc desiccation with mild height loss. There is a central and left greater than right paracentral disc protrusion. There is contact of the descending S1 nerve roots without impingement. No significant spinal canal or neural foraminal stenosis.

Output: Small disc protrusion at the L5-S1 level. No significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 84-year-old female patient with biliary ductal dilatation. ABDOMEN:LIVER, BILIARY TRACT: There is mild intrahepatic biliary ductal dilatation. The common bile duct is dilated up to 14 mm proximally and smoothly tapers distally without evidence of an obstructing mass. The gallbladder is absent. Multiple scattered subcentimeter T2 hyperintense lesions likely represent biliary hamartomas. Mildly decreased signal on out of phase imaging is compatible with hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: There is age-related fatty atrophy of the pancreas. Multiple subcentimeter cystic lesions within the pancreas likely represent sidebranch IPMNs. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Intra- and extrahepatic biliary ductal dilatation without evidence of an obstructing mass; this is likely secondary to a post-cholecystectomy state given normal bilirubin.2.Subcentimeter cystic hepatic and pancreatic lesions likely representing biliary hamartomas and sidebranch IPMN's, respectively.3.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Reason: possible urethral diverticulum History: dribbling, suburethral mass PELVIS:UTERUS, ADNEXA: The uterus is anteverted and anteflexed and is normal in size with reference measurements below. There are several round areas of low attenuation within the myometrium compatible with uterine fibroids. The largest is intramural/subserosal in the right anterior uterine fundus with reference measurements below.No adnexal masses are identified.BLADDER: Bladder is incompletely distended but grossly within normal limits.There is a crescentic fluid-containing structure (with "saddlebag" type configuration) along the posterior and left aspect of the urethra with reference measurements below compatible with a urethral diverticulum.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/23/2016 14:56:14)UTERUS: 7.4 x 4.1 cm (Image 48, Series 501); 4.0 cm (Image 46, Series 601).UTERINE FIBROID: 2.0 x 2.2 cm (Image 52, Series 501).URETHRAL DIVERTICULUM: 2.6 cm (Image 42, Series 501); 2.5 x 1.1 cm (Image 29, Series 601).

Output: 1.Fluid-containing structure inseparable from urethra, appearance compatible with a urethral diverticulum particularly given patient's clinical history.2.Several uterine fibroids.


Instruction: Generate impression based on findings.

Input: 59-year-old female with history of HCC, HCV/alcohol cirrhosis. History of TACE and RFA. Active on the liver transplant list. Evaluate liver lesions, size and characteristics. Last scan was MRI on 3/16/2001. Evaluate vasculature. LUNG BASES: No significant abnormality noted.ABDOMEN: LIVER, BILIARY TRACT: The liver has cirrhotic morphology. Numerous arterially enhancing lesions without washout are again seen throughout the liver, which appear similar to most recent MRI from 3/16/2011. Reference lesion in the inferior right hepatic lobe measures 1.4 cm; measuring 1.7 cm on prior MRI.However, there has been overall progression in size and number of lesions since MRI from 8/25/2010. For example, the aforementioned reference lesion in the inferior right hepatic lobe measured approximately 7 mm at that time.Segment 4 RFA cavity (series 11, image 25) measures approximately 2.6 x 1.1 cm, which is relatively stable on comparison to recent MRI when accounting for differences in technique. However, there is arterial enhancement seen along the superior margin of the RFA cavity (series 9, image 23; series 80613, coronal image 68) without definite washout on delayed images. This may represent marginal tumor recurrence.Gallstones.Portal and hepatic vasculature are patent. SPLEEN: No significant abnormality noted.PANCREAS: Coarse pancreatic calcifications, likely due to chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts bilaterally without areas of abnormal enhancement.RETROPERITONEUM, LYMPH NODES: Numerous small retroperitoneal lymph nodes. Previously described enlarged gastrohepatic lymph node measures 1.5 x 2.5 cm (series 11, image 36), which is relatively stable on comparison to recent MRI when accounting for differences in technique.BOWEL, MESENTERY: Mostly fat-containing ventral hernia (series 11, image 48) with a small amount of herniation of the anterior gastric wall at this level.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Small focus of arterial enhancement along the superior margin of the RFA cavity without definite washout on delayed phase imaging is suspicious for marginal tumor recurrence. The RFA cavity is otherwise stable in size. Patent hepatic and portal vasculature2. Numerous arterially enhancing lesions in the liver without washout appear similar to most recent MRI from 3/16/2011. However, when compared to MRI from 8/25/2010, there has been overall progression in size and number of these lesions.


Instruction: Generate impression based on findings.

Input: 68 years Male (DOB:9/20/1948)Reason: Primary CNS lymphoma History: please compare with last MRI; S/P therapyPROVIDER/ATTENDING NAME: CHADI NABHAN KENNETH S COHEN The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are multiple small foci of signal hyperintensity on T2 and FLAIR MR imaging in the basal ganglia (more on the right basal ganglia versus the left). These are stable and compared to the prior exam from June.There is a punctate focus of signal hypointensity on susceptibility imaging along the medial aspect of the left cerebellar hemisphere. A focus of signal hypointensity on susceptibility imaging is present in the left cerebellar hemisphere in a small focus of encephalomalacia. On the MRI from 5/15/2014 there is an enhancing lesion in this location.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No abnormal enhancing lesions are appreciated within the brain parenchyma to suggest CNS lymphoma.2.There are periventricular white matter lesions and subcortical white matter lesions as well as lesions in the basal ganglia and cerebellum which are stable and compared to the prior exam from June. These are nonspecific. Some of these may be vascular related and others may be posttreatment related.


Instruction: Generate impression based on findings.

Input: 6-year-old with history of allergies and chronic frontal headaches x 10 months. Increasing frequency, duration with fevers and conjunctivitis. Evaluate for intracranial lesion/sinusitis. CT of brain.Examination demonstrates focal area of low attenuation in the left high convexity anterior frontal lobe (images 32 and 33). This finding is nonspecific and could represent a small area of encephalomalacia of undetermined etiology. Possibility of edema cannot be ruled out and I recommend further evaluation with a dedicated infused MRI of brain.CT of paranasal sinuses.The frontal sinuses are not pneumatized. The sphenoid sinus remains within normal limits. Ethmoid sinuses are essentially unremarkable.Minimal patchy areas of mucoperiosteal thickening consistent with chronic inflammatory sinus disease of maxillary sinuses are noted. The right osteomeatal unit of the maxillary sinus is occluded secondary to mucoperiosteal thickening. The left osteomeatal is also suspected of being occluded secondary to mucoperiosteal thickening over this region is not very well visualized.

Output: 1.The small superficially located foci of low attenuation in the left frontal lobe as detailed. Unremarkable CT of brain otherwise. Follow-up MRI is recommended.2.Minimal chronic inflammatory sinus disease of maxillary sinuses with occluded OMUs.


Instruction: Generate impression based on findings.

Input: Reason: seizure, ischemia History: right arm numbness, aphasia, right visual field cut The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Pituitary MRI dated 1/15/15. There is a hypoenhancing lesion within the right pituitary gland that measures up to 12 AP x 10 SI x 15 RL mm and protrudes slightly into the right cavernous sinus. There is no mass effect upon the optic apparatus. The pituitary stalk is intact. There is an unchanged punctate T2 hyperintense lesion along the dorsal aspect of the clivus.

Output: 1. No significant interval change in the right pituitary adenoma.2. Unchanged probable ecchordosis physaliphora.


Instruction: Generate impression based on findings.

Input: 57-year-old male with history of chronic heart failure abdominal pain The study is limited due to poor perfusion secondary to patient's heart failure. Focal lesions and distal organs cannot be optimally evaluated.ABDOMEN:LUNG BASES: Significant cardiomegaly, bilateral pleural effusions, more prominent on the right compared to the left with dependent atelectasis consistent with patient's known heart failure.LIVER, BILIARY TRACT: Liver is enlarged with dilated hepatic veins and IVC secondary to heart failure. Focal, peripheral increased attenuation in the right lobe of the liver likely represents a perfusion abnormality. Focal lesions in the liver cannot be excluded.SPLEEN: No significant abnormality notedPANCREAS: Pancreas is atrophic with dilated duct and numerous parenchymal intraductal calcifications consistent with chronic pancreatitis.ADRENAL GLANDS: Slightly thickened left adrenal gland.KIDNEYS, URETERS: Perfusion of the kidneys is limited. Extensive atherosclerotic disease involving the aorta and renal arteries. Right renal cyst. Calcifications in the kidneys are likely vascular, however, small stones cannot be excluded.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications involving the entire vasculature atherosclerotic plaques and stenosis involving most of the visceral branches of the abdominal aortaBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites. Generalized anasarca.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: The tip of the left femoral venous catheter is in the right ventricle.Ill-defined enhancing lesions lateral to the right psoas muscle in the pelvis. On image number 79, series number 3, at the inferior aspect of this lesion, the lesion measures 2.4 x 2 cm. The etiology is unknown. MRI of the abdomen and pelvis may be helpful for further evaluation.

Output: Limited study due to poor perfusion secondary to patient's congestive heart failure.Cardiomegaly, bilateral pleural effusions, hepatomegaly, ascites, generalized anasarca secondary to patient's known heart failure.Severe and extensive atherosclerotic disease involving the entire vasculature.The tip of the left femoral venous catheter is in the right ventricle.Severe chronic pancreatitis.Enhancing soft tissue density lesions in the right retroperitoneum, adjacent to the psoas muscle. There etiology is unknown. They may represent neoplasm versus abscess. Further evaluation with MRI may be helpful.Bilateral renal calcifications, most of the more vascular, however, small stones cannot be excluded.Dr. Anveroy (3123) was notified and acknowledged about these findings at the time of dictation.


Instruction: Generate impression based on findings.

Input: 65 year old female with BRCA 2 gene mutation and a strong family history of breast and ovarian cancer including her mother and two maternal cousins. The patient underwent a benign left breast MRI guided biopsy on 6/13/2011. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are scattered foci of enhancement seen in both breasts.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: 16-year-old male with right knee pain. MENISCI: The lateral and medial menisci are intact and normal in appearance.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema of the lateral aspect of the distal metaphysis and diaphysis of the lateral femoral condyle of the right femur. Bone marrow signal is normal in the tibia and fibula. The articular cartilage is intact. No fracture. LIGAMENTS: There is a partial tear affecting the lateral collateral ligament complex. Anterior and posterior cruciate ligaments are intact. Intact medial collateral ligament.EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: Partial tear affecting the lateral collateral ligament complex and adjacent bone contusion of the distal metaphysis and epiphysis of the lateral condyle of the right femur. Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: 10-year-old male with sickle cell disease, ACS now with history of seizures and mental status change. There is no evidence of intracranial hemorrhage. Diffuse area of low density seen within the posterior aspect of the right temporal lobe and correlates with subacute ischemic changes and edema seen on brain MRI performed same day.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Blurring of the gray-white junction and low density seen in the posterior aspect of the right temporal lobe consistent with focal edema due to subacute ischemic process as correlated on an MRI performed same day.


Instruction: Generate impression based on findings.

Input: Female, 8 years old. Left thigh soft tissue defect. Pain w/ activity. 2-3mo duration, not improving Focal linear areas of increased signal on fluid sensitive sequences in the subcutaneous tissues of the left anterolateral thigh with overlying skin thickening. Abnormal signal extends to the underlying fascial plane but does not involve the muscle. There is no significant abnormal enhancement in this region. No discrete fluid collection or mass lesion is identified.The deep soft tissues, osseous structures, and imaged right thigh and intrapelvic structures are normal.

Output: A small area of scattered subcutaneous fluid signal in the left anterolateral thigh is nonspecific. No discrete fluid collection or mass lesion.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified disorders of muscleClinical question: please r/o stroke vs MS lesionsSigns and Symptoms: left sided sensory changes and weakness MRI of the brainThere is a 12 x 18 mm axial dimension focus of diffusion restriction present along the right thalamus and posterior limb of internal capsule.There is a moderate degree of periventricular and subcortical patchy hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are very small. The vertebral arteries are similar in size.

Output: 1.There is an acute ischemic cerebral infarction involving the right thalamus.2.There is no evidence for cerebrovascular occlusive disease present.3.There is a moderate degree of periventricular and subcortical white matter patchy lesions present. This is quite unusual at this age. One may consider CADASIL in the differential diagnosis in the appropriate clinical setting. Differential considerations include demyelination, vasculitis. It is nonspecific.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient more lethargic today. Signs and symptoms: Acute mental status change. Lethargic. Unenhanced head CT:Since prior examination from 7 -- 19 -- 11 there is no evidence of any new intracranial hemorrhage. Previously seen small patchy areas of superficial located cortical and subcortical as well as minimally of the subarachnoid hemorrhage remains essentially stable since prior exam.Extensive area of low attenuation involving the cortex and subcortical white matter of right frontal and parietal lobes with extension into the right posterior temporal is also stable in appearance since prior study. Findings are believed to represent extensive encephalomalacia however new overlapping ischemic changes can be obscured. If patient has new symptoms recommend follow-up with an MRI exam.There is evidence of a large right temporal -- frontal craniotomy and small amount of air under the craniotomy flap. A combination of postop changes as well as parenchymal changes results in mass effect and midline shift are proximately 9 mm. There Is evidence of interval increase in the midline shaft which on prior exam measured between 5 to 6-mm.expected residual air within the subarachnoid space in the peri-surgical site remains stable.

Output: 1.Interval increase in leftward midline shift since prior exam.2.No definitive evidence of any additional new findings in the brain parenchyma since prior study.3.Previously noted small amount of parenchymal and subarachnoid hemorrhage in the surgical site shows no interval change.4.Very extensive right hemispheric encephalomalacia/edema remains similar to prior study.5.Recommend further follow-up with an MRI examination if clinical concern persists.


Instruction: Generate impression based on findings.

Input: Female 65 years old. Reason: known plasmacytoma in S1, r/o progression compared to Jan 2015 MRI. History: known plasmacytoma in S1, r/o progression compared to Jan 2015 MRI BONE MARROW: There is widespread patchy marrow replacement in the pelvis including nearly the entire right innominate bone. There is also extensive tumor involvement in the bilateral femurs especially in the right femoral diaphysis. SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Widespread myelomatous lesions in the pelvis and bilateral femurs as described above. No evidence of pathologic fracture.


Instruction: Generate impression based on findings.

Input: Head feeling weird, dizziness, vision change, and abnormal movement. 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 is a small left maxillary sinus retention cyst.

Output: No evidence of intracranial hemorrhage, mass, or ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Clinical question: Please perform Dr.Javed MS protocol 3T scanner. Signs and symptoms: Fatigue, blurring, vertigo, weakness. Nonenhanced brain MRI:Examination demonstrate few tiny foci of flair hyperintensity in the subcortical white matter of bilateral cerebral hemispheres. There is subtle flair hyperintensity in the periventricular white matter of right hemisphere in the posterior parietal occipital region is also noted. There is no convincing evidence of lesions within the corpus callosum or in the posterior fossa. The cerebral cortex, cortical sulci, ventricular system, CSF spaces and margination of brain is otherwise within normal.Calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells are unremarkable.

Output: Few small punctate nonspecific foci of subcortical flair hyperintensity in bilateral cerebral hemispheres and questionably of periventricular white matter on the right.


Instruction: Generate impression based on findings.

Input: 68-year-old male patient with history of metastatic thyroid cancer and CRT. ABDOMEN:LIVER, BILIARY TRACT: A segment 8 lesion demonstrating T1 hypointensity, T2 hyperintensity, diffusion restriction, and enhancement with surrounding hyperemia is decreased in size now measuring approximately 2.2 x 1.6 cm (image 90, series 5), previously 2.3 x 2.2 cm. An additional segment IVb lesion is also slightly smaller in size. A subcentimeter enhancing lesion in segment 6 is also suspicious for a metastatic lesion. There is a subcentimeter cyst within segment 6. No new hepatic lesion is identified.SPLEEN: No significant abnormality noted.PANCREAS: A cystic lesion within the body of the pancreas without evidence of contrast enhancement is unchanged in size measuring approximately 1.2 x 0.9 cm (image 62, series 12) and is compatible with a sidebranch IPMN.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: A metastatic lesion within the L1 vertebral body extending to the right pedicle is again noted.OTHER: No significant abnormality noted.

Output: 1.Decrease in size of two metastatic hepatic lesions. 2.L1 osseous metastatic disease.


Instruction: Generate impression based on findings.

Input: 61-year-old male with weakness, constipation, new vertebral fractures. History of pleural mesothelioma. There is diffuse, patchy foci of abnormal marrow signal throughout the cervical, thoracic, lumbar, and sacral spine involving the vertebral bodies, ventricles, and posterior elements, likely reflecting known metastatic disease. Mild degenerative changes affect the cervical spine, with grade 1 retrolisthesis of C5 on C6. Again seen are vertebral compression fractures of L3 and L4, likely subacute. There is approximately 50% loss of height in L3 and approximately 25% loss of height in L4. There are also very mild compression deformities of T6 and T8. There is no evidence of retropulsion of fracture fragments or acute malalignment. Normal spinal cord signal is preserved throughout.

Output: No evidence of acute cord compression. Compression fractures are redemonstrated in L3 and L4, likely subacute.


Instruction: Generate impression based on findings.

Input: Newly diagnosed right breast cancer with axillary lymph node and supraclavicular node. There is a 4 mm diameter enhancing nodule in the right superior precentral gyrus with mild vasogenic edema. There is a 2 mm diameter nodule in the left middle frontal gyrus with mild vasogenic edema. There is no evidence of intracranial hemorrhage or acute infarct. There is scattered cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a 27 mm diameter right maxillary alveolar cystic lesions with peripheral enhancement. There are secretions in the right maxillary and ethmoid sinuses. There are periodontal left maxillary alveolus inflammatory changes.

Output: 1. Subcentimeter lesions in the bilateral frontal lobes are compatible with metastases.2. Probable odontogenic cyst arising from the right maxillary alveolus. Dedicated maxillofacial imaging may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Right mid lateral 4+3, right lateral apex 4+3, right apex 4+3, left lateral mid 3+3, left apex 4+3. PELVIS:PROSTATE:Prostate Size: 2.8 x 3.7 x 3.6 cmPeripheral Zone: In the right lateral apex there is a 5 x 4 mm focus of decreased T2 weighted signal (series 1201/12) with associated restricted diffusion (series 1 403/1 64) and possible early enhancement.Note is made of a probable prostatic utricle cyst which extends to the base of the prostate.Central Gland: No significant abnormality noted.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The lesion abuts the capsule without specific evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.5 mm right lateral apex lesion is suspicious for prostatic adenocarcinoma. 2.No evidence of extraprostatic extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female 9 years old Reason: follow up study recurrent pain. ?TB ?osteoid osteoma History: pain right sided lower back/pelvis BONE MARROW: Interval resolution of abnormal foci in the right acetabular roof and left acetabular anterior column. No abnormal contrast enhancement. No infiltrative bone marrow signal.SOFT TISSUES: Normal soft tissue signal intensity with no abnormal enhancement.JOINTS: No joint effusions.ADDITIONAL

Output: Interval resolution of abnormal foci in the right acetabular roof and left acetabular anterior column.


Instruction: Generate impression based on findings.

Input: 30-year-old female with abdominal pain and vomiting. Evaluate for plexiform tumor. BONE MARROW: No bone marrow signal abnormality is identified.SOFT TISSUES: There is increased signal abnormality within the right gluteus maximus which is nonspecific but may reflect a combination of postsurgical change and subacute denervation. There is nonspecific subcutaneous edema along the posterior aspect of the right pelvis which may reflect postsurgical change. There is a nonspecific lesion within the right gluteus maximus measuring 12 mm in greatest diameter which demonstrates increased signal abnormality and fluid sensitive sequences. An additional 15 mm lesion is identified within the subcutaneous tissue along the posterior superior aspect of the right gluteal crease. Multiple additional foci of signal abnormality are identified within the right gluteal crease and subcutaneous tissue which are incompletely characterized on this noncontrast examination but likely represent neurofibromas given the patient's history of NF1.JOINTS: There is a small amount of fluid within the joint without evidence of large effusion.ADDITIONAL

Output: Apparent postoperative changes with lesions within the right gluteus maximus muscle and subcutaneous tissue along the posterior aspect of the right hemipelvis are incompletely characterized on this noncontrast examination but likely represent neurofibromas, given the patient's stated history of NF1.


Instruction: Generate impression based on findings.

Input: 54-year-old male with shoulder pain. Evaluate rotator cuff. ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring approximately 16 mm in the AP dimension. There is less than 1 cm of separation of the tendon fibers of the supraspinatus. There is thickening and increased signal abnormality of the supraspinatus tendon consistent with moderate tendinosis. There is also associated tearing of the anterior fibers of the infraspinatus tendon. The supraspinatus and infraspinatus muscles appear intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Although this examination was not protocoled for evaluation of the glenoid labrum, there is increased linear signal abnormality traversing the posterior superior glenoid labrum which is suggestive of degenerative labral tearing.BICEPS TENDON: The long head of the biceps tendon appears intact. There is a small amount of circumferential fluid within the tendon sheath which may represent fluid extension from the glenohumeral joint.ADDITIONAL

Output: 1. Full-thickness tear of the rotator cuff as described above.2. Probable degenerative tearing of the posterior superior glenoid labrum.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:9/25/1961)Reason: dysarthria and left face weakness History: as abovePROVIDER/ATTENDING NAME: NAOUM ISSA The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Clinical question: rule out METs. Signs and symptoms: Right eye pain and vision loss. Examination demonstrates a large destructive bony metastasis of the right frontal bone involving the floor of the right anterior cranial fossa and with a significant extracranial component which measures 80-mm in AP axis and 40-mm in transverse axis (axial image 6 of 50). Although not as well-visualized on this exam as it was noted on MRI of brain dated 10 -- 10 -- 2009 there is a large intracranial extension of tumor into the right anterior and middle cranial fossas. Extensive destructive changes of the frontal bone along the floor of the right anterior cranial fossa, lateral orbital ridge and greater wing of the sphenoid on the right is noted. There is a large extraconal retro-orbital spread of tumor which does not extend to the apex of the orbit. This component of the mass measures 53-mm times 26-mm in transaxial dimensions (axial image 50). There is significant mass effect on the retro-orbital content, including lateral rectus, superior rectus, right optic nerve and globe which is significantly deformed. There is also suggestion of extension of tumor into the right frontal sinus. This component of tumor within the right frontal sinus may be a second smaller metastatic lesion. There is no apparent involvement of the cavernous sinus. No extension of tumor into the apex of the orbit, no involvement of the lamina papyracea. The extracranial component of the tumor appears to extend inferiorly into the right infratemporal fossa. The paranasal sinuses are well pneumatized and demonstrate only minimal opacification of right anterior ethmoid air cells. Mastoid air cells and middle ear cavities are unremarkable.

Output: 1.Large destructive mass involving the right frontal bone along the floor of right anterior cranial fossa with extension into the right orbit, right frontal sinus, right anterior and middle cranial fossas, right frontal temporal extracranial region and right infratemporal fossa. Please see above detailed report.2.Paranasal sinuses are well pneumatized. Please see above comments.


Instruction: Generate impression based on findings.

Input: Pineal cyst, follow-up in 6 months. Evaluate for changes and growth, headaches. Again seen is a pineal cyst measuring 21 mm in the AP dimension, 16 mm in the transverse dimension, and 12 mm in the craniocaudal dimension. There is no significant change since prior. No significant change in smooth enhancement involving the posterior wall measuring approximately 4 mm in thickness. Stable susceptibility effect and low T2 signal involving the inferior aspect of the pineal cyst which may be related to chronic products and/or mineralization. There remains mild mass effect on the tectum. The ventricles are within normal limits in size and configuration.Stable punctate foci of susceptibility associated with the ventricles bilaterally most likely represent chronic hemosiderin related to prior ventriculostomy/fenestration of the pineal lesion. No edema in the brain parenchyma. Unchanged linear area of gliosis in the right frontal lobe along prior catheter tract. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No other intracranial mass or mass-effect. Stable low-lying cerebellar tonsils which remain rounded and without significant crowding at the foramen magnum. There is patchy opacification of the ethmoid air cells and minimal mucosal thickening elsewhere in the paranasal sinuses.

Output: No significant change in pineal cyst compared to recent priors. Cyst is larger when compared to more remote prior study from 6/7/2012.


Instruction: Generate impression based on findings.

Input: Meningioma. Brain: There are multiple foci of restricted diffusion in the left parietal lobe and to a lesser degree left posterior frontal, left posterior temporal and left occipital lobes. There are areas of associated T2/FLAIR hyperintensity as well as T1 hyperintensity reflecting laminar necrosis, which are new since prior from 3/12/2016. There are also areas of associated parenchymal enhancement. Findings are consistent with acute and subacute infarcts. There is also cortical volume loss in the left parietal lobe likely reflecting chronic infarct, but new since prior. There is no associated mass effect or evidence of hemorrhagic confirmation.Multiple additional scattered chronic infarcts including the right temporal parieto-occipital lobes as well as the right postcentral gyrus and left paramedian pons are again seen. There is T2 hyperintensity along the middle cerebellar peduncles, likely reflective of Wallerian degeneration. Additional nonspecific scattered T2/FLAIR hyperintense foci are compatible with small vessel ischemic disease.There is no appreciable change in the enhancing dural-based mass centered in the right cavernous sinus region that measures up to approximately 25 mm in the AP dimension There is mild extension into the right prepontine cistern posteriorly as well as extension into the right middle cranial fossa inferiorly. Tumor extends to fill the right Meckel's cave. There also appears to be intrasellar extension. There is no midline shift or herniation. No hydrocephalus. The flow-voids of the cavernous internal carotid arteries are somewhat diminutive as is the right vertebral artery flow-void. Arterial stenoses are better assessed on prior CTA from 12/4/2015.Orbits: There is no evidence of intraorbital mass lesions or abnormal enhancement. The bilateral globes, lacrimal glands, optic nerves, and extraocular muscles are unremarkable. Optic chiasm is also unremarkable.

Output: 1. Multiple acute and subacute infarcts in the left parietal lobe and to a lesser degree in the left temporal, occipital, and posterior frontal lobes. Additional chronic infarcts including the right cerebral hemisphere and left pons are also again evident.2. No significant change in right cavernous sinus meningioma.3. Arterial stenosis better assessed on prior CTA from 12/4/2015.Dr. Ali discussed findings of infarcts with Dr. Reeti Greenwald (neurology) at noon on 9/21/2016.


Instruction: Generate impression based on findings.

Input: 72-year-old female with history of appearing cancer status post EBRT prior to interstitial brachytherapy for vaginal cuff recurrence PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy.There is a right vaginal cuff nodular lesion measuring approximately 3.3 x 2.2 cm (series 801, image 35) with peripheral enhancement. The lesion demonstrates mass effect on the anterior wall of the rectum with effacement of the intervening fat plane. The lesion also abuts the posterior aspect of the bladder and the sigmoid colon. Involvement cannot be entirely excluded. BLADDER: No significant abnormality noted.LYMPH NODES: Prominent left common iliac lymph node measuring 9 mm. Additional smaller left common iliac and left perirectal lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No suspicious osseous lesions.At the level of the labia, right and posterior to the vaginal introitus is a T2 hypointense, partially T1 hyperintense cystic, nodular lesion that may represent a complex Bartholin's cyst.OTHER: No significant abnormality noted.

Output: 1.Vaginal cuff tumor as described above. Prominent left common iliac lymph node and additional smaller lymph nodes as above.


Instruction: Generate impression based on findings.

Input: 83 year old male with history of CAD with CABG, chronic angina and hypertension referred for dobutamine viability cardiac MRI testing.MEDICATIONS: aspirin, atorvastatin, carvedilol, isosorbide dinitrate, lisinopril, ranolazine, furosemide Viability/ Myocardial ScarThere is transmural late gadolinium enhancement in the basal inferoseptum and inferior walls. These segments are not likely to be viable. The myocardial infarction is non-transmural in the basal inferolateral wall and contractility in this segment improves following the administration of 20mcg/kg/min of dobutamine suggesting that this segment is viable. The mid-ventricular inferior and inferolateral walls have a transmural myocardial infarction and are not likely to be viable. The remainder of the myocardium is free of myocardial infarction and is viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. There is thinning and akinesis of the above described segments with myocardial infarction. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 85 ml/m2 (normal range: 74+/-15), the LVEDV is 137 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 28 g/m2, and the LV mass is 46 g.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 120 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 58 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation. There is mild thickening of the tip of the anterior leaflet.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternotomy wires are present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large, predominantly transmural myocardial infarction in the usual territory of the right coronary artery. Only a small portion of this infarcted territory has evidence of viability. The other coronary territories are free of myocardial infarction and likely to be viable. 2. Normal LV size and mildly reduced systolic function (LVEF 46%) with akinesis of the above described infarcted myocardium.3. Normal RV size and systolic function (RVEF 52%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 50 year-old female with multiple myeloma since 2007. On chemo. Fever of unknown origin on imipenem and vancomycin. Also new onset right upper quadrant pain. Evaluate for source of infection. CHEST:LUNGS AND PLEURA: Multifocal partially solid and ground glass nodular opacities are identified within both lungs. Some of these have a more solid appearance and some are more predominantly groundglass. These effect all lobes of the lung. The majority are in the periphery and are predominantly pleural-based. Small pleural effusion on the right.MEDIASTINUM AND HILA: Heart size normal. No mediastinal lymphadenopathy.CHEST WALL: Multiple lytic lesions are identified with adjacent soft tissue components. This includes a destructive lesion within the sternum with soft tissue component that extends posteriorly near the aortic arch. This soft tissue mass is central low attenuation which is likely due to necrosis. A lytic lesion with soft tissue component is identified in the anterior right fourth rib as well as the posterior right 10th rib. There is compressive atelectasis and consolidation adjacent to the lesion in the right 10th rib. There is right -sided axillary lymphadenopathy. The largest single node measures 1.4 x 1.3 cm (image 23/25 of series number 9).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: Subcentimeter punctate hypodense lesions in the kidneys are too small to characterize but likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesions within the thoracic and lumbar spine at the patient's known myeloma. These extend into the spinal canal and appear grossly to have decreased compared with the patient's MRI on 11/5/2008. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Large inguinal lymph nodes identified. The largest single lymph node measures 2.9 x 1.8 cmBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There are lytic lesions identified within the sacrum and pelvis consistent with multiple myeloma. A large lesion within the right iliac wing has a soft tissue component which measures 3.3 by 2.8 cm. Some of the lesions in the sacrum enter into the spinal canal.

Output: 1. Mixed groundglass and solid nodules in both lungs are nonspecific in etiology. They may represent infection, possibly fungal, drug reaction or less likely metastatic lesions.2. Multifocal lytic lesions with soft tissue component in the chest, abdomen and pelvis due to the patient's multiple myeloma.


Instruction: Generate impression based on findings.

Input: There is mild straightening of the cervical lordosis which may be positional. Otherwise, the cervical vertebral bodies are normally aligned. Posterior decompression laminectomy changes are demonstrated from C3 to C7. An oblique fracture involving the T1 spinous process is again demonstrated with the posterior fragment displaced inferiorly. There is linear high T2 and low T1 signal involving the T2 vertebral body suspicious for nondisplaced fracture without significant compression deformity. The spinal cord is of normal caliber. There is no convincing cord signal abnormality.C2-3: No significant disc bulge, herniation, spinal canal or foraminal stenosis.C3-4: There is a small posterior disc osteophyte complex formation without significant spinal canal or neural foraminal stenosis. C4-5: Small right paracentral disc protrusion with mild flattening of the right ventral cord, contributing to mild central spinal stenosis and mild right foraminal stenosis.C5-6: Disc osteophyte complex with bilateral right greater than left uncinate spurs, contributing to moderate central spinal stenosis and severe right and mild left foraminal stenosis. C6-7: There is a small disc protrusion contributing to mild bilateral foraminal stenosis. No significant central spinal stenosis.C7-T1: No significant disc bulge, herniation, spinal canal or foraminal stenosis.

Output: 1. Redemonstrated T1 spinous process fracture with posterior fragment displaced inferiorly.2. Linear edema involving the T2 vertebral body is likely related to a nondisplaced fracture without significant compression deformity. 3. Severe right foraminal stenosis at C5-C6 with possible impingement upon the right C6 nerve root.4. Additional multilevel mild neural foraminal narrowing and spinal canal narrowing appears improved status post posterior decompression and laminectomy.


Instruction: Generate impression based on findings.

Input: 65-year-old female patient status post motor vehicle collision with rotator cuff injury. ROTATOR CUFF: There is a full-thickness near complete tear of the supraspinatus tendon with nearly 1.5 cm of proximal retraction of the torn fibers. This tear measures approximately 1.5 cm in AP dimension. A few posterior fibers of the tendon appear to insert on the greater tuberosity. There is mild fatty atrophy of the supraspinatus muscle. There is also high-grade partial tearing of the anterior fibers of the infraspinatus tendon involving both the articular and bursal surfaces with mild retraction of the bursal surface fibers. There is mild to moderate fatty atrophy of the infraspinatus muscle. There may be mild tendinosis of the subscapularis tendon, but we see no tear and the muscle appears normal. The teres minor muscle and tendon are normal in appearance.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint with prominent subchondral cyst formation.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral alignment is normal. There is a small amount of fluid within the glenohumeral joint. Mild increased signal intensity within the superior glenoid labrum is suggestive of degeneration.BICEPS TENDON: Given the limitations of this non-arthrographic examination, the biceps tendon appears normal.ADDITIONAL

Output: 1.Full-thickness, near complete tear of the supraspinatus tendon and high-grade partial thickness tearing of the infraspinatus tendon with mild rotator cuff muscle fatty atrophy, as described above.2.Acromioclavicular joint osteoarthritis.3.Subcoracoid bursitis.


Instruction: Generate impression based on findings.

Input: Female, 14 years old, with headaches for 2 years status post concussion. Assess for diffuse axonal injury. A single 4 mm focus of T2 hyperintensity is evident within the left aspect of the body of the corpus callosum (see image 19 series 701). This was present on the prior MRI examination from 2010 and has not significantly changed.The cerebral and cerebellar hemispheres and brainstem otherwise show normal signal intensity and morphology. No restricted diffusion is seen. The pattern of parenchymal enhancement is within normal limits.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: A single 4 mm focus of signal abnormality is evident within the left aspect of the body of the corpus callosum, stable when compared to a prior examination from 2010. This finding is nonspecific.No additional evidence to suggest diffuse axonal injury or other significant posttraumatic injury to the brain.


Instruction: Generate impression based on findings.

Input: Chronic right shoulder pain. Evaluate for rotator cuff pathology, osteoarthritis. Exam is limited by motion artifact.ROTATOR CUFF: Thickening and intermediate signal intensity of the distal supraspinatus tendon. The infraspinatus, subscapularis, and teres minor tendons are intact. Mild atrophy of the supraspinatus and infraspinatus muscles is noted. No significant fluid accumulation in the subacromial/subdeltoid bursa. No full or partial thickness tearing of the rotator cuff tendons is present.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Grade II chondromalacia of the glenoid and humeral articular cartilage is noted. No discrete labral tear is identified identified within the limitations of a nonarthrographic study.BICEPS TENDON: No significant abnormality noted.ADDITIONAL

Output: Supraspinatous tendinopathy.


Instruction: Generate impression based on findings.

Input: Pain. Cuff tear? ROTATOR CUFF: Intermediate signal intensity within the bursal surface fibers of the supraspinatus tendon posteriorly and infraspinatus tendon anteriorly suggests fraying, but I see no discrete fluid-filled rotator cuff tear. The rotator cuff musculature appears normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint, with edema in the distal end of the clavicle and the acromion process. There is a small amount of fluid within the acromioclavicular joint; I see no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is a small amount of fluid in the glenohumeral joint, but I see no frank effusion. The posterior superior labrum appears attenuated and of slightly increased signal intensity, perhaps reflecting degeneration/degenerative tearing. There is low signal intensity adherent to the anterior labrum; this may simply reflect unusually prominent capsular tissue, as the underlying labrum itself appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: 1.Acromioclavicular joint osteoarthritis.2.Mild fraying of the bursal surface of the supraspinatus and infraspinatus, but I see no discrete fluid-filled tear.3.Other findings as above.


Instruction: Generate impression based on findings.

Input: Male, 60 years old, with cervical radicular pain. Spinal alignment is anatomic. Vertebral body heights are preserved. No concerning marrow replacement or marrow edema is detected. Degenerative endplate marrow signal abnormality is seen at C6-7.The visualized spinal cord shows normal signal intensity except as discussed below. No convincing areas of cord signal abnormality are detected. No epidural abnormality is noted.Loss of disc height is evident at C5-6 and C6-7. Additional level specific findings are as follows:C2-3: Unremarkable. C3-4: Left facet hypertrophy. No significant spinal canal or foraminal stenosis. No interval changes. C4-5: Left facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing, mildly progressed. C5-6: Facet hypertrophy. Ligament involving thickening. Posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis with mild cord deformation, mildly progressed from prior. Moderate bilateral foraminal narrowing, also progressed. C6-7: Facet hypertrophy. Posterior disc-osteophyte complex formation. Mild generalized spinal canal narrowing with at most minimal cord deformation. Moderate left foraminal narrowing. No interval changes. C7-T1: Left facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. No interval changes.

Output: 1.Degenerative findings at C5-6 have mildly progressed with a greater degree of generalized spinal canal stenosis and mild deformation of the cord. The neural foramina are also moderately narrowed, more so than on the prior examination.2.Mild degenerative findings at C6-7 with a mild spinal canal stenosis and moderate left foraminal narrowing, without significant interval change.


Instruction: Generate impression based on findings.

Input: Pain. Evaluate for stenosis Five lumbar type vertebral bodies are 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 are postsurgical changes of posterior spinal fusion at L4-L5. Hardware appears well-positioned. There appears to be solid fusion involving the posterior elements at the L4-L5 levels, better seen on CT.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge eccentric to the right. Minimal right neural foraminal narrowing. No significant spinal canal or left neural foraminal stenosis. There is facet arthropathy with vacuum phenomena bilaterally.L4-L5: Minimal disc bulge and right foraminal osteophyte. Otherwise no significant disc disease. Minimal right neural foraminal narrowing. No spinal canal or left neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal stenosis. There is mild bilateral neural foraminal stenosis. Advanced bilateral facet arthropathy with vacuum phenomena.Paraspinous soft tissues demonstrate postsurgical changes but are otherwise unremarkable.

Output: Postsurgical changes of L4-L5 fusion. No significant spinal stenosis at any level. Mild neural foraminal narrowing as described above. There is advanced bilateral facet arthropathy at L5-S1 which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: 67-year-old female with lower back pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is an exaggerated lumbar lordosis which appears unchanged. Alignment is otherwise within normal limits. There is mild edematous change of the L1 anterosuperior endplate which appears grossly similar to prior. Bone marrow signal is benign. The conus medullaris is normal in position. Paraspinous soft tissues are within normal limits.Multilevel degenerative changes are seen, as described below:T12-L1: Minimal disc bulge without significant spinal canal or neural foraminal stenosis.L1-L2: Minimal disc bulge and mild facet arthropathy without significant spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge and mild facet arthropathy without significant spinal canal or neural foraminal stenosis.L3-L4: Moderate to severe facet arthropathy, left greater than right, and mild to moderate diffuse disc bulge with superimposed broad-based foraminal disc protrusion on the left leading to mild to moderate left neural foraminal stenosis, which appears slightly less severe than the prior exam. Minimal spinal canal narrowing is present.L4-L5: Mild disc bulge and moderate to severe facet arthropathy causing mild right neural foraminal stenosis and minimal spinal canal narrowing, appearing similar to the prior exam.L5-S1: Severe right and moderate left facet arthropathy is noted. No significant spinal canal or neural foraminal stenosis.Degenerative changes of the bilateral sacroiliac joints are noted.

Output: Overall no significant interval change in multilevel lumbar degenerative disease, with mild to moderate left neural foraminal stenosis at the L3-L4 level and mild right neural foraminal stenosis at the L4-5 level. No high grade spinal stenosis at any level. There is moderate to severe multilevel facet arthropathy which may be contributing to patient's back pain. Additional details as above.


Instruction: Generate impression based on findings.

Input: Reason: lung cancer, EGFR mutated, back pain at L1, ? met History: back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.There are multiple marrow replacing lesions present within the lumbar spine at L1, L4 and S2 without associated compression fractures over compromise the spinal canal. The largest one is at L4 measuring approximately 21 by 29 mm in sagittal dimensions along the right posterior lateral aspect of L4 vertebral body. Additional marrow replacing lesion is present at T11 centered along the right pedicle. An L2 vertebral body lesion which is hyperintense on T1 and suppresses on fat suppressed images suspected to represent a vertebral body hemangioma.There is multilevel disk desiccation and loss of disk space height present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level. There is a mild disk bulge 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.

Output: 1.Multiple marrow replacing lesions are present in the lumbar spine which are suspicious for metastatic disease.


Instruction: Generate impression based on findings.

Input: 39 years Male (DOB:8/10/1977)Reason: oligodendroglioma now off all Tx. History: oligodendroglioma.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS The patient status post left frontal craniotomy for left frontal lobe mass.. Is a heterogeneous appearance to the tumor bed. T2 and FLAIR signal hyperintensity within the tumor bed has not changed in extent when compared to the August or May exams. Some minor patchy enhancement along the periphery of the tumor bed anteriorly remains stable compared to the prior exam. On the perfusion imaging cerebral blood volume appears decreased within the region of the tumor bed. There is associated exit vacuo effect on the left lateral ventricle.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The patient is status post left frontal lobe surgery for tumor removal. This is known to represent oligodendroglioma. Since the prior exam is no significant change in the appearance of the tumor bed.


Instruction: Generate impression based on findings.

Input: Right shoulder pain for one year. No improvement with therapy and injection. Evaluate for rotator cuff tear. ROTATOR CUFF: There is mild increased signal intensity within the supraspinatus tendon indicating mild tendinosis. There is also a focal tear of the bursal surface fibers at the insertion of the supraspinatus tendon on the greater tuberosity. The tear appears to involve less than 50% of the tendon thickness and is approximately 8 mm in AP dimension. There is perhaps mild fatty atrophy along the myotendinous junction of the supraspinatus muscle, which otherwise appears normal. The infraspinatus muscle and tendon appear normal. The teres minor muscle and tendon appear normal. The subscapularis muscle and tendon appear normal.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint with fluid in the joint. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits; I see no glenohumeral joint effusion. There is increased signal intensity within the posterior fibers of the superior labrum which I suspect represents a degenerative tear, of questionable clinical significance. The inferior labrum appears normal.BICEPS TENDON: The tendon of the long head of the biceps is within normal limits. ADDITIONAL

Output: 1.Supraspinatus tendinosis and insertional bursal surface tear as described above.2.Mild osteoarthritis of the acromioclavicular joint.3.Findings suggestive of tearing of the posterior superior labrum.


Instruction: Generate impression based on findings.

Input: Patient recalled for limited pre and postcontrast imaging of the liver only, as an insufficient field of view was obtained on the 9/26/2016 examination. ABDOMEN:LIVER, BILIARY TRACT: There are surgical changes compatible with prior orthotopic liver transplant. No abnormal hepatic enhancement is evident. Focal narrowing at the bilioenteric anastomosis with associated extrahepatic biliary ductal dilatation, was better evaluated on the 9/26/2016 MRI. Intrahepatic biliary ductal dilatation not well seen on these limited postcontrast images.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: Fat-containing left lateral ventral hernia again evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic plaque affects the abdominal aorta.

Output: Limited pre and postcontrast imaging of the liver demonstrates no abnormal hepatic enhancement or liver lesions. Previously described bilioenteric anastomotic narrowing as well as intrahepatic and extrahepatic biliary ductal dilatation was better evaluated on the 9/26/2016 MRI, please referred to this report for full evaluation.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for stenosis. Signs and symptoms: Pain. Nonenhanced lumbar MRI:Lower most visualized thoracic spine and thoracic cord is unremarkable.T12-L1 is unremarkable.L1-L2 demonstrate mild degenerative changes and unremarkable otherwise.L2-L3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild degenerative disc disease, moderate bilateral ligamentum flavum hypertrophy and mild facet hypertrophy. No spinal stenosis and mild left neural foraminal compromise.L4-L5 demonstrate moderate disc disease, moderate bilateral ligamentum flavum hypertrophy and severe hypertrophic changes of bilateral articulating facets with resultant new grade 1 anterolisthesis. The findings at this level demonstrates significant interval progression and the anterolisthesis is a new finding since prior exam. Findings results in mild central spinal stenosis, significant right and mild left neural foraminal compromise. There is T2 increased signal intensity within the right articulating facet at this level suggestive of facet effusion. There is a tiny retention cyst at this level projecting in the inferior lateral aspect of the right neural foramina (axial T2 series 8 image 19 and sagittal T2/T2 STIR image 12). Small synovial cyst is also noted projecting posterior to the right articulating facet at this level (axial T2 series 7 image 9 and sagittal T2/T2 STIR image 11).L5-S1 demonstrate mild disc disease, moderate left and mild right facet hypertrophic changes and mild ligamentum flavum hypertrophy. No central spinal stenosis or neural foraminal compromise.

Output: 1.Since prior exam there is progression of degenerative changes at L4-L5 level and including new grade 1 anterolisthesis. There is mild central spinal stenosis, significant right and mild left neural foraminal compromise as detailed. Tiny right-sided synovial cyst projecting in inferior lateral aspect of the right neural foramina and a slightly larger synovial cyst projecting posterior to the right articulating facet at this level.2.Mild degenerative changes at other levels however without evidence of central spinal stenosis or any significant neural foraminal compromise. Please see detailed report per level above.


Instruction: Generate impression based on findings.

Input: 59-year-old male with history of prostate cancer who presents for MRI evaluation.Per pathology results 1/21/2016:Left lateral base: Prostatic adenocarcinoma, Gleason grade 3+3=6.Right base: Prostatic adenocarcinoma, Gleason grade 3+3=6. PELVIS:PROSTATE:Prostate Size: 4.5 x 2.7 x 2.0 cmPeripheral Zone: There is a T2 hypointense lesion with corresponding low ADC signal in the left mid gland/apex measuring 3 x 4 mm (series 901, image 9). An additional T2 hypointense lesion with corresponding low ADC signal in the right base measuring 4 x 3 mm (series 901, image 15). T2 hypointense signal in the midline at the base is likely the central zone.Central Gland: Central gland is mildly heterogeneous compatible with benign hypertrophy.Seminal Vesicles: No evidence of extension into the seminal vesicles.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific subcentimeter external iliac chain lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left mid gland/apex and right base subcentimeter suspicious lesions as detailed.


Instruction: Generate impression based on findings.

Input: Diagnosis: Hereditary hemorrhagic telangiectasia. Other malformations of cerebral vesselsClinical question: 3T scanner, please evaluate for cerebral AVMsSigns and Symptoms: HHT MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm, arteriovenous malformation or cerebrovascular occlusion.The anterior communicating artery is identified and is intact. The posterior right communicating artery is intact. There is fetal origin of the left posterior cerebral artery with a hypoplastic left P1 segment. The vertebral arteries are similar in size.

Output: There is no evidence for intracranial arteriovenous malformation.


Instruction: Generate impression based on findings.

Input: History of cervical disc: weakness to right hand. There is multilevel degenerative spondylosis as follows: C2-C3: There is no spinal canal or neural foraminal stenosis.C3-C4: There is no neural foraminal narrowing or spinal canal stenosis. C4-C5: There is no neural foraminal narrowing or spinal canal stenosis. C5-C6: There is uncovertebral hypertrophy with moderate to severe bilateral foraminal stenosis, left greater than right, but no significant spinal canal stenosis. C6-C7: There is uncovertebral hypertrophy with moderate to severe bilateral foraminal stenosis, but no significant spinal canal stenosis.C7-T1: There is a left lateral disc extrusion and uncovertebral hypertrophy with moderate to severe bilateral foraminal stenosis, but no significant spinal stenosis.There is an intravertebral disc herniation in the T1 superior endplate. There is diffuse high T2 and low T1 signal in the C7 and T1 vertebral bodies. The cervical vertebral column alignment is anatomic, without spondylolisthesis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Multilevel spondylosis, which is most pronounced at C5 though T1 in terms of neural foraminal compromise, with associated bone marrow edema in the C7 and T1 vertebrae, but no spinal cord compression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Prior MRI with questionable demyelinating disease. Please assess for new lesions. Signs and symptoms: Cognitive decline/depression. Pre-and post-enhanced MRI:No diffusion weighted abnormalities. Examination redemonstrates stable few subcortical and periventricular foci of flair hyperintensity in bilateral cerebral hemispheres. There is no evidence of any new lesions or any detectable abnormal enhancement.Previously noted lesions within bilateral middle cerebellar peduncles are significantly less conspicuous on current the study and there is no evidence of any new or enhancing lesions in the posterior fossa.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces for patient's stated age. No detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses and mastoid air cells.

Output: 1.No evidence of an acute or new lesions or any detectable abnormal enhancement.2.Revisualization of stable few subcortical and periventricular flair hyperintensity without enhancement since prior exam.3.Previously reported flair hyperintensity in bilateral middle cerebellar peduncles are significantly less conspicuous and demonstrate no enhancement.


Instruction: Generate impression based on findings.

Input: 43 years, Female, right frontal cavernous malformation. Three month follow-up. Compared to 9/28/2015, there is no significant change in size of heterogeneous T2 hyperintense lesion with a rim of susceptibility related to hemosiderin staining. Lesion involves the right superior frontal gyrus, with the T2 hyperintense component measuring approximately 5 to 6 cm. Including the T2 hypointensity, the lesion measures up to 10 mm in the AP dimension and unchanged. There is adjacent linear enhancement suggestive of an associated small developmental venous anomaly. No surrounding edema.Partially empty sella is incidentally noted which can be a normal variant. Remainder of the brain parenchyma appears unremarkable without evidence of recent ischemia or hemorrhage. No no new lesions. No intracranial mass effect. Ventricles and sulci appear within normal limits. Calvarium and extracranial soft tissues are unremarkable.

Output: Again seen is a solitary, subcentimeter right frontal cavernous malformation with a small adjacent developmental venous anomaly. No findings to suggest new hemorrhage or interval enlargement.


Instruction: Generate impression based on findings.

Input: Redemonstration of postoperative changes from a suboccipital craniotomy with resection of the posterior C1 arch. A postoperative extradural fluid collection is again seen within the overlying soft tissues now measuring 4.5 x 7.0 cm (craniocaudal) x 2.8 cm (transverse), which has increased slightly in size compared to the prior exam where it measured 3.3 cm AP x 6.8 x 2.7 cm. However there is still no significant mass effect upon the adjacent neo-dura. The cerebellar tonsils retain a pointed configuration and a thin process is again seen extending through the posterior CSF space as demonstrated previously, unchanged.There are no fractures or subluxations. The marrow signal is benign, including a stable benign hemangioma within the C6 vertebral body. C2/3: Unremarkable and unchanged.C3/4: Unremarkable and unchanged.C4/5: Mild posterior osteophyte disc complex causing minimal anterior cord flattening. There is no resulting stenosis. These findings are unchanged.C5/6: Mild posterior osteophyte disc complex causing minimal anterior cord flattening. There is no resulting stenosis. These findings are unchanged.C6/7: Unremarkable and unchanged.C7/T1: Unremarkable and unchanged.

Output: 1.Redemonstration of post-operative changes of a suboccipital craniotomy with resection of the posterior C1 arch. 2.The postoperative extradural fluid collection has increased slightly within the overlying soft tissues but does not exert mass effect upon the adjacent neo-dura. 3.The cerebellar tonsils retain a pointed configuration and a thin process is again seen extending through the posterior CSF space. These are unchanged.


Instruction: Generate impression based on findings.

Input: History of meningioma status post resection; surveillance. There are postoperative changes of prior left parietal craniotomy related to meningioma resection. There is redemonstration of a large area of encephalomalacia in the left posterior parietal lobe similar to prior study. There is mild dural based thickening along the posterior falx and along the left posterior parietal convexity similar to prior without discrete mass to suggest tumor recurrence.Again seen there is a small right frontal meningioma measuring approximately 8 x 5 mm, previously 8 x 3 mm, without significant interval change since 5/8/2010. In addition there is another right high frontal convexity meningioma which is minimally larger than the prior exam measuring 7 x 7 mm, previously 5 x 6 mm. There is no evidence of acute intracranial hemorrhage or acute infarction. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is prominent enhancement at the left jugular foramen, unclear if this represents nonspecific distention of the left jugular vein versus an extrinsic enhancing mass compressing the left jugular vein.

Output: 1. Postoperative changes of left posterior parietal meningioma resection without evidence of tumor recurrence.2. Small subcentimeter right frontal meningiomas without local mass effect and stable to minimally larger than prior from 2010 allowing for differences in technique.3. There is prominent enhancement at the left jugular foramen, unclear if this represents nonspecific distention of the left jugular vein versus an extrinsic enhancing mass such as meningioma compressing the left jugular vein. Consider high resolution CT of the skull base with noncontrast and postcontrast images per CTV protocol.


Instruction: Generate impression based on findings.

Input: Fever, unspecified. Chronic lymphoid leukemia, without mention of having achieved remission(204.10)Chronic lymphoid leukemia, without mention of having achieved remission(204.10) Nausea with vomiting.. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 3 mm ring-enhancing lesion present in the left cerebellar hemisphere which previously measured 5 mm. There is loss of signal associated with this on the susceptibility weighted images on the current exam but not on the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A 3 mm lesion in the left cerebellar hemisphere has decreased in size compared to the prior exam.


Instruction: Generate impression based on findings.

Input: There has been previous ACDF at C5 and C6 as well as C3-C6 laminectomy. Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: Ligamentum flavum thickening causes slight flattening of the posterior cervical cord without intrinsic cord signal abnormality or resulting central stenosis.C2/3: Mild posterior osteophyte disc complex without stenosis.C3/4: Osteophyte disc complex and bilateral uncinate hypertrophy cause moderate left neural foraminal and mild-to-moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, left facet hypertrophy, and findings suggestive of incorporated bone graft material adjacent to the left lamina. T2 hyperintensity is noted within the cord with slight associated focal atrophy of myelomalacia. There is no central stenosis however there is severe left neural foraminal and moderate to severe right neural foraminal stenosis.C5/6: Minimal posterior osteophyte disc complex, left facet hypertrophy, and findings suggestive of incorporated bone graft material adjacent to the left lamina. T2 hyperintensity is noted within the cord with slight associated focal atrophy or myelomalacia. There are no significant stenoses.C6/7: Minimal posterior osteophyte disc complex, minimal bilateral uncinate hypertrophy, left facet hypertrophy, and findings suggestive of incorporated bone graft material adjacent to the left lamina. There are no significant stenoses.C7/T1: Right facet hypertrophy encroaches the right neural foramen causing mild right neural foraminal stenosis.Facet hypertrophy of the visualized upper thoracic levels encroach the neural foramina bilaterally.

Output: 1.There has been previous ACDF at C5 and C6 as well as C3-C6 laminectomy.2.C3/4: Moderate left neural foraminal and mild-to-moderate right neural foraminal stenosis.3.C4/5: T2 hyperintensity is noted within the cord with slight associated focal atrophy of myelomalacia. There is severe left neural foraminal and moderate to severe right neural foraminal stenosis.4.C5/6: T2 hyperintensity is noted within the cord with slight associated focal atrophy or myelomalacia. There are no significant stenoses.5.C7/T1: Mild right neural foraminal stenosis.6.Facet hypertrophy of the visualized upper thoracic levels encroach the neural foramina bilaterally. If the patient is experiencing symptoms referable to the thoracic spine, a dedicated thoracic MRI could be obtained if deemed clinically beneficial.


Instruction: Generate impression based on findings.

Input: Posterior knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There are no fluid-filled articular cartilage defects identified and the marrow signal of the knee is normal.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Tiny amount of fluid within the semimembranosus/gastrocnemius recess but otherwise normal-appearing knee with no evidence of mass or other specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Female, 24 years old, with intermittent weakness, blurred vision, headaches, worsening over the last three days, five months of right eye blurred vision, sluggish right extraocular muscles today. Brain: Parenchymal morphology is within normal limits. No focal signal abnormality, edema or pathologic enhancement is observed. Diffusion-weighted imaging does not cover the entire brain, but that portion evaluated is free of restricted diffusion. No susceptibility weighted imaging is available. Within that limitation, no evidence of intracranial hemorrhage is seen. No abnormal extra-axial collections are detected. The ventricles are normal in size and morphology. The cerebellar tonsils descend approximately 7 mm below the level of the foramen magnum. However, there is no frank crowding at the foramen magnum.Orbits:The globes are round and symmetric. The extraocular muscles demonstrate normal morphology and enhancement. The optic nerves are free of pathologic signal abnormality and enhancement. No orbital masses are seen. An oval enhancing nodule measuring up to 10 mm is evident situated in the left lateral upper eyelid, adjacent to the lacrimal gland. There is evidence of inflammation in the surrounding soft tissues.C-spine:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or abnormal marrow enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No focal lesions are seen. No pathologic intramedullary or leptomeningeal enhancement is detected.The intervertebral discs are preserved. No significant spinal canal or foraminal stenosis is seen.

Output: 1.Within the study limitations as discussed above, no definite intracranial findings are seen to account for the patient's symptoms. The cerebellar tonsils do, however, descend below the foramen magnum compatible with a Chiari I malformation. The relevance of this to the patient's presenting symptoms is uncertain.2.An enhancing nodule is evident centered on the left upper outer eyelid. This lesion may be related to glandular inflammation. A neoplastic process is considered less likely though cannot be entirely excluded. Clinical follow-up is advised.3.Evaluation of the cervical spine is within normal limits. No specific findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Right upper quadrant discomfort. Liver hemangioma seen elsewhere. ABDOMEN:LIVER, BILIARY TRACT: 1.2 x 1.6 cm T2 hyperintense lesion in the right hepatic lobe with minimal peripheral nodular discontinuous enhancement compatible with an hemangioma, unchanged in size compared to the prior CT on 2/4/2011. Additional scattered punctate nonenhancing T2 hyperintense foci likely represent cysts. No suspicious hepatic lesions are noted. No biliary ductal dilation. Normal appearance of the gallbladder. 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. Normal appearance of the imaged upper abdominal bowel loops.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. No abdominal fluid collections noted.

Output: 1.Unchanged appearance of the hepatic hemangioma.2.No specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Knee pain. History of ACL repair. MENISCI: Compared to the prior study, there is further attenuation of the anterior and posterior horn of the medial meniscus with abnormal signal within the posterior horn compatible with continued degeneration and tearing. The lateral meniscus appears normal. ARTICULAR CARTILAGE AND BONE: Normal bone marrow signal. No focal articular cartilage defects identified.LIGAMENTS: The ACL graft and PCL are intact. The collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1. Intact ACL graft. 2. Further attenuation of the posterior horn of the medial meniscus, compatible with degeneration and tearing.


Instruction: Generate impression based on findings.

Input: 19 year-old male with repeated effusions and medial knee pain. Evaluate MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact.LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The medial and collateral ligaments are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Small amount of fluid in the joint without frank joint effusion. The knee appears normal.