Instruction: Generate impression based on findings.

Input: 79-year-old female with numbness and tingling in bilateral upper extremities The alignment of vertebral column is unremarkable. Marrow signal is benign. The visualized cervical and upper thoracic cord are unremarkable. Cerebellar tonsils are in an appropriate position. Redemonstrated is a left thyroid T2 hyperintense nodule, as has been demonstrated and reported on prior studies.C2/3: Unremarkable and unchanged.C3/4: Mild posterior osteophyte disc complex now causes new slight flattening the anterior cord surface without intrinsic cord signal abnormality. There is also interval thickening of the ligamentum flavum. There remains no significant stenoses.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and slight ligamentum flavum thickening. There is moderate left neural foraminal and severe right neural foraminal stenosis. These findings are unchanged.C5/6: Mild posterior osteophyte disc complex, slight ligamentum flavum thickening, and left uncinate hypertrophy. There is mild bilateral neural foraminal stenosis. These findings are unchanged.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligament flavum thickening. There is flattening of the anterior cord surface, without intrinsic cord signal abnormality. There is mild to moderate central, moderate left neural foraminal, and mild right neural foraminal stenosis. These findings are unchanged.C7/T1: Shallow disc bulge without definitive neural foramina compromise or central spinal stenosis, unchanged.

Output: 1.Redemonstrated is a left thyroid T2 hyperintense nodule, as has been demonstrated and reported on prior studies.2.C3/4: Mild posterior osteophyte disc complex now causes new slight flattening the anterior cord surface without intrinsic cord signal abnormality. There is also interval thickening of the ligamentum flavum. There remains no significant stenoses.3.C4/5: Moderate left neural foraminal and severe right neural foraminal stenosis, unchanged.4.C5/6: Mild bilateral neural foraminal stenosis, unchanged.5.C6/7: Mild to moderate central, moderate left neural foraminal, and mild right neural foraminal stenosis, unchanged.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with bilateral internuclear ophthalmoplegia, right dysmetria and right leg weakness. Evaluate for disease progression. Worsening back pain. MRI brain: Redemonstrated are moderate to extensive findings of demyelinating lesions in the periventricular and subcortical white matter of the bilateral cerebral hemispheres and corpus callosum. There is interval decrease in size of a few lesions in the left periventricular and parietal coronal radiata. There is new single left temporal occipital lesion. There is no evidence of pathologic intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is parenchymal volume loss. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. MRI thoracic spine: There is redemonstration of fairly extensive patchy T2 hyperintense foci of the spinal cord with associated decreased cord caliber. Lesions are most prominent at the left aspect of the T4-T5 level, right aspect of the T5-T6 level, left aspect of T9-T10 and right aspect of T10-T11. On post enhanced images there is no convincing evidence of an enhancing plaque. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.MRI of lumbar spine: The vertebral column is straightened but otherwise within normal limits in alignment. The vertebral body heights are preserved. There is loss of disc height with disc desiccation at L3-L4 and, L4-L5 and L5-S1. The distal spinal cord and conus also demonstrated patchy foci of T2 hyperintense signal with conus terminating at the L1-L2 level. There is a large left paracentral disc extrusion at L5-S1 with superior migration of 1.1 cm contributing to severe spinal canal stenosis with impingement of the descending nerve roots at this level left greater than right. Neural foramina and spinal canal at the remainder of the levels are patent. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. Incidentally noted is a leiomyomatous uterus.

Output: 1.Moderate to extensive amount of demyelinating lesions. There is a single new lesion involving the left temporal occipital junction. There is no evidence of enhancement to suggest active demyelinating process. Multiple previously seen enhancing lesions have evolved in the interval and no longer enhance.2.Extensive nonenhancing demyelinating plaques throughout the thoracic and upper lumbar spinal cord with resultant decreased cord caliber, not significantly changed compared to prior thoracic spine MR from 6/14/2014.3.Large disc extrusion at L5-S1 contributing to severe spinal canal stenosis at this level and impingement of the descending nerve roots.Leiomyomatous uterus is partially imaged which can be further assessed with ultrasound as clinically indicated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 73-year-old female with right breast mass. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass with spiculated margin measuring 18 x 12 x 12 mm at the 4 o’clock position without increased vascularity, 6 cm from the nipple. The inferolateral component of this mass measures 7 x 8 mm corresponding to the homogenously enhancing area on the MRI performed in the morning.The lesion was readily visible. PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, four 12-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. Four specimens sank to the bottom of the prefilled container of 10% formalin. . Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location in the peripheral aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Wang. Dr. Kulkarni was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of the right breast lesion and hydromark clip placement. Pathology is pending at this time.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 81 years old, with history of multiple myeloma and new onset headache for five days. MRI brain:No significant parenchymal signal abnormality is seen including no evidence of restricted diffusion. Brain parenchymal morphology is within normal limits. No acute intracranial hemorrhage or abnormal extra-axial fluid is seen. The pattern of parenchymal enhancement is within normal limits. The ventricular system is normal in size and morphology. No dural abnormalities are suspected. The calvarial marrow shows normal signal characteristics. Scattered polypoid areas of mucosal thickening are seen within the maxillary sinuses.MRI cervical spine:Trace anterolisthesis of C5 relative to C6 and C6 relative to C7 is noted. Mild degenerative wedging of the C5 and C6 vertebral bodies is seen without evidence of marrow edema. No areas of concerning marrow replacement or pathologic marrow enhancement are evident.Foci of spinal cord T2 hyperintensity are seen at the C3-4 level in association with disc osteophyte disease which impinges upon the spinal cord. The spinal cord is relatively thinned at this level. Elsewhere, no definite spinal cord signal abnormality is seen. No epidural abnormalities are suspected. No pathologic cord or leptomeningeal enhancement is seen.Severe disc degeneration is evident at most levels in the cervical spine. This is most severe at C5-6 and C6-7 where there is near complete loss of disc height. Additional level specific findings are as follows:C2-3: Right greater than left facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C3-4: Facet hypertrophy. Posterior disc-osteophyte complex formation with central focality which impinges on the spinal cord and causes a moderate generalized spinal canal narrowing. Severe left and moderate right foraminal narrowing. C4-5: Facet hypertrophy. Posterior disc-osteophyte complex formation which causes a circumferential moderate spinal canal stenosis. Moderate left and mild right foraminal narrowing. C5-6: Facet hypertrophy. Posterior disc-osteophyte complex formation which causes a circumferential mild to moderate spinal canal stenosis. The neural foramina are severely narrowed bilaterally. C6-7: Facet hypertrophy. Posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. C7-T1: Facet hypertrophy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate to severe left foraminal narrowing.

Output: 1.Unremarkable evaluation of the brain with no findings to account for the patient's headaches.2.Severe multilevel disc and posterior element degeneration is seen in the cervical spine. At C3-4, a disc osteophyte process impinges on the spinal cord and is associated with cord signal abnormality which is favored to represent myelomalacia. Spinal canal stenoses are also seen at C4-5 and C5-6. Scattered significant foraminal narrowing is also evident as above.


Instruction: Generate impression based on findings.

Input: 74 year old woman with complex CAD, referred for evaluation of viability. Left VentricleThe left ventricle is severely dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 139 ml/m2 (normal range: 65+/-11), the LVEDV is 230 ml (normal range 109+/-23), the LV end systolic volume index is 83 ml/m2 (normal range 18+/-5), the LVESV is 137 ml (normal range 31+/-10), the LV mass index is 87 g/m2 (normal range 67+/-11), and the LV mass is 145 g (normal range 114+/-24). There is hypokinesis of the basal to mid inferior and inferolateral walls, as well as the mid to distal lateral wall. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The entire myocardium is viable.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 133 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 55 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflets are thickened. There is posterior tethering and malcoaptation of the leaflets. There is moderate to severe mitral regurgitation (ischemic etiology).Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is mild atherosclerosis of the descending aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%.2. There is a large territory of hypokinesis involving basal to mid inferior and inferolateral walls, as well as the mid to distal lateral wall. There is no late gadolinium enhancement to suggesting this entire territory is very likely viable. There is also no evidence of myocardial infarction in the remainder of the ventricle which is also viable. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%.4. Moderate to severe ischemic mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: GH deficiency with previous questionable microadenoma. The majority of the pituitary stalk is thin and non-enhancing. There is no discernible pituitary lesion. The pituitary gland is not enlarged or atrophic. The posterior pituitary bright spot appears to be intact, although there is focal T1 hyperintensity along the upper tuber cinereum as well. The optic apparatus and cavernous sinuses are intact. The cerebellar tonsils are perhaps slightly low-lying.

Output: Unchanged hypoplasia of the pituitary stalk without a discernible pituitary lesion. Pituitary hypoplasia can be associated with a mutation in the growth hormone–releasing hormone receptor gene.


Instruction: Generate impression based on findings.

Input: Recurrent symptoms after microdiscectomy. There is sacralization of the L5 vertebra. There are postoperative findings related to microdiscectomy at L3-4, with patchy enhancement in the soft tissues along the surgical approach. There is a central disc extrusion with superior migration that measures up to 9 mm in width and 17 mm in length superimposed upon a disc bulge at L3-4, which results in severe spinal canal narrowing. In conjunction with bilateral facet hypertrophy at this level, the bilateral neural foramina are at least moderately narrowed. There is a disc bulge and bilateral facet hypertrophy at L4-L5 with mild bilateral lateral recess narrowing and mild left and moderate right neural foraminal narrowing. There is mild degenerative spondylosis at L1-2 and L2-3, without significant spinal canal or neural foraminal stenosis. Aside from mild degenerative signal alterations, the vertebral bone marrow signal is unremarkable. There are multilevel small intravertebral disc herniations, but the vertebral body heights are essentially preserved otherwise. The spinal cord displays normal signal and morphology. There is a large right renal cyst.

Output: 1. Postoperative findings related to microdiscectomy at L3-4, with a central disc extrusion superimposed upon a disc bulge at this level and resultant severe spinal canal narrowing. In conjunction with bilateral facet hypertrophy at this level, the bilateral neural foramina are at least moderately narrowed.2. A disc bulge and bilateral facet hypertrophy at L4-L5 result in mild bilateral lateral recess narrowing and mild left and moderate right neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Smoldering multiple myeloma. Restaging. Sagittal alignment is anatomic. The vertebral bodies are preserved in height. Marrow is slightly heterogeneous though without suspicious focal lesion. T1/T2-hypointense lesion subjacent to the superior endplate of T11 has not changed since the previous examination and represent focal sclerosis, as evident on the CT part of the PET/CT scan dated March 29, 2016. There is desiccation and mild height loss involving L3-L4 and L4-L5 discs. There is focal contrast enhancement and T2-hyperintensity involving the right lateral aspect of the L3-L4 disc, probably representing annular fissure. The spinal canal is preserved. The conus medullaris tip is at upper L2 level. The conus medullaris has normal shape and signal. L4-L5 and L5-S1 facet arthropathy is moderate on the right at L4-L5 facet and mild elsewhere. There is mild right L4-L5 neural foraminal stenosis. The other neural foramina are fairly preserved. There is mild osteoarthritic change involving the sacroiliac joints, slightly more pronounced on the right.

Output: 1.The marrow is mildly heterogeneous but there is no destructive or definite marrow replacing lesion.2.Focal T2-hyperintensity and contrast enhancement in the L3-L4 disc annulus on the right probably represents annular fissuring.3.Degenerative disease in the lower lower lumbar spine otherwise.


Instruction: Generate impression based on findings.

Input: Reason: r knee pain History: pain MENISCI: There is marked deformity and blunting of the posterior horn and body of the lateral meniscus indicating a combination of degeneration and complex degenerative tearing which extends to involve the free edge of the meniscus as well as anterior horn of the meniscus. There is globular increased signal abnormality within the posterior horn of the medial meniscus indicating intrasubstance degeneration. Some of this signal extends to the femoral articular surface indicating superficial fraying.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle and lateral tibial plateau about the posterior horn of the meniscus with large areas completely devoid of articular cartilage. There is a focal near full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle. There is subjective thinning of the articular cartilage of the patellofemoral articulation. There are focal areas of full-thickness articular cartilage degeneration along both the medial and lateral facet of the patella. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Osteoarthritis of the knee with full-thickness articular cartilage degeneration most pronounced along the lateral tibiofemoral compartment.2. Complex degenerative tearing of the lateral meniscus. Intrasubstance degeneration and superficial fraying of the posterior horn of the medial meniscus.3. Baker's cyst and loose body within the joint. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 84-year-old male with a 3 day history of altered mental status, and history of falls on Coumadin. Evaluate for bleed There is no evidence of intracranial hemorrhage, mass or edema. Multiple patchy areas of hypodensity in a periventricular and subcortical distribution consistent with age indeterminate microangiopathic changes. If there is clinical concern for acute ischemia, an MRI may be considered.Prominent sulci and proportionally prominent ventricles, within normal limits for age.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Age indeterminate small vessel disease. No evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Metastatic prostate cancer. There is redemonstration of findings related to right posterior parietal craniotomy with a small amount of fluid at the operative site. There has been gross total resection cystic mass overlying the right parietal lobe. A punctate enhancing focus in the right lateral margin of the section cavity may represent granulation tissue or a focally dilated vein. There is otherwise minimal residual edema in the brain parenchyma surrounding to the surgical bed. There is unchanged diffuse dural thickening and enhancement particularly along the bilateral cerebral convexities, measuring up to 10 mm in maximal thickness on the right side. There has been interval decease in the edema adjacent to the left inferior frontal lobe lesion. There is leftward midline shift of approximately 5 mm. The basal cisterns remain patent. There is no evidence of new mass or acute infarct. The major cerebral flow voids are intact. There is persistent fluid in the mastoid air cells bilaterally. There is a small retention cyst in the right maxillary sinus. The orbits and scalp soft tissues are grossly unremarkable.

Output: 1.Postoperative findings related to right posterior parietal craniotomy and resection of an right parietal dural metastasis with markedly decreased surrounding right parietal lobe edema.2. No significant change in size of the extensive remaining bilateral dural based metastatic disease, although left inferior frontal lobe edema has subsided.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for memory loss. History of on transplant rejection medication (Prograf, prednisone, CellCept), heart and kidney transplant. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates mild to moderate periventricular and subcortical, bilateral basal ganglia and more extensively pontine foci of flair/T2 hyperintensity. Although findings are nonspecific the appearance is highly suggestive of chronic small vessel ischemic strokes.Susceptibility MR images demonstrate extensive supratentorial and infratentorial punctate foci of susceptibility and a single larger focus in the cortex of right posterior frontal lobe which are not visible on any other MR sequences. Findings are highly suggestive of multiple microhemorrhages and raising the possibility of amyloid angiopathy.There is prominence of cortical sulci and mild prominence of lateral ventricles which could be at the upper limits of normal however underlying volume loss is also suspected. The signal void of major intracranial arterial branches are identified.There is no detectable abnormal parenchymal, leptomeningeal or calvarial of enhancement. Unremarkable images through the orbits including axial post-enhanced series. Minimal opacification of left posterior ethmoid air cells and unremarkable paranasal sinuses otherwise

Output: 1.Negative diffusion weighted images.2.Findings highly suggestive of small vessel ischemic strokes involving subcortical and periventricular white matter as well as bilateral basal ganglia and extensively of the pons. Numerous foci of susceptibility consistent with microhemorrhages in both supine infratentorial spaces are identified and concerning for amyloid angiopathy. Parenchymal volume loss is suspected.3.No abnormal parenchymal, leptomeningeal or calvarial enhancement.


Instruction: Generate impression based on findings.

Input: Patient complains of electrical left ear pain and jaw pain. Pain can radiate to eye. Brain: There appears to be a fine linear low signal band that traverses a portions of the left Meckel cave obliquely, separate from the trigeminal rootlets. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The cavernous sinuses appear to be intact. 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 are unremarkable. There is mild left frontal sinus and frontoethmoid recess mucosal thickening. There is a pneumatized right anterior clinoid process. There are small nasopharyngeal retention cysts. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1. An apparent fine linear low signal band that traverses a portions of the left Meckel cave obliquely, separate from the trigeminal rootlets is of uncertain etiology, by may represent an arachnoid adhesion. Otherwise, no evidence of lesions along the other imaged portions of the left trigeminal nerve.2. No evidence of temporal bone region lesions.


Instruction: Generate impression based on findings.

Input: History of thyroid cancer. Post treatment. Head CT:There is no evidence of intra-axial mass, hemorrhage or infarction. Neck CT:Post-treatment changes are again present at the right masticator space, and parotid space. There is no evidence of interval change of the soft tissues in the surgical bed.An enhancing lesion at the greater wing of right sphenoid bone is again seen, with extension into the orbit. Accounting for differences in imaging techniques, there is no evidence of significant change compared to the more recent MRI study of 3/19/2010. On the CT study, the lesion measures approximately 1.7 x 2 cm on axial plane compared to prior measurement of approximately 2.1 x 2.1-cm on the prior MRI study.There is a heterogeneous nodule in the posterior aspect of the right thyroid lobe, measuring 9 x 9 mm, compared to previous CT measurement of 9 x 8 mm.There is a slightly prominent lymph node at the level 1A region which is still within normal limits in size. There is no evidence of interval change. It demonstrate slightly increased enhancement compared to prior study, but this can be secondary to technical factors. No evidence of adenopathy is seen based on radiological criteria.A developmental venous anomaly is seen in the right cerebellum.There are degenerative changes in the cervical spine. There are numerous nodules in the lungs, consistent with metastatic lung disease.

Output: 1. Metastatic lesion involving right sphenoid bone, with no significant interval change. 2 Stable small lymph nodes in the neck. No evidence of pathological adenopathy.3. Unchanged small right thyroid nodule is nonspecific in imaging appearance but may represent the thyroid cancer as per clinical history.4. Numerous pulmonary metastasis. Please correlate with CT chest.


Instruction: Generate impression based on findings.

Input: 49 years, Male, with history of TIA causing left-sided weakness and dysarthria. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Foci of T2/FLAIR hyperintensity are seen in the periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is diffuse opacification of the bilateral mastoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits. Redemonstration of cystic lesions with T1 hyperintensity at the nasopharynx, with a dominant lesion seen on the right, measuring 21 x9 mm. Smaller lesions are seen on the left.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. Again seen are few foci of T2/FLAIR hyperintensity in the supratentorial white matter, which are nonspecific but may represent mild chronic small vessel ischemic changes. 2. Redemonstration of multiple cystic lesions in the nasopharynx likely representing mucous retention cysts.


Instruction: Generate impression based on findings.

Input: Intracerebral hemorrhage [431], Reason for Study: ^Reason: aneurysm History: hx aneurysm There is about 8 mm sized lesion on the left posterior superior aspect of gyrus rectus. The lesion shows low signal intensity rim with the speckled internal low signal intensity on gradient echo indicating hemosiderin deposition. There is no surrounding edema. Small focal high signal intensity in side of the lesion may indicate subacute hemorrhage. Above described findings are indicating cavernous malformation on the left posterior superior gyrus rectus.There are no other lesion is seen on the scan. However, dedicated gradient echo MR imaging could be necessary to clarify additional parenchymal lesions if clinically indicated.There is no evidence of acute ischemic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.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. Focal hemorrhagic lesion on the left posterior superior aspect of gyrus rectus, most likely represent cavernous malformation.2. Otherwise unremarkable brain MRI and MRA.


Instruction: Generate impression based on findings.

Input: Can't move legs. Per chart history of spina bifida and multiple spinal cord and tethering procedures. Last surgery was on 10/6/2015 Compared to 7/29/2015, interval postsurgical changes of redo cord untethering are seen. Again seen is evidence of prior lipomyelomeningocele and multiple prior spinal surgeries. There is wide laminectomy at the L4-L5 level. Dysplastic/dysraphic posterior elements at the L5-S1 level also noted. Cord again noted to terminate near the L4-L5 level with the distal cord abutting the posterior margin of the thecal sac. Scar tissue is evident involving the thecal sac at the L5-S1 level.There has been development of a fluid collection in the posterior paraspinous soft tissues extending from the mid L3 to the upper S1 levels measuring approximately 2.5x4.4x6.6 cm. Smaller fluid collections extending towards the skin surface are also seen more superficially.Vertebral body heights and alignment are maintained. No significant disc disease. No spinal canal or neural foraminal stenosis at any level. No evidence of epidural hematoma.

Output: Again seen is evidence of multiple cord untetherings related to lipomyelomeningocele. There has been development of a posterior paraspinous fluid collection measuring approximately 2.5 x 4.4 x 6.6 cm extending from the mid L3 to the upper S1 levels likely representing a pseudomeningocele. Additional smaller pockets of fluid are also seen extending toward the skin surface.No evidence of mass effect on the thecal sac. No hematoma within the spinal canal. No significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Male, 13 years old, with history of cerebellar juvenile pilocytic astrocytoma, yearly follow-up examination. Postoperative findings are again seen compatible with tumor resection from the posterior fossa. A small resection cavity in the left paramedian cerebellum is unchanged. Minimal surrounding T2 hyperintensity and susceptibility are unchanged. No edema, mass effect or pathologic enhancement is observed. The brain parenchyma otherwise demonstrates normal signal intensity and morphology. Ventricular size is stable and within normal limits.

Output: Redemonstration of postoperative findings with no evidence of recurrent tumor.


Instruction: Generate impression based on findings.

Input: 64-year-old male. Evaluate prostate for cancer lesions. PELVIS:PROSTATE:Prostate Size: The prostate measures 5 cm in transverse, 3.3 cm in AP, and 4.6 cm in craniocaudal diameter.Peripheral Zone: In the posterior-lateral left mid gland, there is a 0.8 x 0.9 cm lesion that is hypointense on T2 and ADC that is consistent with the dominant tumor. No definite extracapsular extension. No seminal vesicle invasion. Other diffuse T2 hypointense foci are also noted on the right.Central Gland: No significant abnormality noted.Seminal Vesicles: Unremarkable.Extracapsular Extension: None.BLADDER: There are 2 posterior urinary bladder diverticula (axial series 1701 images 83, 92).LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant tumor in the posterior-lateral left mid gland measuring 0.8 x 0.9 cm.2.There are 2 posterior urinary bladder diverticula.


Instruction: Generate impression based on findings.

Input: 56-year-old male with right deltoid pain and mass. Concern for muscle tear. Multiple skin markers are identified presumably representing the patient's palpable area of concern. Multiple sequences are degraded by patient motion artifact. Note is made of a 5.6 x 3.4 x 1.4 cm (CC x AP x TR) mass along the lateral aspect of the distal fibers of the deltoid muscle which demonstrates fat signal intensity on all sequences. There is no pathologic enhancement on postcontrast sequences. No additional focal mass lesions are identified. The deltoid muscle appears intact, as clinically questioned. The imaged musculature of the right arm is normal in appearance. No bone marrow signal abnormality is identified. There is a trace amount of fluid within the subacromial subdeltoid bursa. The rotator cuff musculature is incompletely evaluated by this examination. Mild degenerative changes affect the acromioclavicular joint. There is a small amount of fluid within the glenohumeral joint without evidence of a large effusion. No evidence of lymphadenopathy.

Output: 5.6 cm mass along the lateral aspect of the distal fibers of the deltoid muscle with imaging characteristics most consistent with a lipoma.


Instruction: Generate impression based on findings.

Input: Clinical question: Source of headache, history of uterine cancer. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates several punctate foci of nonspecific flair hyperintensity only in the subcortical and periventricular white matter of cerebral hemispheres. Although nonspecific in proper clinical setting they could represent minimal chronic small vessel ischemic strokes.The anatomical morphology and the signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. Unremarkable C. cortex, cortical sulci, ventricular system and CSF spaces.Post enhanced images demonstrate no convincing evidence of a study lesion. There is a tiny focus of enhancement superficially in a right posterior frontal sulci which is highly suggestive of representing a vessel. Remote possibility of metastases cannot be however entirely excluded. This finding is best appreciated on axial post enhanced series 1001 image 21 and sagittal reformatted series 1203 image 116. There is no associated signal abnormality at this site on any of the other MRI sequences.Calvarium demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses and bilateral mastoid air cells demonstrate normal signal intensity.

Output: 1.Negative diffusion weighted images.2.Findings suggestive of mild chronic small vessel ischemic strokes. 3.No convincing evidence of metastatic disease.4.Punctate superficially located focus of enhancement in right posterior frontal most likely representing a vasculature, however remote possibility of tiny metastases cannot be entirely excluded. Please see above comments.


Instruction: Generate impression based on findings.

Input: 2-year-old male with oral aversion and vomiting. Evaluate for brainstem or posterior fossa lesion. There are scattered areas of periventricular white matter T2 hyperintensity, left more than right. There is otherwise a normal degree of myelination and the brainstem and cerebellum are unremarkable, however. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The corpus callosum is fully formed and intact. The brainstem and cerebellum are normal in appearance. The ventricles and basal cisterns are normal in size and configuration, albeit the left lateral ventricle is larger than the right. There is no midline shift or herniation. The major cerebral flow voids are intact. There is scattered mucosal thickening of the ethmoid air cells, right sphenoid sinus and right maxillary sinus. The orbits, skull and scalp soft tissues are grossly unremarkable.

Output: Scattered areas of periventricular white matter T2 hyperintensity, left more than right, are nonspecific. Differential considerations include prior ischemia or infection in addition to terminal zones of myelination. The brainstem and cerebellum are unremarkable, however. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chronic low back pain with standing Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild straightening of the lumbar spinal curvature as well as minimal retrolisthesis of L2 on L3. Bone marrow signal is benign with small foci of T1 hyperintensity compatible with small hemangiomas or foci of fat. The conus medullaris is normal in position. There are multilevel degenerative changes including disc desiccation as well as severe loss of disc height at the L2-L3 level. Disc heights at the remainder of the levels are grossly preserved. Additional details as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Severe disc height loss which has progressed since prior MRI from 2/3/2005. There is also a disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening contributing to mild spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L3-L4: Disc bulge, facet arthropathy, and ligamentum flavum thickening, contributing to mild to moderate spinal canal stenosis. There is also mild to moderate left and mild right neural foraminal stenosis.L4-L5: Mild disc bulge, facet arthropathy, and ligamentum flavum thickening. No significant spinal canal or neural foraminal stenosis.L5-S1: Minimal disc bulge. There is bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine, relatively worse at the L2-L3 and L3-L4 levels. There is mild L2-L3 and mild to moderate L3-L4 spinal canal stenosis. No higher grade spinal canal stenosis. There is also mild to moderate right L2-L3 and left L3-L4 neural foraminal stenoses. Additional details as above.


Instruction: Generate impression based on findings.

Input: Pain in leg, unspecified [M79.606] / Raynaud's syndrome without gangrene [I73.00] / Family history of epilepsy and other diseases of the nervous system [Z82.0], Reason for Study: ^Reason: Brother with syringomyelia on recent MRI screening for family Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRIProminent central canal is seen especially from C56 to C7 level. Otherwise there is no definitive evidence of syringomyelia. There is no evidence of other abnormal signal intensity of spinal cord.Vertebral alignment is anatomic. Vertebral height is preserved. No evidence of spinal canal stenosis.No evidence of neuroforaminal stenosis.Thoracic spine MRIThere is syringomyelia extending from T2 level to T12. Most prominent syrinx segment is seen between T6 to T8 level.Vertebral alignment is anatomic. Vertebral height is preserved. No evidence of spinal canal stenosis.No evidence of neuroforaminal stenosis.

Output: 1. Normal brain MRI2. Syringomyelia on thoracic spine and prominent central canal on cervical spine as described above.3. No neuroforaminal stenosis. No spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Right side weakness There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate significant (more than 50%) of luminal stenosis and irregularity on the right MCA M1 segment. The left MCA shows subtle luminal irregularity but did not show any significant luminal stenosis. Bilateral PCAs are fetal origin.Vertebrobasilar system shows relatively smaller diameter and shows tortuosity, however, do not show any significant luminal narrowing. There is no evidence of intracranial arterial aneurysm.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The right vertebral artery origin appear to be normal but the left vertebral artery appears to be small in diameter. The left vertebral artery completes as left PICA. No aneurysm was seen.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Significant (more than 50%) stenosis of the right MCA M1 segment with irregularity as well as left MCA luminal irregularity indicate atherosclerotic changes.3. Bilateral fetal PCAs with relatively small vertebrobasilar system, especially left vertebral artery is hypoplastic.4. Bilateral carotid bifurcations appear to be normal.


Instruction: Generate impression based on findings.

Input: 60 year-old female, with peripheral vascular disease status post left above-the-knee amputation with open wound and left leg edema. Evaluate for fluid collection, tracking air.IMAGE ACQUISITIONS: Non-IV contrast enhanced CT of the pelvis and both thighs. Lack of IV contrast decreases the ability to detect small abscesses.Patient is status post left above-the-knee amputation. Irregularity of the soft tissues of the distal end of the remaining left thigh is compatible with the stated history of open wound, and there several small pockets of gas density seen within the soft tissues surrounding and adjacent to the amputated distal left femur. There are no specific features of osteomyelitis on this study, although MRI would provide a more sensitive assessment for osteomyelitis. No abscess is identified within the left thigh. Air does not extend into the proximal thigh.There is moderate bilateral stranding of the subcutaneous fat of the thighs compatible with edema, which extends into the subcutaneous fat of the pelvis and lower abdomen. An intramedullary rod is present in the right femur and results in metallic artifact that slightly limits the exam of the surrounding anatomic structures. There are atherosclerotic calcifications seen within the pelvis and both thighs as well as a femoral artery stent on the right.

Output: Status post left above-the-knee amputation with stump wound and small foci of air immediately adjacent to the distal left femur. No abscess evident.


Instruction: Generate impression based on findings.

Input: Female, 82 years old, with history of parafalcine meningioma status post fractionated radiotherapy. A T2 heterogeneous, T1 isointense tumor nodule is seen along the anterior interhemispheric falx just above the cingulate gyrus. The lesion is bilateral but predominantly right sided. Since the prior examination, there has been perhaps a slight decrease in lesion size as it now measures 17 x 15 mm in the axial plane, previously 19 x 16 mm. The lesion abuts the adjacent frontal lobe parenchyma but causes no edema or mass effect.Patchy periventricular white matter T2 hyperintensity is again seen, a finding which likely reflects chronic microvascular ischemic disease. No evidence of parenchymal edema, mass effect or restricted diffusion is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are observed. The ventricles and sulci are prominent compatible with parenchymal volume loss.

Output: The treated anterior parafalcine tumor is perhaps slightly smaller than on the prior examination. No new intracranial lesions are detected.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, with cavernoma, presenting with seizures, balance loss, intermittent expressive aphasia, double vision, fatigue, headaches and memory loss. Functional assessment requested for speech and motor to assess surgical risk. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical activation maps along the bilateral calcarine sulci.Of the tested language paradigms, all produce reliable language related cortical activation. Language is strongly left dominant. The putative Broca's area is best visualized on the word generation paradigm and maps to the pars opercularis and pars triangularis of the left inferior frontal gyrus. The putative Wernicke's area is best visualized on the sentence completion paradigm and maps along the posterior aspect of the left superior temporal sulcus. Both Broca's and Wernicke's areas are visualized on the verb generation paradigm. All language related cortical activity is well removed from the visualized left medial temporal lobe lesion.

Output: 1.Sensorimotor cortical activation maps as expected along the pre and postcentral gyri. Visual cortical activation maps as expected along the bilateral calcarine sulci.2.Language is left dominant. Broca's and Wernicke's areas are identified in their customary locations.


Instruction: Generate impression based on findings.

Input: 42-year-old woman with history of pain in the right deltoid muscle and a subcutaneous nodule noted on sonography. ROTATOR CUFF: There is a focal, full-thickness tear of the supraspinatus tendon (series 5, image 18) near its insertion without evidence of muscle atrophy or retraction. A small amount of subacromial/subdeltoid bursa fluid is noted. The infraspinatus, teres minor, and subscapularis are intact.SUPRASPINATUS OUTLET: No significant abnormality with a type II acromion.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is anatomic and no significant abnormality is noted. The labrum is grossly intact.BICEPS TENDON: The biceps tendon is situated within the bicipital groove without evidence of tear. ADDITIONAL

Output: 1.Nonspecific, ill-defined area of enhancement and T1/T2 signal abnormality within the subcutaneous soft tissues overlying the deltoid muscle. While this may represent an inflammatory process, neoplasm cannot be excluded, but there is no evidence of intramuscular involvement.2.Focal full-thickness tear of the supraspinatus tendon without retraction or muscle atrophy.


Instruction: Generate impression based on findings.

Input: 34-year-old male with history of excision/XRT for left wrist synovitis sarcoma. The field of view was increased to include the distal forearm. Again seen are foci of susceptibility artifact in the medial wrist related to previous resection. There is no discrete mass lesion present to suggest tumor recurrence. Again seen is edema and reticulation in the subcutaneous tissues along the ulnar aspect of the wrist/forearm, without significant interval change. There is persistent mild edema and enhancement within the pronator quadratus and extensor digitorum muscles, as seen previously, likely reflecting posttreatment change, most significant along the ulnar aspect of these muscle bellies. The extensor and flexor tendons are intact. There is unchanged fluid in the radiocarpal joints which may reflect mild synovitis.

Output: Posttreatment changes in the left wrist without evidence of disease recurrence.


Instruction: Generate impression based on findings.

Input: A 5 mm focus of T2 hyperintensity with associated mild enhancement and restricted diffusion is again seen in the left centrum semiovale, unchanged from the previous study. A similarly sized right parietal lobe nonenhancing T2 hyperintense lesion without restricted diffusion is also unchanged from the previous study.Patchy enhancing T2 hyperintensity that was present on the previous studies involving the left medial temporal lobe, lateral thalamus and basal ganglia also shows no significant interval change. Single voxel spectroscopy of this lesion demonstrates decreased NAA, decreased choline, and decreased creatine relative to the contralateral normal side. rCBV imaging shows reduced cerebral blood volume correlating to all the above noted lesions.Streaky enhancement in the right parietal lobe is seen in a peri-venular pattern, unchanged. No new signal abnormality or pathologic enhancement is detected. No evidence of hemorrhage, mass effect, or edema is seen. The ventricular size is normal with no midline shift.

Output: 1. No change in the appearance of the high T2/FLAIR signal and enhancing lesions in the left temporal lobe, right parietal lobe, and the left centrum semiovale.2. Spectroscopic pattern of the dominant left temporal lesion is compatible with parenchymal injury and argues against an aggressive or highly proliferative neoplastic process.3. There is a reduced cerebral blood volume within the described lesions that also argues against an aggressive neoplastic process.4. Differential diagnosis favors inflammatory or granulomatous conditions such as sarcoidosis or lupus, post inflammatory auto-immune phenomena, and atypical demyelinating disease.


Instruction: Generate impression based on findings.

Input: 48-year-old with history of right mastectomy for breast cancer. Left breast lift surgery in October 2014 There is scattered fibroglandular tissuein left breast. Status post right mastectomy with reconstruction.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or right reconstructed breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 85-year-old female patient with cystic lesion in the head of the pancreas. ABDOMEN:LIVER, BILIARY TRACT: Layering gallstones within the gallbladder. No evidence of cholecystitis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is a unilocular T2 hyperintense and T1 hypointense lesion in the pancreatic head that measures 2.0 x 2.9 x 2.7 cm (series 601 image 18 and series 501 image 16) and appears to communicate with the pancreatic duct. The cyst is thin-walled without any enhancing nodular component. No upstream pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Complex exophytic cyst in the superior pole of the right kidney with thin septations measures 3.1 x 2.4 cm (series 601 image 17).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: S shaped scoliosis.OTHER: Bronchiectasis, scarring and trace bilateral, right greater than left, pleural effusions.

Output: 1.Unilocular cyst measuring 2.9 cm that appears to communicate with the pancreatic duct without enhancing soft tissue component is favored to represent a branch duct IPMN. 2.Bibasilar airspace opacities in the lungs appear similar compared to prior examination and may reflect aspiration pneumonia.


Instruction: Generate impression based on findings.

Input: Neck pain. Craniovertebral junction appears within normal limits. There is minimal rotation of C1 on C2 which is nonspecific and can be positional. The cervical vertebral bodies are appropriate in height. There is minimal anterolisthesis of C2 on C3 as seen on prior studies. Alignment is otherwise maintained. Bone marrow signal is within normal limits. Ligamentous structures at the craniocervical junction and the remainder of the cervical spine are intact without evidence of disruption or edema.The cervical spinal cord has normal signal characteristics and overall morphology. There is no significant disc disease or spinal canal or neural foraminal stenosis at any level. No epidural collections. Paraspinous soft tissues are unremarkable without evidence of edema or hematomas.

Output: 1. Again seen is mild rotation of C1 on C2 as well as minimal anterolisthesis of C2 on C3 as seen on CT. No associated ligamentous disruption or edema in the adjacent soft tissues to suggest a traumatic etiology.2. MR evaluation of the cervical spine is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 28 year old female status post shunt internalization The intracranial catheter courses through right frontal lobe, enters the left lateral ventricle with tip terminating near the left anterior limb of the internal capsule. This catheter course is unchanged when compared to prior examination.The CSF spaces are appropriate for the patient's stated age with no midline shift or evidence of hydrocephalus.Low density change in the pons, bilateral temporal lobes, and left cerebellar folia are noted, but much better demonstrated on previous MRI.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: Unchanged position of right frontal approach ventriculostomy and unchanged ventricular sizes without evidence of hydrocephalus.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils lie up to 8 mm below the level of the foramen magnum, maintaining a rounded morphology. Biphasic CSF flow is noted posteriorly at the level of the foramen magnum and cerebellar tonsils.The spinal cord is normal in signal and morphology throughout without MRI evidence of syrinx. The conus is normal in signal and morphology and terminates at mid-L1 level. There is no fat within the filum. Upon prone maneuvering, the conus and proximal cauda equinus slightly translates anteriorly.There are no osseous dysplasias, disc pathologies, or stenoses. There are no fractures or subluxations. The marrow signal is benign. The visualized paraspinal contents are unremarkable.

Output: 1.The cerebellar tonsils lie up to 8 mm below the level of the foramen magnum providing MRI evidence of Chiari malformation. Biphasic CSF flow is noted posteriorly at the level of the foramen magnum and cerebellar tonsils.2.The spinal cord is normal in signal and morphology throughout without MRI evidence of syrinx.3.No MRI evidence of fatty filum or tethered cord.


Instruction: Generate impression based on findings.

Input: 49-year-old female with right knee pain. MENISCI: There is globular increased signal abnormality within the posterior horn of the medial meniscus indicating intrasubstance degeneration. There is blunting of the free edge of the body of the lateral meniscus suggesting fraying or perhaps a small tear. There is a small focus of intermediate signal along the undersurface of the posterior horn of the lateral meniscus which likewise may reflect a tiny tear, but the clinical significance of this finding is uncertain.ARTICULAR CARTILAGE AND BONE: There is edema within the medial aspect of the patella as well as within the lateral aspect of the lateral femoral condyle likely representing bone contusions from prior transient patellar dislocation. The cortex along the medial aspect of the patella is indistinct which may reflect an avulsion fracture, although the fracture fragment is not discretely visualized. There is flattening of the femoral trochlea, superiorly, indicating dysplasia. There is also slight lateral translation of the patella relative to the femoral trochlea. There is a 13 mm ovoid focus of signal abnormality within the posterior aspect of the distal femoral metaphysis likely representing a benign enchondroma. There is deep fraying of the articular cartilage of the lateral facet of the patella with at least one full-thickness cleft. There is a small full-thickness defect of the articular cartilage of the lateral aspect of the femoral trochlea. There is mild heterogeneity of the articular cartilage of the lateral tibial plateau that may represent mild degeneration. The articular cartilage of the medial compartment appears intact.LIGAMENTS: The ACL appears intact, but is slightly thickened with fluid signal intensity along its proximal fibers which may represent a ganglion. There is an approximately 1 cm ovoid focus of low to intermediate signal intensity along the anterior fibers of the ligament that may represent focal arthrofibrosis. The MCL appears intact, however, there is extensive edema along the medial supporting structures of the knee indicating retinacular disruption and likely tearing of the medial patellofemoral ligament, the femoral attachment of which is not visualized. Edema extends posteriorly along the posterior oblique ligament which may be sprained. The PCL appears intact. The LCL appears intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact.ADDITIONAL

Output: 1. Findings indicating prior transient lateral patellar dislocation.2. Blunting of the free edge of the body of the lateral meniscus may reflect fraying or a small tear.3. Articular cartilage degeneration/tearing as described above.4. Thickening of the ACL may reflect mucoid degeneration or perhaps prior injury with an ovoid focus of signal abnormality along the anterior aspect of the distal fibers which may represent focal arthrofibrosis.5. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Images are motion degraded. Given this caveat:There is slight reversal of normal cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Posterior osteophyte disc complex asymmetric to the right combined with right uncinate hypertrophy causes slight anterior right hemicord flattening without intrinsic cord signal abnormality. There is mild right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate to severe left neural foraminal and minimal right neural foraminal stenosis.C7/T1: UnremarkableT1/2: Endplate spurring towards the left causes mild encroachment of the left neural foramen.

Output: 1.C5/6: Posterior osteophyte disc complex asymmetric to the right combined with right uncinate hypertrophy causes slight anterior right hemicord flattening without intrinsic cord signal abnormality. There is mild right neural foraminal stenosis.2.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate to severe left neural foraminal and minimal right neural foraminal stenosis.3.T1/2: Endplate spurring towards the left causes mild encroachment of the left neural foramen.


Instruction: Generate impression based on findings.

Input: Cervical spine:Multilevel degenerative changes affect the cervical spine with anterior osteophyte formation and multilevel disc desiccation affecting C3 through C6 along with mild endplate irregularity at these levels. There is a grade I retrolisthesis of C5 on C6, measuring 3 mm. Vertebral body heights are preserved.At the C2/C3 level, there is no significant canal stenosis. Facet and uncovertebral hypertrophy cause moderate, left greater than right, bilateral neural foraminal stenosis.At the C3/4 level, a small posterior disc-osteophyte complex causes moderate canal stenosis along with ligamentum flavum thickening/facet hypertrophy leading to mild right and moderate to severe left neural foraminal stenosis. There is no significant signal cord abnormality.At the C4/C5 level, a moderate posterior disc-osteophyte complex causes moderate to severe canal stenosis. There is a focus of increased T2 signal within the spinal cord at this level which may be secondary to compressive myelopathy. Facet and ligamentum flavum hypertrophy also contribute to moderate to severe right and severe left neural foraminal stenosis.At the C5/6, a small posterior disc-osteophyte complex causes moderate to severe canal stenosis. Bilateral ligamentum flavum, uncovertebral, and facet hypertrophy contribute to severe bilateral neural foraminal stenosis.At the C6/7, a small posterior disc-osteophyte complex causes mild canal stenosis. There is ligamentum flavum and facet hypertrophy contributing to mild to moderate bilateral neural foraminal stenosis.At the C7/T1, there is no significant canal stenosis. There is left greater than right facet hypertrophy with mild right and moderate left neural foraminal stenosis.Lumbar spine:There is anatomic alignment of the lumbar spine. Vertebral body heights are preserved. Signal within the visualized cord is within normal limits. Developmental narrowing of the mid to distal lumbar spinal cord is again identified. Multilevel degenerative changes of the lumbar spine appears similar to that described on prior study from 1/19/2016. An asymmetric heterogeneous abnormal signal intensity collection within the subcutaneous tissues overlying the right gluteal musculature at the level of L5 appears similar to the prior study. There is nodular thickening within the partially imaged left adrenal gland measuring up to 2.0 x 2.1 cm. There is also thickening of the partially imaged right adrenal gland. There is a 1.2 cm hyperintense lesion within the left kidney which likely represents a simple cyst.

Output: 1. Multilevel degenerative changes of the cervical spine with grade I retrolisthesis of C5 on C6 and multilevel moderate to severe spinal canal stenosis and neural foraminal stenosis as described above, which is most prominent at C4/C5 where there is signal abnormality within the cord which may be secondary to compressive myelopathy.2. No significant interval change in degenerative changes of the lumbar spine as described on recent MRI.3. Heterogeneous collection within the right subcutaneous soft tissues at the level of L5 is similar in appearance. This may represent a small fluid collection/hematoma; correlation with physical examination and history of trauma/procedure is suggested. 4. Thickening of the adrenal glands with more focal nodular appearance on the left, which is unchanged; comparison to prior outside body imaging is suggested if available, otherwise, dedicated adrenal imaging may be considered if clinically warranted.


Instruction: Generate impression based on findings.

Input: 47-year-old female. Right knee lateral meniscus tear status post ACL surgery by Dr. Leland. Right knee pain and swelling. MENISCI: Globular signal abnormality contacting the tibial and femoral articular surfaces in the posterior horn of medial meniscus consistent with complex degenerative tearing. Lateral meniscus is intact without evidence of tear.ARTICULAR CARTILAGE AND BONE: Serpiginous ovoid T1 hypointensity in the posterior lateral femoral condyle consistent with osteonecrosis, unchanged. Diffuse marked cartilage thinning of the medial patellar facet with areas of near full thickness cartilage loss; mild thinning of the lateral patellar facet cartilage near the apex . Tibiofemoral compartment cartilage is intact without a focal defect.LIGAMENTS: Postsurgical findings of ACL reconstruction with an intact graft. PCL is intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex degenerative tearing of the posterior horn of the medial meniscus. 2. Moderate knee joint effusion and a small Baker's cyst.


Instruction: Generate impression based on findings.

Input: Reason: 81M with h/o prostate cancer s/p prostatectomy 5/2016 with persistently elevated PSA History: Look for residual disease at prostate bed. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Not applicable.Central Gland: Not applicable.Seminal Vesicles: Not applicable.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: There is a subcentimeter focus of intermediate T1 signal within the right posterior acetabulum which is nonspecific but lacks associated restricted diffusion. There is redemonstration of a sclerotic focus within the left ilium which appears similar to the comparison CT and likely reflects a bone island.OTHER: No specific evidence of local recurrence within the prostatectomy bed. The vesicourethral anastomosis appears within normal limits.The large field-of-view postcontrast images demonstrate a cystic structure with a thin enhancing rim along the right pelvic sidewall (series 1701, image 95) measuring 1.4 x 2.3 cm which likely represents a postoperative fluid collection (such as a lymphocele). There are no significant surrounding adjacent inflammatory changes.Amorphous material and surgical clips within left inguinal canal compatible with prior hernia repair.Small amount of fluid within the right inguinal canal appearing similar to comparison CT.

Output: Status post prostatectomy without specific evidence of local residual disease.


Instruction: Generate impression based on findings.

Input: Prostate cancer, currently on active surveillance. Pathology dated 1/31/2016 showed 3+ 3 1-mm 5% left lateral base, 3+ 3 1-mm 5% right base. PELVIS:PROSTATE:Prostate Size: 3.4 x 5.0 x 5.0 cmPeripheral Zone: In the right apex there is a subtle linear region of restricted diffusion measuring 7 x 7 mm (series 403/224) associated with mild decreased T2 weighted signal intensity (series 801/12 and series 601/19). There appears to be a symmetric less restricting signal on the left, and thus these lesions are felt to be normal anatomy.Mild nonspecific restricted diffusion in the right base without associated T2-weighted signal (series 403/384) is not nodular, and is of unclear significance given that biopsy at the right base previously showed 3+3 neoplasm.No additional discrete suspicious lesion. Central Gland: Mild changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No 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.No distinct suspicious lesions as described above.2.No evidence of extraprostatic extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Ms. Jackson is a 31-year-old female with a personal history of Marfan's disease. Family history of breast cancer in mother, diagnosed at the age of 33. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. There is a benign morphology mass with nonenhancing dark internal septations identified in the left lower inner breast, compatible with a fibroadenoma, and stable when compared to the prior MRI from 2012. No abnormal axillary lymph nodes are identified in either axillary region.Median sternotomy wires are identified.

Output: No MRI evidence for malignancy. Stable fibroadenoma of the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: N - Routine Mammogram.


Instruction: Generate impression based on findings.

Input: Glioblastoma treated with surgery and TMZ. There is an unchanged right frontal lobe resection cavity with an unchanged thin rim of hemosiderin and confluent high T2 signal surrounding the resection cavity. There is no abnormal enhancement in the brain. There is mild dural enhancement and thickening at the craniotomy site, but no abnormal intraparenchymal enhancement or elevated relative cerebral blood volume. The ventricular system appears to be unchanged and there is no midline shift. The skull and extracranial soft tissues are also unchanged.

Output: Stable post-treatment findings in the right frontal lobe without evidence of tumor progression. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: left shoulder dislocations History: Shoulder pain ROTATOR CUFF: No significant abnormality noted. No muscle atrophy.SUPRASPINATUS OUTLET: Mild to moderate increased signal in the distal supraspinatus tendon indicating tendinopathy. No distinct tear is noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Mild-to-moderate supraspinatus tendinopathy.2.Multiple small floating loose bodies noted in the joint space.


Instruction: Generate impression based on findings.

Input: 51 year old female status post left mastectomy in August of 2014 for invasive ductal carcinoma. Patient received radiation, chemotherapy. Status post left mastectomy and left axillary lymph node dissection.There is heterogeneous amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.There is a benign lymph node at right axillary tail.No abnormal enhancement is seen in right breast or left mastectomy bed. 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: Male, 23 years old, with headaches and visual changes. No edema or mass effect is detected. No evidence of restricted diffusion is seen. There is no pathologic parenchymal or extra-axial enhancement. A small developmental venous anomaly is evident in the right anterior temporal lobe. No findings are seen to suggest acute or chronic intracranial hemorrhage. No abnormal extra-axial fluid collections are detected and the ventricular system is normal in size and morphology. The pituitary region is within normal limits. Although not a dedicated examination, no specific abnormalities of the orbits or optic apparatus are detected.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: No current breast related complaints. Minimal parenchymal enhancement is noted bilaterally. There is heterogeneous amount of fibroglandular tissue in both breasts.Right breast: No abnormal enhancement.Left breast: There is redemonstration of 4 mm enhancing focus in the left upper outer breast, approximately 2:00 position, posterior depth. This focus has been unchanged in size and morphology since 2011. No abnormal lymph nodes are identified in either axillary region.

Output: Stable left breast enhancing focus.No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Metastatic head and neck caner with suspicious lesion on head CT. There are at least six bilateral cerebral hemisphere nodular and ring-enhancing lesions with minimal to mild vasogenic edema. For example, the largest measures up to 9 mm in the left middle frontal gyrus, which appears to be smaller and associated with diminished edema compared to the prior CT, accounting for difference in technique. There is also a punctate enhancing lesion in the left cerebellar hemisphere. In addition, there are multiple enhancing lesions within the skull, the largest of which measures up to 25 mm in the occipital bone with minimal associated enhancement of the overlying subgaleal tissues, but no evidence of epidural extension. There is no evidence of acute intracranial hemorrhage or cerebral infarction. The ventricles are normal in size and configuration. There is no midline shift or herniation. There is minimal fluid within the left mastoid air cells. The orbits are unremarkable.

Output: 1. Several subcentimeter supratentorial and infratentorial subcentimeter lesions are compatible with metastases.2. Multiple skull lesions are also compatible with metastases.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of upper lobe, right bronchus or lung [C34.11], Reason for Study: ^Reason: r/o metastatic brain lesion History: lung cancer No evidence of acute ischemic or hemorrhagic lesion on the scan.There is no evidence of abnormal enhancement.Underlying brain shows patchy scattered bihemispheric high signal intensities on FLAIR/T2 images on periventricular white matter indicating non specific small vessel ischemic disease. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 69-year-old woman with history of Crohn's disease status post ileostomy and pancreatic lesion seen on MR enterography. ABDOMEN:LIVER, BILIARY TRACT: There is stable hepatomegaly, otherwise the liver is normal in signal and morphology.The gallbladder is normal and there is no intra or extrahepatic biliary ductal dilatation. Nodule adjacent to the gallbladder fundus (401/8) is unchanged from the prior examination.SPLEEN: No significant abnormality noted.PANCREAS: A 10 x 6 mm T2 hyperintense, nonenhancing pancreatic tail lesion with simple septation is again noted (301/26) and unchanged in size from the prior examination on which it measured 10 x 6 mm. Additional, 8 mm T2 hyperintense focus without enhancement in the pancreatic body (701/42) and additional tiny foci of T2 hyperintensity communicate with the pancreatic duct and are stable. There is no pancreatic ductal dilatation. No additional focal pancreatic parenchymal lesions are identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts are stable. The kidneys are otherwise normal without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post colectomy with a right midabdominal end ileostomy. There is mild, asymmetric enhancement of the small bowel within the ostomy, but no secondary signs of inflammation. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable subcentimeter cystic pancreatic lesions, likely sidebranch IPMNs.2.Stable gallbladder fossa lymph node.3.Mild enhancement of the small bowel within the ostomy without proximal dilation, mild inflammation not excluded.


Instruction: Generate impression based on findings.

Input: Evaluate labral versus cuff pathology. Pain and decreased range of motion. ROTATOR CUFF: The infraspinatus, supraspinous, teres minor and subscapularis are normal in appearance. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. Contrast is identified within the glenohumeral joint, without communication with the subacromial/subdeltoid bursa.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal MRI of the right shoulder.


Instruction: Generate impression based on findings.

Input: HPV+ T3N2b left tonsillar SCC, on OPTIMA clinical trial induction then RT alone from 11/23/15-12/24/15. There are treatment effects in the left oropharyngeal region. However, there is no residual measurable tumor in the left tonsillar fossa. There is no residual significant cervical lymphadenopathy. The parotid, submandibular, sublingual, and thyroid glands are unremarkable. The cervical arterial flow voids are grossly intact. There is mild degenerative spondylosis of the cervical spine. There is scattered paranasal sinus mucosal thickening. There is a right subacromial bursa effusion. The orbits and imaged intracanal structures are unremarkable. Thre is mild mucosal thickening in the right maxillary sinus. There are nodular lesions in the imaged portions of the lungs.

Output: 1. Post-treatment findings without evidence of residual or recurrent tumor in the oropharynx and no significant residual cervical lymphadenopathy.2. Nodular lesions in the imaged portions of the lungs may be related to sarcoidosis. Please refer to the separate chest CT report for additional details.


Instruction: Generate impression based on findings.

Input: 79 year old female with metastatic breast cancer to bone. CVA with left hemiparesis. Hydronephrosis in the past and a stage IV decubitus ulcer presenting with altered mental status. Nonenhanced head CT:Examination demonstrate no evidence of gross intracranial metastatic disease. To entirely exclude possibility of metastatic lesions enhanced MRI or CT exam is recommended. Finding highly suspected of advanced small vessel disease of indeterminate age are noted.There is no evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus.Multiple poorly defined lytic bony changes with no definitive evidence of breakthrough of cortex are suspected for metastatic lesions.

Output: 1.Limited value examination for metastatic disease due to lack of intravenous contrast. No gross evidence of metastases no disease to the brain. Small osseous lytic skull metastases.2.Small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with right base of tongue cancer status post CRT. No evidence of any mucosal tumor-like lesion is seen. No pathologic adenopathy is detected by size criteria. Atrophy and increased T2 signal of the muscles of the right neck are unchanged and likely related to prior surgery or treatment. The salivary glands are unremarkable. The marrow signal characteristics show evidence of prior radiotherapy but are otherwise unremarkable.

Output: No evidence of recurrent primary tumor or pathologic adenopathy.


Instruction: Generate impression based on findings.

Input: 58-year-old female with history of a left mastectomy, now with pain and swelling along the lateral and superior aspects of the left chest wall and axilla LUNGS AND PLEURA: Minimal left apical parenchymal scarring as well as changes of discoid atelectasis in the left upper lobe are present. No pulmonary masses or nodules can be identified. There is no evidence of a pericardial or pleural effusionMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Surgical clips are identified in the left axilla. No osseous metastases can be identified. Degenerative changes are noted in the left glenohumeral joint region (see recent MRI of the left shoulder).UPPER ABDOMEN: Small hiatal hernia. Otherwise, no significant abnormalities.

Output: 1. Minimal scarring and discoid atelectasis in left upper lobe.2. No evidence of metastatic disease


Instruction: Generate impression based on findings.

Input: 60 year old woman with a history of bilateral benign breast biopsies. Her family history is positive for breast cancer diagnosed in her sister at age 56, as well as ovarian and breast cancer diagnosed in a paternal aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is redemonstration of multiple benign enhancing foci 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: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Female 43 years old Reason: Please follow protocol IRB # 14-0288. Rectal cancer, please assess extent of disease state post induction therapy with Chemo and radiation, RECIST compare to previous MRIs, prior to planned potential surgery. History: Additional history as per chart, patient has history of tumor palpable approximately 3 to 4 cm proximal to the anal verge. PELVIS:UTERUS, ADNEXA: There is a 1.5 cm left adnexal cyst, otherwise the uterus and adnexa are unremarkable. BLADDER: The bladder appears normal.LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: NoneLymph nodes outside the mesorectal fascia: Subcentimeter inguinal lymph nodes. No suspicious lymphadenopathy.BOWEL, MESENTERY: Rectal Tumor:Size: 1.8 x 1.3 cm in greatest thickness (series 3, image 42) approximately 3.2 cm from the anal verge.Tumor appearance: The tumor demonstrates low T2 signal and is predominantly circumferential. Additionally, there are areas in which the serosal lining of the rectum is not well visualized (series 3, image 30). There is minimal enhancement of the thickened bowel wall.Tumor location: The tumor extends from 3.2 cm from the anal verge proximally to the sigmoid colon (series 3, image 26).Circumference of the rectum involved: The tumor is circumferential.Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): There is no involvement of the mesorectal fat or fascial.MRI T-stage: T3BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic free fluid is noted, likely physiologic.

Output: Circumferential rectal wall thickening and signal abnormality representing rectal carcinoma with likely posttreatment changes. Although the serosal surface appears to be involved, the mesorectal fascia and adjacent organs are spared.


Instruction: Generate impression based on findings.

Input: Tender subcutaneous nodule right postauricular scalp. There is a well-defined enhancing nodular lesion in the right post-auricular scalp that measures 5 x 15 mm in cross-section. The underlying mastoid bone appears to be intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered foci of nonspecific cerebral white matter T2 hyperintensity. 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 are grossly unremarkable.

Output: A well-defined lesion in the right post-auricular scalp that measures up to 15 mm may represent a peripheral nerve sheath tumor or "traumatic neuroma", for example.


Instruction: Generate impression based on findings.

Input: Left cerebellar lesion, status post biopsy. There are postoperative findings related to left occipital approach stereotactic guided biopsy of the left upper cerebellar lesion. The lesion again presents as mildly T2 hyperintense, with small foci of intrinsic T1 signal likely related to minimal postprocedural blood product. The lesion measures up to 20 mm in maximum diameter and has not significantly changed in size from the prior exam. As before, the inferior margin of the lesion is sharply defined and distinct from the normal cerebellar parenchyma, whereas the superior margin is less well defined and seems to blend with the cerebellar folia. A small enhancing focus within the lesion is also unchanged. There is elevated rCBV and rCBF which correlates with this enhancing nodule, unchanged from prior. Once again, single and multi voxel spectroscopy of the lesion demonstrates elevation of choline and reduction of NAA within the lesion with an abrupt return to a normal pattern beyond the lesion margins.The brain parenchyma is otherwise normal. There is no other pathologic parenchymal or leptomeningeal enhancement. Incidentally noted developmental venous anomalies are present in the right parietal and left frontal lobes. 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 trace fluid in the right mastoid air cells.

Output: The lesion in the left upper medial cerebellar hemisphere has not significantly changed in size since the prior exam. A focus of enhancement internal to the lesion also remains unchanged. Elevated rCBV and rCBF is demonstrated associated with the enhancing nodule, similar to prior. Again, the spectroscopic assessment of the lesion reveals elevation of choline and reduction of NAA, similar to prior.


Instruction: Generate impression based on findings.

Input: 63-year-old man with history of HCV and HCC status post TACE/RFA 8/24/2016. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with fibrosis and multiple regenerative nodules. Segment 8 zone of ablation appears unremarkable with T1 hyperintense areas suggestive of hemorrhage but no abnormal enhancement.Adjacent to this zone of ablation, there is a 16 x 15 mm T2 hyperintense, arterially enhancing, and newly washing out (12/499) lesion which abuts the capsule.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: Splenomegaly, otherwise the spleen appears normal.PANCREAS: There is pancreas divisum and the pancreas parenchyma is atrophic.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts 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.Satellite lesion near the zone of ablation which, compared to prior exams, now washes out on delayed phases of enhanced imaging and is compatible with HCC progressed from a dysplastic nodule.2.Zone of ablation with expected findings and no evidence of residual disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial hemorrhage, fracture. Signs and symptoms: Head trauma. Nonenhanced CT brain:Diffuse area of encephalomalacia in the left frontal, temporal, parietal lobes with ex vacuo dilatation of the left lateral ventricle is consistent with an old stroke. This examination is otherwise unremarkable and in particular no evidence of acute intracranial process is detected.There is a slight widening of calvarium on the left side believed to be secondary to underlying parenchymal volume loss. Area of sclerotic change of the squamosal portion of left temporal bone may also be result of intracranial process however possibility of fibrous dysplasia should be considered. Visualized paranasal sinuses and mastoid air cells are unremarkable. There is no definitive abnormality of soft tissues of the scalp.Nonenhanced CT of cervical spine:The alignment of cervical spine remains within normal limits.There is no definitive evidence of fracture or malalignment. Advanced degenerative disk disease with large anteriorly projecting osteophytes at C3 -- C4 through C6 -- C7 levels are present. At C5 -- C6 within the anteriorly projecting osteophytes and lucent line is identified. Remote possibility of fracture of this osteophyte cannot be ruled out. There is no detectable soft tissue abnormality associated with this finding. Correlated with physical exam and direct palpation and if clinical concern persists a follow-up with an MRI is recommended.

Output: 1.No evidence of acute intracranial or calvarial pathology.2.Large area of encephalomalacia in the left frontal, temporal and parietal lobes with resultant ex vacuo dilation of left lateral ventricle.3.Calvarial changes secondary to significant left hemispheric parenchymal volume loss is evident by thickening of calvarium on the left. Focal area of fibrous dysplasia of the squamosal portion of the left temporal bone.4.No definitive evidence of fracture of the cervical spine. Lucent line traversing the anterior osteophyte at C5 -- C6 likely not a fracture. Please correlate with history and if clinical concern persists follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Facial droop left face today, trouble talking since yesterday, bilateral arm numbness. The images are degraded by patient motion. There has been interval evolution of the patchy areas of cerebral white matter T2 hyperintensity, which are generally more conspicuous. However, there is now resolution of the associated restricted diffusion. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. There are right maxillary sinus retention cysts.

Output: The limited exam demonstrates interval evolution of the cerebral white matter lesions, which may represent methotrexate-related neurotoxicity.


Instruction: Generate impression based on findings.

Input: There are multiple small foci of restricted diffusion within the pons with surrounding associated T2/FLAIR signal abnormality consistent with edema. Some of these foci demonstrate peripheral enhancement on post-contrast imaging. The restricted diffusion is suspected to represent purulent material within abscesses. The relatively largest in the right pons measures 4 mm with associated susceptibility artifact consistent with microhemorrhage. A subtle additional extra-axial focus of diffusion hyperintensity noted adjacent to the left superior parietal lobule with enhancement possibly represents an arachnoid granulation. Foci of T2/FLAIR signal abnormality are noted within the bilateral cerebral peduncles which are likely reflective of edema. An additional focus of T2/Flair signal abnormality within the left external capsule is non-specific. There is no leptomeningeal or pachymeningeal enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multiple foci of peripheral enhancement in the pons with diffusion restriction and surrounding edema which are suspected to represent infection with small abscesses. Pyogenic and atypical organisms/etiologies including Listeria should be considered. HSV may also involve this region although less common. 2. No evidence of intracranial mass effect.Findings communicated via telephone by Dr. Grebenciucova to Dr. Staisch at the time of this report on 1/12/2016.


Instruction: Generate impression based on findings.

Input: 68 years Female (DOB:4/8/1948)Reason: lumbar stenosis, back pain and worsening leg numbness History: back pain and worsening leg numbnessPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to neural foramina. There is marked bilateral facet hypertrophy present at this level. There is mild anterior subluxation of L5 on S1 which is stable compared to the prior exam.. There is a mild disc bulge present at this level. There is effacement of the fat at the left lateral recess adjacent to the nerve root at the left lateral recess. This is unchanged compared to the prior exam.At L4-5 there is no significant compromise to neural foramina. There is a moderate degree of facet and ligamentum flavum hypertrophy present at this level. There is partial effacement of fat at the left lateral recess at this level and some crowding of nerve roots within the thecal sac overall there is a mild to moderate degree of spinal stenosis at this level. This was also present on the prior exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a small central disc extrusion present at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a large right-sided renal cyst present which was also present on the prior exam and measures 35 x 31 mm axial dimensions. It is unchanged compared to the previous exam.

Output: 1.There are multilevel degenerative changes present in the lumbar spine with some moderate spinal stenosis at L4-5 and encroachment of nerve roots at the left lateral recess at L5-S1 which are stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: There is no mass or structural abnormality. There is no abnormal enhancement. The ventricles and sulci are within normal limits. No extra-axial fluid collections identified. Diffusion weighted images are normal without evidence of infarct. Susceptibility weighted images are normal. The major intracranial vascular structures enhance normally. The paranasal sinuses and mastoid air cells have normal signal. Orbits appear unremarkable.

Output: Normal MRI of the brain. No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 29-year-old female with self-reported dislocation one month prior that was self reduced. LIGAMENTS: The majority of the lateral collateral ligament proper is poorly defined, the radiocapitellar articulation is slightly widened, and the long axis of the radius is directed posterior to the center of the capitellum on the sagittal images. These findings suggest a tear of the lateral collateral ligament, although there may be a few fibers intact anteriorly. Although the distal fibers of the lateral ulnar collateral ligament can be seen inserting on the ulna, the proximal fibers are not well visualized likely representing a tear.The proximal fibers of the anterior bundle of the ulnar collateral ligament are not well-visualized indicating rupture. We suspect that the tear involves the posterior bundle as well.TENDONS: The tendon of the extensor carpi radialis brevis can be traced to its origin at the lateral epicondyle. However, the more posterior components of the common extensor tendon, including the extensor digitorum and extensor carpi ulnaris, show increased signal intensity proximally and do not clearly extend to the lateral epicondyle, indicating at least an incomplete tear of the common extensor tendon. The anconeus muscle may also be at least partially stripped from its humeral origin. There is mild edema within the proximal fibers of the extensor digitorum as well as the proximal fibers of the extensor carpi radialis longus, with slight heterogeneity of signal of the soft tissues lateral to the lateral epicondyle, likely corresponding to small foci of ossification seen on recent radiographs.There is mild edema of the brachialis muscle, but the brachialis tendon can be followed to its insertion on the ulna. The biceps muscle and tendon appear normal.There is edema within the pronator muscle and proximal fibers of the flexor digitorum superficialis indicating a strain injury. The edema extends into the fibers of the common extensor tendon, but I see no full-thickness tear.The triceps tendon is intact.ARTICULAR SURFACES AND BONE: There is edema within the capitellum (extending into the lateral epicondyle) and head and neck of the radius which may represent bone contusion, but we see no discrete fracture line. The articular cartilage of the radial head is difficult to discern on this study which may represent traumatic tearing, although this is equivocal. There is also edema within the medial epicondyle, without discrete fracture.SURROUNDING STRUCTURES: The ulnar nerve appears perched upon the posteromedial aspect of the medial humeral condyle suggesting subluxation.ADDITIONAL

Output: 1. Disruption of the lateral collateral ligament, lateral ulnar collateral ligament, and at least incomplete tearing of the common extensor tendon.2. Disruption of the ulnar collateral ligament and strain of the proximal flexor/pronator musculature.3. Subluxation of the ulnar nerve.3. Small joint effusion. Other findings as described above.