Instruction: Generate impression based on findings.

Input: Male, 78 years old, with altered mental status, history of AML in blast crisis, evaluate for ischemia versus hemorrhage versus leukostasis. MRI brain:Restricted diffusion compatible with acute ischemia is seen within the right MCA distribution affecting the posterior frontal lobe, much of the parietal lobe, part of the insula, and part of the temporal and occipital lobes.Restricted diffusion is also seen within the left MCA territory involving a moderately sized portion of the left posterior frontal lobe and frontal operculum. Numerous small foci of restricted diffusion are evident elsewhere in both cerebral hemispheres and in the cerebellum. The affected tissue demonstrates T2 hyperintensity and mild edema but no significant generalized mass effect, midline shift or brain herniation is seen. No hemorrhagic conversion is suspected as of yet. There are small foci of susceptibility scattered through the brain but these may represent chronic microhemorrhages.Extensive patchy periventricular T2 hyperintensity is seen, a nonspecific finding which may reflect chronic microvascular ischemic disease. There is mild effacement of the right lateral ventricle. Elsewhere, the ventricular system is unremarkable.MRA brain:Abrupt cessation of flow related signal is seen within one of the proximal M2 branches of the right MCA. A paucity of MCA vessels is visualized in the right cerebral hemisphere. Scattered areas of narrowing are seen within the M2 and M3 branches of the left MCA as well. The intradural right vertebral artery is not well visualized.MRA neck:The origins of the great vessels are not well visualized due to technical limitations. The common carotid and internal carotid arteries are free of significant vascular stenosis. The left vertebral artery is free of significant vascular stenosis. The right vertebral artery is not visualized.

Output: 1. A large acute infarct is evident within the right MCA distribution with a moderately sized acute infarct seen in the left MCA distribution. Scattered small ischemic lesions are demonstrated elsewhere throughout the cerebrum and cerebellum. The pattern of disease is largely territorial and therefore a thromboembolic process or possibly in situ cerebral vessel thrombosis would be the favored etiology.2. Correlating with the large right MCA infarct, there is abrupt occlusion of one of the proximal M2 branches of the right MCA. Scattered vascular stenoses are also seen within the left MCA distribution.3. The right vertebral artery is not identified in the neck or intradurally. This may reflect a proximal occlusion or severe atherosclerosis or a congenitally diminutive vessel. The cervical carotid vessels are unremarkable.


Instruction: Generate impression based on findings.

Input: Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: Negative MRI of the brain and internal auditory canals including gadolinium enhancement. Specifically, there is no MRI evident acoustic neuroma as clinically questioned.


Instruction: Generate impression based on findings.

Input: 79 year-old female history of HCC status post TACE/RFA x2. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Low signal intensity peripheral segment 3 lesion without enhancement. No suspicious masses or enhancement is seen.The intraluminal portion of the distal TIPS is not well assessed due to artifact, however the remaining portions of the shunt appear patent. The main portal vein is open. The intrahepatic portal veins are not well opacified, appearing similar to prior.Cholelithiasis.SPLEEN: SplenomegalyPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nonenhancing subcentimeter simple/hemorrhagic cyst.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: Unchanged segment 3 ablation zone with no evidence of disease recurrence. Non-opacification of the intrahepatic portal veins appearing similar to prior.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for growth of grade lll oligodendroglioma. Signs and symptoms: Grade lll oligodendroglioma. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates interval near complete resolution of bilateral (left greater than right) subdural collections since prior exam with minimal residual left anterior temporal subdural remaining.There is postoperative changes of right temporal craniotomy with right anterior temporal lobectomy. Posterior to the surgical site there is a large focus of cystic encephalomalacia and extensive surrounding gliosis involving the right temporal lobe and with extension into the right basal ganglia similar to prior exam. Similar to prior exam there is ex vacuo dilatation of right anterior temporal horn. There is also no detectable parenchymal enhancement.Interval resolution of a small focus of previously suspected hemorrhagic contusion along the interhemispheric aspect of left frontal lobe since prior study. Patchy foci of cortical encephalomalacia in the left anterior frontal lobe without enhancement is present without significant change.Multiple small foci of FLAIR hyperintensity in bilateral subcortical and periventricular white matter remain similar to prior exam and likely representing chronic small vessel ischemic strokes. Moderately enlarged supratentorial ventricular system and mild rightward negative shift of midline is present. This is an improvement compared to prior study which midline was deviated to the right more severely due to presence of subdurals.

Output: 1.No acute intracranial process.2.Stable postoperative changes of right anterior temporal lobectomy and extensive focus of nonenhancing cystic encephalomalacia and gliosis of right temporal lobe since prior exam.3.Interval near complete resolution of bilateral subdurals since prior study with resultant decreased midline shift.4.Interval expected evolution of left anterior frontal foci of contusion.5.Findings suggestive of chronic nonhemorrhagic small vessel ischemic strokes of mild degree.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. There is a subtle tuft of enhancement within the distal right IAC which does not extend laterally to involve the inner ear structures or along the labyrinthine facial nerve segment to the geniculate ganglion. The left ICA is unremarkable in appearance. There are no masses or enhancing lesions in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.Cervical spine MRI:There is straightening of the cervical spine which is likely positional. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no significant degenerative changes or stenoses. Axial T2 technique demonstrates an approximately 4 mm focus of hyperintensity within the posterior left thyroid gland.

Output: 1.There is a subtle tuft of enhancement within the distal right IAC which does not extend laterally to involve the inner ear structures or along the labyrinthine facial nerve segment to the geniculate ganglion.2.Axial T2 technique demonstrates an approximately 4 mm focus of hyperintensity within the posterior left thyroid gland. This is nonspecific in appearance, and a femur clinically beneficial thyroid ultrasound could further characterize.3.Findings were discussed with Dr. Reeti Raychaudhuri on 6/6/2016 at approximately 9:45 AM.


Instruction: Generate impression based on findings.

Input: Evaluate presumed meningioma reported on an MRI from another institution, please compare to uploaded outside MRI: vision and hearing loss. There is no evidence of mass lesions within the left middle cranial fossa. There are bilateral lens implants. The bilateral orbital contents are otherwise unremarkable, without evidence of tumor or abnormal enhancement. The imaged portions of the skull appears unremarkable as well.

Output: No evidence of middle cranial fossa or orbital mass.


Instruction: Generate impression based on findings.

Input: Optic nerve hypoplasia. Orbits: The optic nerve are perhaps mildly hypoplastic bilaterally, but do not display abnormal signal or enhancement. The globes and ocular adnexa are unremarkable. There is no evidence of orbital mass lesions. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal scattered 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 skull and scalp soft tissues are grossly unremarkable. There is mild right maxillary sinus mucosal thickening.

Output: 1. The optic nerve are perhaps mildly hypoplastic bilaterally.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Female 58 years old with Hx of R-ear hearing loss, bifrontal headaches worse when lying supine, periods of sweating and blurred vision, evaluate for structural abnormality. There is a lobulated suprasellar mass, measuring 15 mm craniocaudal x 10 mm transverse x 13 mm anteroposterior dimension, which enhances homogeneously and is situated along the right optic tract/chiasm. It appears to have a dural attachment along the posterior planum sphenoidale and projects into the suprasellar cistern with impingement on the right optic nerve and chiasm, displacing it posteriorly. Although it enhances similarly to the pituitary gland, it appears separate from the gland itself and is extra-sellar in origin. Although these are not dedicated pituitary images, the pituitary gland appears to be normal in morphology.No evidence of other enhancing intracranial lesions, hemorrhage, or restricted diffusion to suggest acute infarct. There are a few nonenhancing focal periventricular T2/FLAIR hyperintense lesions, which are nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Lobulated dural based extra-axial mass situated along the planum sphenoidale just anterior and superior to the sella with no definite sellar involvement. The lesion impinges on the right optic nerve and chiasm. The pituitary gland itself appears unremarkable. The differential includes a meningeal-based tumor such as a meningioma or hemangiopericytoma. Additional considerations include germinoma and craniopharyngioma.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of cervix uteri, unspecified site Examination of participant in clinical trialClinical question: Evaluate for abnormality; compare to previous scan There is redemonstration of an ill-defined area of enhancement located in the right middle frontal gyrus extending to the right precentral gyrus. Enhancement is located within the sulci and adjacent packing meninges. This includes a precentral sulcus as well as the right superior frontal sulcus. Estimated measurement of the area of enhancement is 21 x 14 mm mm axial dimensions and has not changed substantially since the prior exam. There are surrounding vasogenic edema in an area measuring approximately 43 x 39 mm axial dimensions. Previously vasogenic edema measured 27 x 26 mm axial dimensions. There is some susceptibility artifact associated with the enhancement.There is redemonstration of pachymeningeal thickening associated with underlying perivascular space and parenchymal enhancement at the anterior aspect of the right frontal lobe.Pachymeningeal thickening measures approximately 4 mm on the current examination on the prior exam measured approximately 2 mm. There is associated signal change in the right frontal lobe this involves gray and white matter and measures approximately 16 by this axial dimensions when measured 11 x 16 mm axial dimensionsNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Focal meningeal enhancement and intraparenchymal enhancement along the right middle frontal gyrus is not substantially changed in extent when compared to the prior exam. The associated vasogenic edema however has increased. Right frontal polar enhancing lesion has enlarged since the prior exam. Differential considerations do include metastatic disease. A multifocal infectious process would be less likely. Granulomatous disorder and lymphoma are also differential considerations.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: CT head w/ e/o extra-axial hyperattenuation along the right frontal parietal convexity. Please assess if lesion is hematoma vs venous thrombus. Please obtain thin section post-contrast images. Brain MRIThere is a thin (about 4 mm) layer of extra-axial T2 low signal intensity and T1 iso and/or slightly high signal intensity lesion along the right frontal parietal convexity with susceptibility artifacts indicating acute/subacute hemorrhage.The lesion does not appear to be crossing the subarachnoid space, therefore, the possibility of thrombosed cortical vein is unlikely.There is no evidence of acute ischemic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. Thin (about 4mm) extra axial blood products on the right fronto-parietal convexity. Differential diagnosis include extra axial blood products. Cortical vein thrombosis is unlikely.2. No evidence of acute ischemic lesion.


Instruction: Generate impression based on findings.

Input: 43 year old with known right breast cancer There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Multiple cysts are again seen in both breasts.RIGHT BREAST AND AXILLA:A known cancer, previously demonstrated as an irregularly shaped, rim enhancing mass becomes smaller and less enhancing on the current study. The mass measures 10 x 10 x 16 mm (AP x LR x CC, previously 29 x 22 x 35 mm). Satellite masses or segmental non mass enhancement extending outer quadrants are no longer visualized.In the right axilla, there is no abnormal lymph node. One lymph node with marker clip, which is proven metastatic node, shows normal morphology with thin cortex.LEFT BREAST AND AXILLA:Multiple benign enhancing masses and foci are unchanged.No abnormal lymph nodes are identified in left axillary region.

Output: Marked decrease in size and extent of known right breast cancer and right metastatic axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: rule out osteomyelitis of sacral decubitus ulcer There is a decubitus ulcer posterior to the sacrum and coccyx containing low signal intensity presumably representing packing material. The ulcer extends laterally along the posteromedial aspect of the gluteus maximus muscles, left greater than right. The ulcer extends to and beneath the coccyx, and there is signal abnormality within the coccygeal segments, particularly the first and second segments, compatible with osteomyelitis. There is enhancement of the soft tissue surrounding the coccyx and the individual coccygeal bones are poorly defined on the post gadolinium images. There is also enhancement along the lower sacral segments, but the bone marrow signal intensity of the sacrum is preserved. There is mild enhancement of the posteromedial aspects of the gluteus maximus muscles bilaterally where the muscles contact ulcer, compatible with inflammation. Inflammation extends to the perirectal soft tissues, but we see no discrete fluid collection to indicate a soft tissue abscess. There is mild peritrochanteric enhancement bilaterally, but we see no adjacent ulceration or findings to suggest osteomyelitis of the proximal femora. There is edema within the subcutaneous fat along the left flank posteriorly. There is high signal intensity within several muscles of the pelvis and upper thigh, likely representing a combination of inflammation and atrophy, but we see no discrete fluid collection to indicate an abscess.Mild osteoarthritic changes affect both hips. There is a small amount of fluid in the hip joints, but no frank effusions.Foley catheter is noted within the bladder. Mildly enlarged pelvic sidewall lymph nodes bilaterally are likely reactive in etiology.

Output: Decubitus ulcer with findings compatible with osteomyelitis of the coccyx and other findings as described above.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is blunting of the posterior horn of the medial meniscus likely relating to partial meniscectomy. There is linear branching signal within the posterior horn which appears less extensive than the prior examination and likely relates to degeneration as opposed to true tearing as it does not clearly extend to the articular surface. However there is some irregularity of the superior articular surface of the posterior horn and as a result a small tear cannot be excluded.There is blunting of the posterior horn of the lateral meniscus also likely relating to prior partial meniscectomy. There is globular increased signal within both the anterior and posterior horns of the meniscus which also appear less extensive than the prior examination and are likely reflective of degeneration as opposed to true tearing.ARTICULAR CARTILAGE AND BONE: Again seen is moderate diffuse articular cartilage loss of the medial compartment with areas of near full-thickness loss. Overall this appears similar to the prior exam. The articular cartilage of the lateral compartment is preserved. Heterogeneous signal intensity of the lateral patellar facet is noted without evidence of full-thickness defect.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Abnormal morphology and signal intensity of the lateral and medial menisci which likely reflects a combination of prior meniscectomy and degenerative change. There is irregularity of the articular surface of the posterior horn of the medial meniscus and a small tear in this region cannot be excluded.2. Moderate diffuse articular cartilage loss of the medial compartment, similar to the prior exam.


Instruction: Generate impression based on findings.

Input: History of ADEM, new bladder complaints Brain:Brain parenchyma appears within normal limits. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Spine:No abnormal T2 signal within the cord is seen. No abnormal parenchymal or meningeal enhancement is seen. The cord caliber is normal throughout. The conus terminates at T12-L1 which is normal. The cauda equina appears to be free of abnormal enhancement or signal intensity. Spinal alignment is within normal limits. Vertebral body heights and intervertebral disk spaces are maintained. Marrow signal characteristics are within normal limits. No central spinal stenosis or neuroforaminal compromise is identified.

Output: 1.MRI of the brain is within normal limits. No new lesions or abnormal parenchymal or meningeal enhancement.2.MRI of the spine demonstrates no cord signal abnormality or abnormal enhancement within the spinal canal. In particular lumbar spinal canal demonstrates no abnormal thickening or enhancement involving the cauda equina or extrinsic spinal canal stenosis. If there is significant suspicion for an active inflammatory process, further evaluation with lumbar puncture can be considered.


Instruction: Generate impression based on findings.

Input: History of prostate cancer scheduled for robotic assisted laparoscopic prostatectomy. 3/9/2016 biopsy right base 3+4, right mid to 3+3. PELVIS:PROSTATE:Prostate Size: 2.5 x 4.4 x 3.6 cmPeripheral Zone: No significant intrinsic T1 weighted signal abnormality.The peripheral zone is thinned with diffuse decreased signal intensity.In the peripheral zone there are several foci of restricted diffusion with the most discrete lesion in the right base/mid gland measuring 7 x 7 mm focus of restricted diffusion (series 4 and 3/284). There is associated multi-focal regions of T2-weighted hypointensity in the right hemi-gland and left apex.Central Gland: Mild changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extra capsular 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: Findings compatible with patient's known right sided prostatic adenocarcinoma without evidence of extra prostatic extension or enlarged pelvic lymphadenopathy. Based on multi-focal signal abnormality, multi-focal disease not excluded.


Instruction: Generate impression based on findings.

Input: Ms. Rudsinski submitted outside study for review. Submitted for review:-breast MRI: 12/8/2015This examination was performed at Silver Cross Hospital. Multiple MR sequences were obtained per the outside institution. Unfortunately, this examination is severely limited by motion artifact, such that the subtraction sequences (and even the post-contrast sequences) are very tough to evaluate.In addition, there is moderate-severe background parenchymal enhancement noted bilaterally, which inherently limits the sensitivity of this examination.Within these limitations, there is a peripherally enhancing, centrally necrotic mass identified in the right medial breast measuring approximately 2.7 x 4.2 x 4.2 cm (AP times ML times SI). The mass does abut against the pectoralis muscle, causing obscuration of the fat plane. However, due to the severe motion, the actual pectoralis muscle cannot be adequately assessed. However, the possibility of underlying muscle invasion cannot be excluded. Located approximately 0.9 cm lateral to this mass is an additional enhancing lesion measuring 0.9 x 0.5 x 1.1 cm. This is highly suspicious for an additional satellite lesion.In addition, seen throughout the majority of the superior right breast and the anteromedial breast are numerous areas of non-mass enhancement and enhancing foci. These are very difficult to further characterize on this MRI, but they are certainly asymmetric when compared to the contralateral breast. Susceptibility artifact from multiple surgical clips project over the right axilla, of uncertain etiology/significance. Two enlarged right axillary lymph nodes are seen, the largest of which measures approximately 2.6 cm. No definite abnormal enhancement seen in the left breast.

Output: (1) Extremely limited MRI examination due to motion artifact. In addition, there is moderate-severe background parenchymal enhancement, which inherently limits the sensitivity of this examination.(2) 4.2 cm enhancing mass in the right medial breast abutting the pectoralis muscle, compatible with biopsy proven malignancy. Due to the above limitations, the actual muscle cannot be adequately assessed, however, there is obscuration of the fat plane. The possibility of underlying muscle invasion cannot be excluded. (3) 1.1 cm enhancing mass seen just lateral to the index lesion in the right breast, suspicious for a satellite lesion.(4) Enlarged right axillary lymph nodes, measuring up to 2.6 cm. One of which has apparently been biopsied and is positive for malignancy.(5) Multiple additional areas of non-mass enhancement and enhancing foci seen in the right superior breast/right antero-medial breast which are very difficult to further characterize on this MRI, but are asymmetric when compared to the contralateral breast.RECOMMENDATIONS:(1) Clip placement in the index lesion/axillary lymph node cannot be assessed on this limited MRI. Recommend a postprocedure right unilateral mammogram to confirm placement and appropriate positioning of biopsy marker clips in the right breast and right axillary lymph node.(2) An MR directed US can be performed for the suspected satellite lesion seen just lateral to the index lesion. If correlate identified, an US-guided biopsy with clip placement can be performed if clinically warranted.(3) Based on the EMR, patient will not be able to return until July 2016 for official treatment. At that time, it will have been approximately 6 months since her original MRI. A repeat MRI can potentially be performed at that time to re-assess the multiple additional areas of asymmetric enhancement seen in the right breast, which may all be artifactual given the limited MRI. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female 39 years old Reason: infertility Scout AP film of the pelvis was normal. Opacification of the uterine cavity revealed a normally oriented uterine cavity without filling defects in the uterine cavity. Both tubes were freely opacified with free spillage on both sides into the pelvis, indicating tubal patency. Possible arcuate configuration of the uterus, correlation with ultrasound or MRI is recommended if clinically warranted.TOTAL FLUOROSCOPY TIME: 3.1 minutes.

Output: Normal uterine cavity and patent fallopian tubes. Possible arcuate configuration of the uterus, correlation with ultrasound or MRI is recommended if clinically warranted.


Instruction: Generate impression based on findings.

Input: Seizures. There is no corresponding lesion is identified that corresponds to the abnormality suggested by the prior PET. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No corresponding lesion is identified that corresponds to the abnormality suggested by the prior PET, although this is a limited preoperative planning MRI.


Instruction: Generate impression based on findings.

Input: 9-year-old male with history of thigh mass resected September 2015; per pathology report, the mass was determined to be myofibroblastic and histiocytic proliferation without evidence of malignancy Within the subcutaneous tissues of the lateral right thigh is a small focus of T2 hyperintensity which demonstrates enhancement following contrast administration. The area now measures 1.3 x 0.4 x 2 cm as compared to 1.7 x 0.6 x 2.7 cm previously. There is no evidence of a discrete enhancing mass. No additional lesions or abnormal enhancement is identified within the thigh. The underlying muscle signal and caliber is normal. The bone marrow signal of the femur is normal.

Output: Small focus of enhancement within the subcutaneous tissues of the lateral right thigh likely represents an area of scarring and has decreased from the prior exam. There is no discrete enhancing mass identified.


Instruction: Generate impression based on findings.

Input: 15 years Female (DOB:2/17/2001)Reason: epilepsy History: seizuresPROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE There is redemonstration of multiple nonenhancing subependymal and periventricular nodules in the left lateral ventricle which have signal intensity similar to gray matter.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Multiple left lateral ventricular subependymal and periventricular nodules. These are suspicious for heterotopic gray matter.2.Please note that this is a limited exam for the purpose of stereotactic guidance. More subtle abnormalities such as mesial temporal sclerosis may not be adequately imaged on this study exam


Instruction: Generate impression based on findings.

Input: There is a T2/FLAIR hyperintense cortical and subcortical mass involving the right mesial temporal lobe, including at least the head of the hippocampus. The mass has ill-defined margins but appears overall stable allowing for differences in technique, approximately measuring in the transverse axis 2.3 cm (previously 2.4 cm), and in the craniocaudal axis 2.3 cm (previously 2.5 cm). The margins in the AP view could not be well delineated. This mass has no restricted diffusion. There is thin smooth dural enhancement superomedial to the mass, but the mass itself is not enhancing. Tiny T2 hyperintense cystic areas are seen along the anterior aspect of the mass. The right temporal horn is posteriorly displaced due to mass effect.There are no susceptibility abnormalities. The ventricular size is normal. There is no midline shift. Basal cisterns are patent. Vascular flow voids are normal.

Output: There is an overall stable appearance of a nonenhancing slightly ill-defined mass involving the mesial right temporal lobe with thin smooth superomedial dural enhancement. Differential diagnosis includes pleomorphic xanthoastrocytoma, DNET, pilocytic astrocytoma or other low grade astrocytoma, and ganglioglioma.


Instruction: Generate impression based on findings.

Input: 69 years Male (DOB:9/11/1947)Reason: Evaluate for etiology of L trigeminal neuralgia History: L sided trigeminal neuralgiaPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A punctate focus of signal loss and susceptibility imaging is present in the left thalamus and another one is present in the left frontal lobe subcortical white matter.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts along the floor of the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. The basilar artery is not adjacent to the trigeminal nerves. No sizable arterial structures are identified abutting the trigeminal nerves.The anterior communicating artery is identified. The posterior communicating arteries are identified. The left posterior communicating artery is medium-sized whereas the right posterior communicating artery is very small and the anterior communicating artery is medium-sized. The left vertebral artery is larger than the right vertebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for trigeminal nerve compression4.No evidence for intracranial mass lesion.5.A couple microhemorrhages are identified which do not have a specific pattern and are of unknown clinical significance.6.A couple subcortical white matter lesions are nonspecific and likely of little clinical significance


Instruction: Generate impression based on findings.

Input: 23 year old male. Reactive arthritis. History of large effusion. MENISCI: The medial and lateral menisci are intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Mild edema type signal in the posterior medial tibial plateau suggestive of a small contusion. No bone erosion is evident. Patellofemoral and tibiofemoral compartment cartilage is intact without a focal defect.LIGAMENTS: ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact with normal signal and morphology.ADDITIONAL

Output: Large knee joint effusion. Edema type signal at the posterior medial tibial plateau suggestive of a small contusion. No evidence of a meniscal or ligamentous injury.


Instruction: Generate impression based on findings.

Input: Female 63 years old Reason: r/o neoplasm History: cystic structure 4x4x1 in the right adnexa PELVIS:UTERUS, ADNEXA: Uterus measures 4.5 x 3.3 x 6.7 cm. Well-circumscribed T2 hypointense lesions within the uterus represent small leiomyomata.1.2 x 1.0 cm on cystic structure in the right adnexa likely represents a small adnexal cyst.Tubular structure in the pelvis adjacent to the right adnexa fills with contrast and is a pelvic vein.Left adnexa is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific rectal thickening suboptimally evaluated due to collapse.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.2 cm T2 hyperintense structure in the right adnexa may represent a small adnexal cyst.2.Tubular structure near the right adnexa fills with contrast and likely represents a pelvic vein.3.Submission of the outside ultrasound images is recommended so a one-to-one correlation can be performed.


Instruction: Generate impression based on findings.

Input: Female 71 years old Reason: rule out infectious process, abscess, fistula History: fever, E.coli bacteremia, dilated common bile duct on imaging ABDOMEN:LIVER, BILIARY TRACT: There is proximal mild to moderate intrahepatic biliary ductal dilatation as well as extrahepatic biliary ductal dilatation. Biliary ductal wall thickening and enhancement with associated peribiliary restricted diffusion and patchy T2 signal is concerning for cholangitis.Multiple stones are present within the distal common bile duct measuring approximately 2.0 x 0.8 cm. Punctate foci of high T2 signal within the gallbladder fundus suggests adenomyomatosis.The gallbladder wall is mildly thickened and the gallbladder contains stones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal lymph nodes are not pathologically enlarged by size criteria. There is atherosclerotic plaque along the aortic wall.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multifocal linear high signal within the anterior body wall likely reflects postsurgical change. OTHER: No significant abnormality noted.

Output: 1.Obstructive distal common bile duct stones resulting in intrahepatic and extrahepatic biliary ductal dilatation.2.Biliary ductal wall thickening and enhancement as well as peribiliary restricted diffusion and patchy high T2 signal concerning for cholangitis. No liver abscess or parenchymal infection is evident.


Instruction: Generate impression based on findings.

Input: 36-year-old female with left shoulder pain ROTATOR CUFF: Bone marrow edema at the greater tuberosity with small subchondral cysts. Abnormal signal is noted at the foot plate of the supraspinatus tendon insertion on the greater tuberosity. There is infraspinatus, subscapularis, teres minor are intact. Normal muscle bulk. No fatty infiltration.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Abnormal signal at the insertion of the supraspinatus tendon compatible with supraspinatus tendinopathy with reactive bone marrow edema at the greater tuberosity.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: evaluating lumbar discs History: chronic lumbar back pain, pt reported h/o chronic lumbar disc dz, pain worsening, notes change in urinary stream For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level.Degenerative changes are specified by the intervertebral level as follows: T12-L1: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L1-L2: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L2-L3: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L3-L4: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: broad based disc bulging with central disc protrusion which abuts thecal sac, associated with bilateral ligamentum flavum thickening, there is moderate degree spinal stenosis. L5-S1: there is broad based central to left disc protrusion which narrows left lateral recess.

Output: 1. Central disc protrusion with moderate spinal canal stenosis at the level of L45.2. Central to left broad based disc protrusion results left lateral recess narrowing at the level of L5S1.


Instruction: Generate impression based on findings.

Input: 68-year-old female patient with diplopia. Diplopia secondary to CN 3 palsy OS thought related to DM. There is apparent mild T2 hyperintensity circumferentially along the bilateral inferior rectus muscles. Otherwise, the bilateral extraocular muscles are not particularly enlarged or atrophic. There are bilateral lens implants. The optic nerves are unremarkable bilaterally. There is no evidence of intraorbital mass lesions. The cisternal segments of the oculomotor nerves and cavernous sinuses are unremarkable. There are scattered foci of T2 hyperintensity in the imaged portions of the cerebral white matter.

Output: 1. Apparent mild T2 hyperintensity circumferentially along the bilateral inferior rectus muscles is likely artifactual rather than related to early denervation effects or thyroid eye disease. However, assessment is limited due to the lack of intravenous contrast.2. Nonspecific scattered foci of T2 hyperintensity in the imaged portions of the cerebral white matter may represent small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Other myelitis [G04.89], Reason for Study: ^Reason: Evaluate for etiology of LE weakness. Pt w/ h/o transverse myelitis History: Weakness. Motion artifacts degraded image quality significantly.Comparing to prior scan, the cervical spinal cord size appears to be normal on today's scan without showing evidence of abnormal cord signal intensity.Subtle patchy increased signal intensities on cervical spinal cord especially around C3 to C5 level more likely artifactual than real lesion.There is no evidence of spinal cord swelling/enlargement on thoracic spine either.The cervical spine appears to be straightened.However, the cranial-cervical junction is normal. There is normal thoracic kyphosis.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of L1.

Output: 1. Interval resolution of upper cervical spinal cord T2 high signal intensity lesions with spinal cord swelling since prior scan. At this point, there is no evidence of abnormal signal intensity, nor evidence of spinal cord swelling on both cervical and thoracic spinal cord.2. Straightening of cervical spine, otherwise unremarkable C and T spine MRI.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with low back pain, possible SI joint arthropathy. A severe scoliotic curvature of the thoracic and lumbar spine is seen. Sagittal alignment is within acceptable limits.A slight left lateral loss of disc height is evident at the L3 level secondary to scoliosis. Otherwise, vertebral body heights are largely preserved.The visualized spinal cord and conus are unremarkable. The conus tip terminates at the L1 level which is within normal limits. The nerve roots of the cauda equina are unremarkable except as discussed specifically below.Severe degeneration and related endplate signal abnormality is demonstrated along L3-4 and to a lesser degree along L2-3. Additional level specific findings are as follows:T12-L1: Facet hypertrophy. Right far lateral disc osteophyte complex. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing.L1-2: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disc. Mild generalized spinal canal stenosis with slight crowding of the cauda equina. Severe left and mild right foraminal narrowing. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disc. Severe spinal canal stenosis with crowding of the cauda equina. Severe bilateral foraminal narrowing. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disc. Severe spinal canal stenosis with crowding of the cauda equina. Severe right and moderate left foraminal narrowing. L5-S1: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disc with a left subarticular/foraminal protrusion. Mild narrowing of the left lateral recess. Moderate left foraminal narrowing. Tarlov cysts are evident within the sacral spinal canal.

Output: Severe disc and posterior element degeneration is seen likely secondary to a significant scoliotic deformity of the thoracolumbar spine. These findings result in severe generalized spinal canal stenosis at L3-4 and L4-5 with scattered severe foraminal narrowing as above.


Instruction: Generate impression based on findings.

Input: Syncope and collapse [R55] / Malignant neoplasm of lower-outer quadrant of left female breast [C50.512], Reason for Study: ^Reason: eval for brain metastases History: breast cancer, syncope No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancementThe ventricles, sulci and cisterns are 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 mastoid air cells are clear. Mucosal thickening with retention cysts seen on bilateral maxillary sinus, bilateral ethmoid sinus, frontal sinus and sphenoid sinus

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.2. Pansinusitis.


Instruction: Generate impression based on findings.

Input: Female 42 years old with left knee pain and swelling after a fall. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is marked diffuse narrowing of the articular cartilage in the medial compartment but no focal cartilage defect. The articular cartilage demonstrates generalized thinning in the patellofemoral compartment where there are several fissures in the medial and lateral patellar facets including a full-thickness medial patellar facet fissure. The cartilage in the lateral compartment is relatively normal in appearance. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Degenerative changes including osteophytes and cartilage loss as described above.2.Small joint effusion.3.Cruciate and collateral ligaments and menisci are intact.


Instruction: Generate impression based on findings.

Input: 13 year old male with history of Proteus and lymphatic-venous malformation.EXAMINATION: CT of the right lower extremity from the lower pelvis to the ankles after IV administration of 80 cc Omnipaque 300. 1/29/16. There is diffuse subcutaneous reticulation within the lateral aspect of the left lower leg and bilateral right greater than left thighs extending into the gluteal soft tissues. There is a large soft tissue lesion located medial to the biceps femoris spanning a craniocaudal distance of 10.5 cm with maximal axial dimensions of 3.6 x 1.7 cm likely representing a lymphatic venous malformation. The underlying osseous structures are unremarkable. No hip or knee joint effusions. The femoral heads are directed into well-formed acetabula.The known vascular malformations within the pelvis are better evaluated on recent MRI, however appear stable in size. There is diffuse reticulation and skin thickening of the scrotum. There is a well-circumscribed fluid density lesion within the right anterior inferior pelvis extending into the right inguinal canal measuring 5.4 x 2.5 cm

Output: Extensive venous lymphatic malformations as above.


Instruction: Generate impression based on findings.

Input: Altered mental status. History of lung cancer. Rule out brain metastasis. The study is moderately limited by patient motion.There are tiny, subtle foci of diffusion hyperintensity in the posterior left frontal deep white-matter (centrum semiovale), on the surface of the right cerebellar hemisphere and in the medial aspect of the right middle cerebellar peduncle with no associated contrast enhancement, which are suspected to represent subacute infarcts.A 4 mm focus of T1-hyperintensity in the left globus pallidus may reflect mineral deposition. A tiny (3 mm in diameter) focus of contrast enhancement to the right of midline in the pons is associated with susceptibility artifact but no perceptible abnormality on the other sequences and favored to represent incidental capillary telangectasia. Minimal periventricular T2/FLAIR hyperintense signal without diffusion restriction or contrast enhancement is nonspecific but most likely reflect chronic microvascular ischemia. The ventricles and the other CSF-containing spaces are mildly enlarged, reflective of global brain volume loss. There is no midline shift or brain herniation. There is no extra-axial fluid collection. Major intracranial vascular flow voids are preserved, reflecting gross vessel patency.There is moderate ethmoid and mild maxillary and sphenoid sinus mucosal thickening, associated with minimal fluid. This is nonspecific but in the proper clinical setting may reflect sinusitis. There is fluid in the mastoid air cells which is nonspecific. There is no gross orbital abnormality. There is an infiltrative, destructive, heterogeneously contrast enhancing mass involving the right lateral mass of C1 as well as the adjacent soft tissues. This lesion is not completely assessed or covered on this examination but involves the subjacent right lateral epidural space without mass effect on the spinal cord. In the axial plane, this contrast enhancing tissue measures up to 4.6 cm x 4.2 cm. Craniocaudad, it measures 2.6 cm. The mass is close proximity to the right vertebral artery (V3 segment), patency of which is not well assessed on this examination.

Output: 1.There is no convincing evidence of intracranial metastatic disease. Please note examination is motion degraded which limits evaluation for small lesions. As such follow-up study may be considered to better exclude the possibility of intracranial metastatic disease. 2.Few punctate foci of diffusion hyperintensity in the left frontal lobe and right cerebellar hemisphere/middle cerebral peduncle are suspected to represent subacute infarcts. 3.Enhancing mass involving the right lateral mass of C1 likely represents osseous metastasis. There is mild involvement of the right lateral epidural space at this level without mass effect on the cord.


Instruction: Generate impression based on findings.

Input: Female, 16 years old, with persistent vomiting and epigastric pain. Evaluate for brain mass or brain abnormalities. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. Trace mucosal thickening seen in the left maxillary sinus.

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


Instruction: Generate impression based on findings.

Input: History of a new retroperitoneal mass measuring about 9 cm per outside hospital CT. Please characterize. LUNG BASES: Probable flow-phenomena artifact in the right atrium, without definite evidence of a filling defect to suggest thrombus. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a focal suspicious lesion. No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder without gallstones. The vessels are patent. Punctate probable cyst in the anterior segment of the right hepatic lobe.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal mass extending from the L3-4 intervertebral disc space inferiorly to the superior endplate of T12/level of the caudate with a predominant IVC intraluminal component which causes expansion of the vessel. The lesion abuts the orifice of the right and left renal veins without definite invasion, within the limitations of the exam. The extraluminal component abuts the aorta with mass effect on the right psoas muscle and draping over the adjacent vertebral bodies. Anteriorly there is mass effect on the pancreatic body without evidence of invasion. The mass measures approximately 9.2 cm in the craniocaudal dimension (series 7/23) and up to 4.7 x 3.9 cm in the axial dimension (series 8/26). The mass demonstrates heterogeneous enhancement with central necrosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid diverticulosis without acute diverticulitis. Giant diverticulum at the anterior rectosigmoid junction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Centrally necrotic retroperitoneal mass with a dominant expansile IVC intraluminal component most compatible with an IVC/retroperitoneal leiomyosarcoma. Other etiologies are considered less likely but include a malignant fibrous histiocytoma or malignant nerve sheath tumor. No evidence of distant metastatic disease.


Instruction: Generate impression based on findings.

Input: Lymphoma: vision changes. Brain MRI: There is further decrease in size and enhancement associated with the right lateral and central skull base tumor with extracranial and intracranial soft tissue components since April 2016. There is diffuse enhancement within the left internal auditory canal and perhaps along the cisternal segments of the bilateral trigeminal nerves. Otherwise, there is no evidence of intraparenchymal tumors or acute infarction. There is no midline shift or herniation. There is a right transfrontal ventricular catheter that terminates in the right lateral ventricle. There is mild T2 hyperintensity surrounding the catheter in the right frontal lobe. There is slight interval enlargement of the right lateral ventricle, which is otherwise narrower than the left lateral ventricle. There are persistent right mastoid effusions. There are persistent enhancing lesions within the bilateral mandibular condyles and left medial temporal bone.Brain MRV: There is a persistent filling defect in the right sigmoid sinus and jugular bulb. There is narrowing of the upper right internal jugular vein. The rest of the cerebral venous sinuses are intact.Orbit MR: There is decreased prominence of the optic nerve discs and dilatation of the optic nerve sheaths. The orbital contents are otherwise unremarkable bilaterally.

Output: 1. Slight interval increase in size of the shunted right lateral ventricle.2. Further decrease in size and enhancement associated with the right lateral and central skull base tumor with extracranial and intracranial soft tissue components, likely attributable to treatment effects, but persistent thrombus in the right sigmoid sinus and jugular bulb. . 3. Enhancement within the left internal auditory canal and perhaps along the cisternal segments of the bilateral trigeminal nerves is likely a manifestation of lymphoma, but can also be treatment-related.4. Decreased prominence of the optic nerve discs and dilatation of the optic nerve sheaths since April 2016, likely indicating lower intracranial pressure. 5. Persistent enhancing lesions within the bilateral mandibular condyles and left medial temporal bone likely represent additional lymphoma deposits.


Instruction: Generate impression based on findings.

Input: 24 years, Female, seizures. Brain parenchyma appears within normal limits without findings to suggest a seizure focus. No cortical malformation or gray matter heterotopia. No intracranial mass or mass effect. Bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture. No evidence of infarct or hemorrhage. Ventricles are within normal limits. Major flow-voids are preserved. Bone marrow signal and intracranial soft tissue structures are unremarkable.

Output: MRI of the brain is within normal limits without findings to suggest a seizure focus.


Instruction: Generate impression based on findings.

Input: Male, 66 years old. Reason: diagnosis of primary hyperparathyroidism. Please evaluate for adenomas History: diagnosis of primary hyperparathyroidism. Please evaluate for adenomas RIGHT LOBE MEASUREMENTS: 1.6 x 2.3 x 4.9 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.9 x 1.4 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Mildly heterogeneous echotexture, without focal lesion.LEFT LOBE: Mildly heterogeneous echotexture, without focal lesion.ISTHMUS: Mildly heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: An ovoid hypoechoic structure measuring 1.0 by 0.5 x 0.5 cm is located posterior to the inferior pole of the left thyroid lobe, with increased vascular flow.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: A less than 1 cm hypoechoic structure posterior to the inferior pole of the left thyroid lobe is compatible with a parathyroid adenoma. See same-day nuclear medicine parathyroid scan for additional findings.


Instruction: Generate impression based on findings.

Input: Intellectual impairment, poor articulation, and mild cerebellar ataxia. The images are partly degraded by dental brace artifacts. Nevertheless, there is marled diffuse cerebellar volume loss. The brain stem and supratentorial brain appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The supratentorial ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Marked diffuse cerebellar volume loss, which may be related to a neurodegenerative process.


Instruction: Generate impression based on findings.

Input: Recent biopsy of a brainstem lesion, with new right 6th nerve palsy and dysphagia. There are postoperative findings related to right transfrontal biopsy of the cervicomedullary lesion. There is a small amount of susceptibility effect along the biopsy track, which traverses the lateral margin of the right red nucleus and the posterior right pons, in the region of the abducens nucleus and the root of the abducens nerve, as well as the medulla, in the region of the right hypoglossal nucleus. There is no evidence of acute infarct. There is a small amount of pneumoventricle, but the ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The paranasal sinuses and orbits are unremarkable.

Output: Postoperative findings related to right transfrontal biopsy of the cervicomedullary lesion. There is a small amount of susceptibility effect along the biopsy track, which traverses the posterior right pons, in the region of the abducens nucleus and the root of the abducens nerve, as well as the medulla, in the region of the right hypoglossal nucleus.


Instruction: Generate impression based on findings.

Input: Patient with anterocollis and possible dystonia. Please evaluate C1 -- C2 (non-legible wording) non-infused head CT, history of subdural hematoma weighted (non-legible wording). Non-infused head CT:There is no evidence of intracranial hemorrhage, edema, mass, mass effect, midline shift or hydrocephalus.There is generalized slight prominence of cortical sulci of left hemisphere compared to the right. There is however no evidence of any density abnormality of the left cerebral hemisphere. Considering provided clinical history of subdural hematoma which is no longer identified on this exam, the findings of the left hemisphere may be result of posttraumatic volume loss. This can be further evaluated with a dedicated MRI of brain.Visualized paranasal sinuses and mastoid air cells are unremarkable.Calvarium is intact.CT of the cervical spine:There is reversal of cervical lordosis to a kyphotic deformity. On sagittal 2-D reformatted images there is grade 1 retrolisthesis of C3 in respect to C4. There is apparent mild anterior displacement of the entire C1, C2 and C3. This finding is best appreciated on sagittal reformatted images. This results in more anterior projection of the posterior arch of C1 compared to the posterior lip of foramen magnum. There is however maintained alignment of C1 and C2 and C3. There is no definitive evidence of any fracture. On coronal reformatted images there is evidence of a slight widening of the articulating space between the right occipital condyles and right lateral mass of C1 compared to the left. The clinical significance of this finding is not clear however this finding may be result of an old injury or due kyphotic deformity of cervical spine. On reformatted images the subarachnoid space at the level of foramen magnum and C2 -- C3 levels are identified both posteriorly and anteriorly. There is however effacement of the subarachnoid space at the level of grade 1 anterolisthesis of C3 -C4 with suggestion of central spinal stenosis.At C4 -- C5 level mild degenerative disk disease and bulge of disk material is noted. Subarachnoid space anterior and dorsal to the cord on reformatted images is identified.At C5 -- C6 and C6 and C7 levels there is moderate degree of degenerative disk disease and sclerotic changes of the adjacent endplates are noted. These changes are primarily along the anterior aspect of intervertebral disk space likely result of kyphotic deformity. Shallow ventral hypertrophic spur at these levels is also present.

Output: 1.Non-infused head CT demonstrates no evidence of an acute intracranial findings. There is no evidence of residual subdural as clinically is mentioned. There is generalized prominence of cortical sulci in the left hemisphere compared to the right which may indicate underlying parenchymal volume loss. If further evaluation is desired an MRI examination can add additional information of the cause of this finding. Calvarium is intact. Paranasal sinuses and mastoid air cells are unremarkable.2.Non-infused CT of cervical spine demonstrate grade 1 anterolistheses of C3 in respect to C4 with effacement of the subarachnoid space at this level and possible central spinal stenosis. There appears that the entire C1, C2 and C3 has shifted forward in respect to C4 and posterior lip of foramen magnum. There is however normal articulation of the occipital condyles and C1. Mild to moderate degenerative disk disease primarily at C5 -- C6 and C6 and C7 levels as described above.


Instruction: Generate impression based on findings.

Input: Again seen are postsurgical changes of left temporal craniotomy for resection of left temporal lobe metastatic lesion. There is unchanged T2/FLAIR hyperintensity along the left temporal resection cavity consistent with gliosis. There is minimal enhancement around the resection cavity which is consistent with treatment change. No evidence of residual or recurrent tumor at the resection cavity. There is no abnormal enhancement within the remainder of the brain to suggest new lesions. There are no masses, mass effect or hydrocephalus. There is no evidence for intracranial hemorrhage or diffusion-weighted abnormalities. Scattered foci of T2/FLAIR hyperintensity in the white matter are nonspecific but compatible with mild chronic small vessel ischemic disease. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.

Output: 1.Post-treatment changes without evidence of residual or recurrent tumor at the left temporal resection cavity. 2.No new intracranial metastasis.


Instruction: Generate impression based on findings.

Input: Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: eval s/p balloon occlusion History: ptosis Brain MRI:There are two high signal intensities on DWI, at bilateral precentral gyrus hand-motor coordination centers. Since corresponding ADC maps are equivocal, these lesions could represent artifacts or hyperacute focal ischemic lesions. Otherwise there is no evidence of hemorrhagic lesion on this scan.About 29mm x 26mm sized left cavernous sinus giant aneurysm is seen on this scan. The aneurysm sac shows iso-to slightly lower signal intensity to that of gray matter on T1 and lower signal intensity on T2 weighted images with peripheral wall enhancement on Gad enhanced T1 images. There is no no evidence surrounding parenchymal edema or evidence of subarachnoid hemorrhage on this scan.Constellation of above findings indicate acute or hyperacute thrombosis of giant aneurysm at the left cavernous sinus segment ICA.Underlying brain shows patchy scattered high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating non specific small vessel ischemic disease.  The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. A small retention cyst in the left maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate 29mm x 26mm sized left cavernous sinus aneurysm with partial thrombosis.There are also two intracranial aneurysms on the right distal ICAs; the proximal one is 5.9mm x 5.2mm with wide neck and the distal one is measured 3.3mm x 5.1mm. Vertebrobasilar system appears to show ectatic and tortuous but does not show evidence of intracranial arterial aneurysm.

Output: 1. Two high signal intensities on DWI without showing definitive diffusion restriction on ADC maps at bilateral frontal lobes indicating possible artifacts or hyperacute ischemic lesions as described above.2. Underlying brain shows non specific small vessel ischemic disease.3. A giant aneurysm at the left ICA cavernous sinus segment with partial hyperacute or acute thrombosis.4. Two distal right ICA aneurysms (about 6mm and 5mm) are seen.5. No evidence of intracranial hemorrhages especially no evidence of SAH.


Instruction: Generate impression based on findings.

Input: Reason: history of multiple myeloma, r/o lesions and plasmacytoma History: sciatica, groin pain Again seen is a lesion of the right sacrum involving the right sacral wing which extends to the level of the fourth sacral segment on the right appearing similar to the prior study. This also extends to the mid body of the sacrum at the level of S2. The mass results in narrowing of the right S1 neural foramen and likely abuts the S1, S2 and probably S3 nerve roots. The mass extends anteriorly along the right inferior margin of the L5 vertebral body and is inseparable from the right L5 nerve root. The bandlike nature of this lesion indicates a prior pathologic fracture appearing similar to the prior study. The signal intensity and enhancement of the mass appears similar to the prior study. Much of the lesion does not appear to enhance significantly which presumably related to treatment effects. There is minimal signal abnormality within S5 that is less pronounced than on the prior examination and could reflect treated myeloma. We see no additional lesions. There is signal abnormality within the medial aspect of the right iliac wing which is likely related to altered biomechanics and prior bone marrow biopsies, unchanged. Mild degenerative changes affect the left sacroiliac joint. Deformity of the pubic symphysis likely represents osteoarthritis due to altered biomechanics. There is edema within the soft tissues posteriorly which is nonspecific but is not necessarily of any current clinical significance. Degenerative disc disease and facet joint osteoarthritis affect the lower lumbar spine.

Output: Sacral plasmacytoma appearing similar to the prior study and other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with Parkinson's disease, patient with existing right deep brain stimulator, planning for new left deep brainstem related. A right frontal approach deep brain stimulator lead is in place coursing medially and inferiorly to terminate just below the level of the right thalamus. A left cerebral tract is visualized likely correlating to a previously removed left-sided deep brain stimulator lead.No pathologic intracranial enhancement is seen. T2 hyperintensity is seen along the left periatrial white matter. Mild proportionate prominence of the ventricles and sulci likely reflects parenchymal volume loss. Mucous retention cysts and/or mucosal thickening is seen in the maxillary sinuses.

Output: The examination was acquired for presurgical planning and consists of limited sequences. A right sided deep brain stimulator lead is in place. Evidence of a previously removed left-sided deep brain stimulator lead is also seen.


Instruction: Generate impression based on findings.

Input: Male, 51 years old. Neck pain, hyper-reflexia. The cervical spine alignment is anatomic. The vertebral body height is preserved. There are degenerative endplate marrow signal changes. There is no evidence of abnormal enhancement or mass. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: C2-C3: There is a right foraminal/far lateral disc bulge, with mild to moderate right neural foraminal narrowing, and no significant central canal stenosis.C3-C4: There is uncovertebral and facet joint hypertrophy and diffuse disc bulge, with moderate left and marked right neural foraminal narrowing and moderate to severe spinal canal stenosis. There is impingement on the cord anteriorly and associated high T2 signal within the spinal cord and slight cord narrowing at this level.C4-C5: There is uncovertebral and facet joint hypertrophy and diffuse disc bulge, with marked bilateral neural foraminal narrowing and severe spinal canal stenosis. There is impingement on the cord anteriorly and posteriorly with associated high T2 signal within the spinal cord at this level.C5-C6: There is uncovertebral and facet joint hypertrophy and diffuse disc bulge, with more focal right-sided prominence. There is moderate left and marked right neural foraminal narrowing and severe spinal canal stenosis. There is impingement on the cord anteriorly and posteriorly with associated high T2 signal within the spinal cord at this level.C6-C7: There is uncovertebral and facet joint hypertrophy and diffuse disc bulge, more prominent of the left. Marked left and moderate right neural foraminal narrowing, and mild to moderate spinal canal narrowing.C7-T1: There is no significant neuroforaminal narrowing or spinal stenosis.

Output: Extensive degenerative changes throughout the cervical spine, with spinal canal stenosis, most pronounced at the C3-4 through C5-6 levels, with associated myelomalacia at these levels. Marked bilateral neural foraminal narrowing at multiple cervical levels.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 lower back pain, evaluate for spinal stenosis versus facet disorder. Five lumbar type vertebral bodies are presumed to be present. There is grade 1 retrolisthesis of L4 on L5 measuring 5 mm as well as minimal grade 1 retrolisthesis of L5 on S1. The vertebral body heights are well-maintained. There is a small Schmorl's node in the inferior endplate of L4. No focal marrow signal abnormality is appreciated. There is diffuse disc desiccation and mild multilevel disc narrowing with relative sparing of L5-S1. The conus medullaris terminates at mid-L2. There is bilateral sclerosis and narrowing of the sacroiliac joints. There is abnormal intrinsic thin linear T1 hyperintensity along the midline dorsal thecal sac from L2 to L3 to the distal end of the thecal sac, measuring less than 1 mm in thickness.T12-L1: There is no significant spinal canal or neural foraminal narrowing. L1-L2: There is a shallow left foraminal disc protrusion with mild facet arthropathy as well as mild left neural foraminal narrowing. There is no significant right neural foraminal narrowing or spinal canal narrowing.L2-L3: There is a trace disc bulge with left foraminal prominence with abutment of the descending left L3 nerve root. There is a left paramedian annular fissure. There is mild left facet arthropathy. There is moderate left neural foraminal narrowing. There is no significant right neural foraminal narrowing or spinal canal narrowing.L3-L4: There is a diffuse disc bulge as well as a thickened ligamentum flavum. There is left greater than right facet arthropathy. There is mild-to-moderate left neuroforaminal narrowing and mild right neural foraminal narrowing.L4-L5: There is some degree of disc uncovering with a diffuse disc bulge that indents the thecal sac. There is no significant spinal canal narrowing. There is mild to moderate left neural foraminal narrowing and severe right neural foraminal narrowing. L5-S1: There is bilateral facet hypertrophy. There is no significant neural foraminal narrowing or spinal canal narrowing.

Output: 1. Grade 1 retrolistheses of L4 on L5 and L5 on S1.2. Severe right neural foraminal stenosis at L4-L5, with mild to moderate narrowing at several other neural foramina as described above.3. Compression of the descending left L3 nerve root by a left foraminal prominence of a disc bulge.4. No significant spinal canal narrowing.5. Fatty filum terminale with normal conus termination. This is a normal variant but can be seen with a tethered cord. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 45-year-old male with diabetic ulcer and spiking fevers on antibiotics. Evaluate for osteomyelitis. Right foot: There is significant soft tissue edema within the midfoot and forefoot of the right foot particularly along the dorsal aspect. There is normal bone marrow signal present on all sequences. No evidence of osteomyelitis. Severe degenerative changes affect the interphalangeal joint of the first toe.Right tibia/fibula: There is diffuse intramuscular edema throughout the lower leg. There is normal bone marrow signal present within the tibia and fibula. No evidence of osteomyelitis.

Output: No evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: There is a small collection posterior to the right paramedian cerebellum/sinus confluence which is relatively mid intensity on T1, hyperintense on T2, without enhancement, demonstrating no significant mass effect or susceptibility abnormality. This correlates with the previously identified hypodense fluid collection on the prior CT. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem or cerebellar infarction. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: There is a small collection posterior to the right paramedian cerebellum/sinus confluence which is relatively mid intensity on T1, hyperintense on T2, without enhancement, demonstrating no significant mass effect or susceptibility abnormality. This is most suggestive of evolving subdural hemorrhage mixed with CSF.


Instruction: Generate impression based on findings.

Input: 61-year-old female with history of pain ROTATOR CUFF: There is tendinopathy of the supraspinous tendon without evidence of discrete tear or tendon retraction. The supraspinatus muscle appears within normal limits. The tendons and musculature of the infraspinatus, subscapularis, and teres minor appear within normal limits.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears intact within the limitations of a non arthrographic examination.BICEPS TENDON: The biceps tendon is situated within the bicipital groove and appears within normal limits.ADDITIONAL

Output: Supraspinatus tendinopathy without evidence of rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Male 59 years old with a history of rectal adenocarcinoma s/p excision with negative margins, but with lymphovascular invasion. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: There is no abnormal enhancement or restricted diffusion within the rectum or sigmoid colon.BONES, SOFT TISSUES: Bone marrow signal intensity is within normal limits.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease in the pelvis.


Instruction: Generate impression based on findings.

Input: Known ulcerative colitis with new onset pruritus and elevated alkaline phosphatase. Evaluate for PSC versus other etiology of cholestasis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, and signal intensity without a focal lesion. Distended gallbladder without cholelithiasis. No choledocholithiasis. There is mild irregularity of the biliary system which is not adequately evaluated without MRCP images.There is suggestion of mild fatty infiltration.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal liver morphology without a suspicious lesion.There is mild irregularity of the biliary tree which is not adequately evaluated without MRCP images. The patient is being called back for dedicated MRCP images without intravenous contrast.


Instruction: Generate impression based on findings.

Input: Female, 64 years old. Reason: thyroid nodule History: as above RIGHT LOBE MEASUREMENTS: 2.6 x 2.5 x 5.2 cmLEFT LOBE MEASUREMENTS: 2.1 x 1.2 x 2.9 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Mildly heterogeneous echotexture. A right mid to lower pole nodule measures 1.9 x 1.6 x 2.4 cm, predominantly solid, heterogeneous, iso- to hypoechoic, noncalcified, with mild internal vascularity.LEFT LOBE: Mildly heterogeneous echotexture, without focal lesion.ISTHMUS: Mildly heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified.OTHER: No significant abnormality noted.

Output: Mildly heterogeneous thyroid with a dominant 2-cm solid nodule in the right lobe.


Instruction: Generate impression based on findings.

Input: 62 years Male (DOB:1/2/1954)Reason: s/p SRS please compare HPROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA The patient is status post left parietal lobe surgery and left-sided craniotomy for a mass previously present left precuneus. There is now some susceptibility effect along the left precuneus associated with some volume loss. There is no evidence for new enhancing lesion.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.On susceptibility weighted imaging there is a focus of susceptibility effect present in the left putamen of the basal ganglia which has been previously present. A punctate focus of susceptibility effect is present in the left dentate nucleus of the cerebellum. These foci of susceptibility have not changed since the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the ethmoid air cells and right sphenoid sinus and to a lesser degree left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post left parietal lobe surgery without evidence for local recurrence.2.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.3.A couple microhemorrhages are present left basal ganglia and left cerebellar hemisphere which are too few to establish a pattern.


Instruction: Generate impression based on findings.

Input: Cough question: Rule-out intracranial hemorrhage. Signs and symptoms: Altered mental status. Unenhanced CT of brain: Large vessel intracranial vascular calcification of vertebral basilar and cavernous carotids is noted.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal range for patient stated age of 56.Calvarium is intact. Visualized paranasal sinuses are unremarkable.Follow-up with an MRI is recommended if clinical concern persists.

Output: Negative nonenhanced CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: Right asymmetrical SNHL. 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. There is a small area of encephalomalacia in the left pons.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: Female, 22 years old, status postthree possible seizures, with childhood generalized tonic clonic disorder, also with history of osteosarcoma. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is observed.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The medial temporal lobe structures are symmetric, normal in size and free of pathologic signal change.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

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


Instruction: Generate impression based on findings.

Input: Transsphenoidal resection for a pituitary mass. There are postoperative findings related to transsphenoidal surgery. There is an enhancing mass that measures up to 37 mm within the sella with extension into the left cavernous sinus and parasellar region and suprasellar cistern. There is resultant encasement of the left internal carotid artery without significant narrowing of the flow void. There is also mass effect upon the right prechiasmatic optic nerve, but not the optic chiasm. The mass may also abut the left prechiasmatic optic nerve, without associated significant mass effect. The infundibulum is intact, but deviated to the right. There are secretions within the constricted sphenoid sinuses. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles are unchanged in size and configuration. There is a subcentimeter left parietal scalp mass.

Output: Residual pituitary macroadenoma with mass effect upon the right prechiasmatic optic nerve and encasement of the left internal carotid artery.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of esophagus, unspecified [C15.9], Reason for Study: ^Reason: 67 year old with esophageal adenocarcinoma and OSH report of brain met. Need to evaluate CNS involvement. History: na There was a 4.8 mm sized nodular enhancing lesion on the right occipital lobe. On today's scan, there is FLAIR high signal intensity at the same location within the right occipital lobe white matter, however, there is no evidence of contrast enhancement which is non specific. There is no other enhancing lesion seen on this scan. There is inhomogenous marrow signal intensity at C2 and C3 with minimal enhancement. This could represent normal variation of bone marrow signal intensity, however, if indicated dedicated cervical spine MRI can be considered for further imaging evaluation.There is no evidence of acute ischemic or hemorrhagic leison.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: 1. No evidence of abnormal enhancement.2. No acute ischemic or hemorrhagic lesion.3. FLAIR high signal intensity lesion on the right occipital lobe, non specific finding.4. Inhomogenous marrow signal intensity at C2 and C3.Comment: Regarding the enhancing lesion seen on prior out side MRI which is not seen on today's scan may need follow up imaging study. In addition, if clinically indicated, dedicated cervical spine MRI with and without contrast enhancement can be considered for further evaluation of the C2, C3 inhomogenous bone marrow signal intensity.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for sinus disease/infection. Signs and symptoms: 55-year-old female with MDS and severe facial pain. Concern for invasive sinusitis. Non-enhanced CT of paranasal sinuses:Frontal sinuses, worsening of frontal sinus disease since prior study.Sphenoid sinus, worsening of sinusitis since prior exam.Ethmoid sinuses, significant worsening of the left ethmoid sinus disease since prior exam. Minimal new right posterior ethmoid sinus disease.Maxillary sinuses demonstrate significant interval worsening of left maxillary sinus disease with near complete opacification on the current exam. Complete occlusion of left ostiomeatal unit. Unremarkable right maxillary sinus and with patent right ostiomeatal unit which has remained stable since prior exam.There is thinning of the posterolateral wall of left maxillary sinus with a suspect a small area of bony defect. There is also effacement of fracture plane in the left infratemporal fossa and including the left retromaxillary fat pad. There is also effacement of fascial planes between the masticator muscles at this site. There is edematous changes of the musculature. Comment a follow-up with an enhanced MRI exam for further evaluation.There is no detectable retro-orbital space abnormality on the left however the edematous changes of the left infratemporal fossa extends into the left inferior orbital fissure.Images through nasal cavity demonstrate increased soft tissue density in the posterior aspect of left nasal cavity.Visualized mastoid air cells and middle ear cavities are unremarkable.Above findings were discussed at the time of interpretation with Dr. Scott Siglin pager number 2953.

Output: Interval worsening of sinusitis in particular on the left with extension of edema/inflammatory changes into the left infratemporal fossa with effacement of fascial plane which also extends into the left inferior orbital fissure. Follow up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Right lower extremity pain and swelling Note that evaluation for a soft tissue mass is limited by the lack of intravenous contrast.There is abnormal marrow signal within the proximal diaphysis of the right tibia. No discrete fracture line is evident. There is diffuse soft tissue edema particularly along the posterior medial and anterior portions of the lower extremity. There is surrounding muscular edema at the level of the abnormal marrow signal as well. The marrow signal of the fibula and left tib-fib are normal. Within the limits of exam, no discrete mass is identified within the anterior soft tissues.

Output: 1. Abnormal marrow signal within the proximal diaphysis of the right tibia may represent early bone infarction or possibly stress injury. No discrete fracture line is evident.2. Diffuse soft tissue edema and inflammation without discrete soft tissue mass although the exam is limited by the lack of contrast administration.


Instruction: Generate impression based on findings.

Input: Reason: re evaluated cervical spianl cord after fusion has meatllic hardware cervical spine History: Bilateral hand paresthesia The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine. The patient is status post laminectomies at C4 and C5 where there is a pseudomeningocele defect. The patient is also status post posterior fusion at C4, C5 and C6. The cervical spinal cord and mildly deviates into the pseudomeningocele defect. There is a cord signal abnormality with T2 signal hyperintensity within the spinal cord at the C5 vertebral body level. This was also present on the prior exam.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are large anterior osteophytes present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is signal hyperintensity within the disk space at this level with associated contrast enhancement. The endplates appear preserved.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery appears to be hypoplastic compared to his unchanged since prior exam

Output: 1.Status post laminectomy and fusion in the cervical spine. There is no spinal stenosis currently. The spinal cord mildly deviates into the pseudomeningocele defect. The exam was obtained with the patient in supine position and this effect is presumed to be gravitational.2.A small focus of myelomalacia is redemonstrated in the spinal cord at the C5 vertebral level which is unchanged since the prior exam 2013.3.Some signal changes within the C4-5 disk are suspected to be related to inflammatory reaction but are nonspecific.


Instruction: Generate impression based on findings.

Input: Neoplasm of uncertain behavior of pituitary gland [D44.3], Reason for Study: ^Reason: history of pituitary tumor s/p apoplexy now with panhypopituitarism and new vision changes, please evaluate for recurrent tumor History: intermittent vision changes The pituitary gland is very small or nearly empty sella.There is no hypo-enhancement or signal abnormality suggestive of neoplasm. The pituitary stalk is located at midline without deviation, and is normal in caliber, signal intensity and enhancement. The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable. The orbits and contents are unremarkable. On T2 weighted coronal scan, there is about 5mm x 3.6mm sized top of basilar artery and left side P1 junctional aneurysm. On prior scan, the coronal T2 weighted image demonstrated subtle outward bulging lesion on the top of basilar artery. However, it was insufficient to make a diagnosis of basilar artery aneurysm.

Output: 1. Empty sella, otherwise unremarkable pituitary MRI.2. Top of basilar artery and the left PCA P1 segment junctional aneurysm (5mm x 3.6mm) as described above..


Instruction: Generate impression based on findings.

Input: Stated history of endometrial cancer. Endometrial adenocarcinoma, endometrioid type, FIGO grade I, with focal squamous differentiated. PELVIS:UTERUS, ADNEXA: The uterus is markedly enlarged, measuring 18.3 x 10.6 cm and lobular in contour containing numerous well-defined T2 hypointense masses demonstrating gradual heterogeneous postcontrast enhancement compatible with multiple fibroids with the largest in the fundus measuring 9.6 x 6.9 cm in the sagittal plane.The endometrial cavity is distended with T2 weighted hypointense and T1 weighted mildly hyperintense nonenhancing blood product extending into a distended cervix and the proximal vaginal canal. This includes several submucosal fibroids.In the right fundus of the uterus there is a broad-based mucosal based lesion measuring 5.2 x 2.0 cm demonstrating mild postcontrast enhancement compatible with patient's stated history of endometrial carcinoma. Within the limitations of a heterogeneously enhancing myometrium there appears to be minimal tumoral extension involving less than 50% of the myometrial thickness. The parametrial soft tissues are unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: 2.9 x 2.3 heterogeneously enhancing lesion in the right inguinal region suspicious for a pathologic lymph node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially imaged 5.4 cm fat-containing umbilical hernia.OTHER: Multilevel degenerative disc disease.

Output: 1.9.6 x 6.9 cm endometrial mass with minimal tumoral extension appearing to involve less than 50 % of the myometrial thickness. 2.2.9 x 2.3 cm suspicious right inguinal lymphadenopathy. No enlarged pelvic lymphadenopathy delineated.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: please assess left sciatic notch and lumbar spine, s/p fall 10/15, persistent pain and atrophySigns and Symptoms: pain over left sciatic notch and lumbar area after fall Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There are minor degenerative changes present in the lumbar spine.


Instruction: Generate impression based on findings.

Input: 62 years, Male, dizziness, visual changes, weakness. History of lung cancer and head and neck cancer. 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. Tiny focus of calcification along the right lateral aspect of the fourth ventricle again seen. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Minimal right maxillary sinus mucosal retention cyst. Mastoid air cells are clear. There is nonspecific heterogeneous marrow signal without large destructive lesions.

Output: No evidence of recent infarct, mass, or mass effect.


Instruction: Generate impression based on findings.

Input: Vague lower back pain with SI joint symptoms of unknown etiology. There is mild loss of lumbar lordosis. The vertebral body and disc space heights are preserved. There are scattered vertebral body hemangiomas as well as patchy areas of increased T1 and T2 signal within the sacrum and vertebrae, compatible with fatty marrow. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. At T12-L1, L1-2, and L2-3, there is mild facet arthropathy without significant compromise to spinal canal or neural foramina. At L3-4, there is mild disc bulging and facet arthropathy causing mild bilateral neural foraminal stenosis, but no significant spinal canal stenosis. At L4-5, there is facet arthropathy, ligamentum flavum thickening, and a left paracentral disc protrusion causing moderate left neural foraminal stenosis without significant spinal canal stenosis. At L5-S1, there is no significant narrowing of spinal canal or neural foramina. However, there is a subcentimeter posterior right synovial cyst at this level.

Output: 1. Mild multilevel spondylosis with a left paracentral disc protrusion causing moderate left neural foraminal stenosis at L4-5.2. No evidence of inflammatory changes involving the sacroiliac joints.3. Scattered areas of fatty bone marrow in the imaged axial skeleton, which may indicate incipient osteopenia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.