Instruction: Generate impression based on findings.

Input: Brain MRI: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Note is made of a probable developmental venous anomaly anterior to the cingulate sulcus on the left side.Head MRA: The intracranial internal carotid arteries are normal in course and caliber. The right A1 segment is hypoplastic. There is a 2 mm aneurysm at the junction of the left anterior cerebral artery and anterior communicating artery directed posteriorly and medially. No other definite aneurysm is identified.There is fetal supply of the right PCA. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course. There is no evidence of flow-limiting stenosis or additional aneurysm. The left vertebral artery is hypoplastic and terminates as the PICA. The right vertebral artery continues on as the basilar artery.Neck MRA: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber, without evidence of stenosis or occlusion.Both vertebral artery origins are patent. The right vertebral artery is dominant. There is no evidence of stenosis or occlusion.

Output: 1. 2 mm aneurysm at the junction of the left anterior cerebral artery and anterior communicating artery. No other definite aneurysm is identified.2. No evidence of acute intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, history lung cancer and brain metastases. Numerous parenchymal metastases are redemonstrated, predominantly within the supratentorial compartment. Since the prior examination, all lesions show a reduction in the size of enhancement and reduction in the degree of associated parenchymal edema. For reference purposes, a lesion in the right occipital lobe measures 10 mm in maximal diameter, previously 18 mm. No new or growing lesions are detected.Brain morphology is otherwise unremarkable. No significant generalized mass-effect or midline shift is seen. Some of the parenchymal lesions are associated with mild susceptibility artifact compatible with blood product, but no large or significant intracranial hemorrhage is detected. There are no abnormal extra axial fluid collections. The ventricular system is normal in size and morphology.

Output: Response to therapy with interval reduction in the size of numerous parenchymal metastases as well as a reduction in associated edema. No new or growing lesions are detected


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB:11/13/1974)Reason: sciatica left side History: as abovePROVIDER/ATTENDING NAME: KATARINA VESKOVIC KATARINA VESKOVIC 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. Incidental note is made of left-sided Tarlov cysts in the sacral spinal canal especially at the level of the left L2 nerve root where there is a cyst measuring 10 mm in size.At L5-S1 there is an enhancing lesion present at the left lateral recess measuring 9 x 12 mm axial dimensions associated with a disc extrusion at the left lateral recess. Some of this lesion extends behind the adjacent endplates and tracks behind the S1 segment at the left lateral recess. It compresses the nerve root at the left lateral recess. There is disc desiccation present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a mild disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, mild disc bulge and Schmorl's nodes at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a left lateral recess enhancing disc extrusion present at the L5-S1 level which compresses the nerve root at the left lateral recess (probably left S1 nerve root). Enhancement may indicate active inflammation.2.There are mild degenerative changes present in the lower lumbar spine.3.There are perineural cysts present in the left half of the sacral spinal canal


Instruction: Generate impression based on findings.

Input: Reason: eval knee, s.p ACL recon. MARS protocol History: swelling MENISCI: There is blunting of the free edge of the anterior horn and body of the lateral meniscus likely representing superficial fraying. The meniscus otherwise appears intact.There is linear fluid signal abnormality within the posterior horn of the medial meniscus which extends to the tibial articular surface indicating a longitudinal tear.ARTICULAR CARTILAGE AND BONE: There is a focal near full-thickness to full-thickness articular cartilage defect along the weightbearing surface of the lateral femoral condyle above the posterior horn of the lateral meniscus. There is bone marrow signal abnormality in the underlying area likely degenerative in etiology. There is partial-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle, more anteriorly.The patellofemoral articular cartilage appears relatively spared.LIGAMENTS: The cruciate and collateral ligaments appear intact. Note is made of postsurgical changes of prior ACL graft reconstruction EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Findings consistent with the stated history of ACL graft reconstruction. The graft appears intact.2. Longitudinal tear of the posterior horn of the medial meniscus.3. Superficial fraying of the free edge of the lateral meniscus.4. Focal full-thickness articular cartilage defect along the lateral femoral condyle.5. Mucoid degeneration of the PCL.


Instruction: Generate impression based on findings.

Input: 66-year-old male with altered mental status and known metastatic melanoma to brain. Evaluate brain mets and edema. There is a punctate focus of restricted diffusion involving the right posterior medial parietal region with corresponding dark ADC suspicious for a punctate microinfarct.Redemonstrated are multiple lesions with FLAIR signal abnormality along the left anterior temporal lobe, left paramedian frontal lobe, right posterior temporal lobe are compatible with metastatic lesions. The lesion in the left anterior temporal lobe again demonstrates extensive surrounding vasogenic edema. There is small amount of vasogenic edema around the left paramedian frontal lobe lesion. Size comparisons are limited given the absence of contrast but these lesions appear similar in size and configuration. There is redemonstration of underlying mild periventricular and subcortical FLAIR signal abnormality which is nonspecific but is likely related to chronic small vessel ischemic disease. There is mild diffuse volume loss.There is no evidence of intracranial hemorrhage. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid within the right mastoid air cell. The orbits, skull, paranasal sinuses, and scalp soft tissues are otherwise grossly unremarkable.

Output: 1.Findings suspicious for a punctate micro-infarct involving the posterior medial parietal region without mass effect or intracranial hemorrhage.2.Multiple areas of FLAIR signal abnormality corresponding to the enhancing lesions in the previous MRI exam within the left anterior temporal lobe, right posterior temporal lobe and left perimedian frontal lobe. Full comparison is limited in the absence of contrast, however the lesions appear grossly similar.3.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.4.The exam is somewhat limited due to the patient's inability to cooperate. SWI and T1 axial imaging were not performed.


Instruction: Generate impression based on findings.

Input: Medial malleolus swelling Tendons: The tibialis anterior, extensor hallucis longus, and extensor digitorum longus tendons are intact and demonstrate a normal course.The tibialis posterior, flexor hallucis longus, and flexor digitorum longus tendons are intact and demonstrate a normal course. The peroneal tendons are intact and demonstrate a normal course.The Achilles tendon is intact. The plantar aponeurosis is intact. There is no tendinosis or tenosynovitis.Ligaments: The anterior talofibular, calcaneofibular, and posterior talofibular ligaments are intact. The anterior and inferior tibiofibular ligaments are intact. The deep and superficial components of the deltoid ligament are intact. The spring ligament is intact.Joints: Along the medial malleolus is a small fluid collection which demonstrates thin peripheral enhancement. There is no abnormal internal signal or associated osseous abnormality adjacent to the collection. A mild amount of subcutaneous edema is seen tracking along the medial soft tissues. There is no joint effusion. The articular cartilage of the ankle joint is intact and without evidence of full thickness defect. There are no osteochondral lesions of the ankle articulation.Alignment: There is normal alignment.Sinus tarsi: The sinus tarsi is normal with preservation of fat signal.Muscles: There is no muscle atrophy or tear.Bone marrow: The bone marrow signal is normal. There is no fracture or contusion. There is no marrow replacing lesions.

Output: Bursitis of the medial malleolus. Remaining evaluation of the ankle is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Female 24 years old Reason: meniscus tear History: pain Images are suboptimal secondary to patient body habitus.MENISCI: The lateral meniscus is intact. There is ghosting and blunting of the posterior horn of the medial meniscus (series 22, image 10 and 11), indicating a radial tear.ARTICULAR CARTILAGE AND BONE: Articular cartilage is intact. Bone marrow signal is within normal limits for patient's age.LIGAMENTS: ACL, PCL, MCL, and lateral collateral complex is intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Radial tear of the posterior horn of the medial meniscus.2.Genu varus deformity with widening of the lateral aspect of the joint and an associated joint effusion


Instruction: Generate impression based on findings.

Input: Evaluation of neck pain x 3 years with radiation down BUE, numbness, hx of MVA 2012. There are small posterior disc-osteophyte complexes at C5-6 and C6-7 with associated mild left neural foramen stenosis at these levels. There is no significant spinal canal stenosis. There is mildly diminished cervical lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Small posterior disc-osteophyte complexes at C5-6 and C6-7 with associated mild left neural foramen stenosis at these levels.


Instruction: Generate impression based on findings.

Input: There is a homogeneously enhancing mass within the right internal auditory canal without expansion or extension into the adjacent cerebellopontine angle. The left internal auditory canal is clear. The visualized brain parenchyma demonstrates punctate foci of T2 hyperintensity within the white matter. Mucosal thickening is noted within ethmoid air cells and the left maxillary sinus.

Output: 1.MRI evidence for right internal auditory canal acoustic schwannoma.2.Partially imaged chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Altered mental status, visual hallucination. Evaluate for stroke. Nonenhanced head CT:CT is insensitive for detection of early acute strokes.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The cortical sulci and ventricular system as well as CSF cisterns are within normal limits.Very subtle periventricular and subcortical low attenuation of cerebral white matter is suspected of small vessel ischemic disease. These findings are significantly less noticeable on this study compared to prior MRI exam.Calvarium is intact. Visualized paranasal sinuses, mastoid air cells and orbits are unremarkable.

Output: Very subtle findings of small vessel ischemic strokes of indeterminate age. Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Male 9 years old with cyst shown on CT, headache, dizziness.Additional history per EMR: CT demonstrates a fluid filled cyst over the right frontal region with possible bone remodeling around it. These findings are likely consistent with an arachnoid cyst, which can remodel the surrounding bone; however, the fluid within the cyst is not quite the same density as the fluid in the ventricles. There is cystic enlargement of the subarachnoid space along the right frontal cerebral convexity measuring up to 6 mm in thickness (series 601 image 17), which follows CSF signal on all sequences and does not demonstrate diffusion restriction or enhancement. There is overlying osseous remodeling and mild mass effect on the adjacent parenchyma. There is no evidence of intracranial hemorrhage, enhancing mass, or acute infarct. There is a prominent curvilinear vein in the right temporal lobe compatible with a dural venous anomaly. The brain parenchyma and pituitary gland otherwise 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: Cystic enlargement of the subarachnoid space along the right frontal cerebral convexity compatible with an arachnoid cyst.


Instruction: Generate impression based on findings.

Input: 16 day old female with fever and prior subdural hemorrhage, evaluate for infectious complications Several sequences are motion greater. Given this caveat:Previously demonstrated high T1 signal intensity in the subdural spaces overlying the posterior left cerebellar and cerebral convexities has nearly resolved. There is new high T1 signal intensity material within the ventricles (right greater than left) with layering in the occipital horns consistent with interval formation of intraventricular hemorrhage. There is corresponding hypointensity with susceptibility technique. There is no evidence of acute infarct. The brain parenchyma appears unremarkable, with a normal degree of myelination for age. 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 mastoid air cells and middle ear cavities are clear.

Output: 1.Previously demonstrated subacute subdural hemorrhage along the left posterior cerebellar and cerebral convexities has nearly resolved.2.New intraventricular hemorrhage as described in detail above.3.No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified nature of brain [239.6], Reason for Study: ^Reason: eval tumor rsxn History: postop There is no acute ischemic lesion on the scan.Near total resection of previously shown the right parieto-temporal lobe large cystic mass. Resection area blood products are seen and shows layering which is measured about 19.1mm x 19.1mm sized. On gad enhanced images, there are irregular and multifocal enhancing areas especially lateral and inferior aspect of the original mass, these enhancing lesions may indicate residual mesion but could also be postoperative reactive changes. Follow up MR imaging study can be considered if clinically indicated.Resection margin and overlying dura and craniotomy sites also show blood products indicating postoperative changes.There are minimal amount of subdural fluid collections with pneumocephalus, again related to surgical resection.Midline shift toward left side is minimal. Other intra axial lesions including corpus callosum, left posterior temporal, left lateral ventricle occipital horn ependymal lining and left temporal lobe anterior horn appear to be stable in terms of size and MR characteristics.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Near total resection of the right parieto-temporal lobe intra axial mass with resection cavity blood products as described above.2. Multifocal and irregular enhancing areas of resection cavity are seen which may indicate residual lesion or post resection reactive changes. Follow up MR study can be considered for further evaluation.3. No change of other multifocal intra axial lesions including corpus callosum, left temporal lobe anterior horn, left lateral ventricle occipital horn ependymal lesion and left posterior temporal lobe lesion.


Instruction: Generate impression based on findings.

Input: 6-year-old male with tuberous sclerosis and seizure. Increasing frequency of seizures status post fall. Multiple densely calcified lesions in the subependymal bilateral ventricular system is noted. Additional similar findings within the parenchyma is also present. Multiple less calcific lesion and some with low density there is 30 are also believed to represent hamartomas of tuberous sclerosis. Further evaluation with a dedicated postinfusion MRI exam is recommended. No evidence of hemorrhage is identified and no evidence of any mass effect or midline shift. The cortical sulci and ventricular system remain within normal range. Calvarium is unremarkable.

Output: Extensive findings of tuberous sclerosis however no evidence of hydrocephalus or hemorrhage. Further evaluation with an infused MRI of brain is recommended.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer, brain mets, no therapy to brain lesions. EGFR/T790M+, on Tagrisso therapy. There is slight interval increase in size of several enhancing supratentorial lesions. For example, a right superior frontal sulcus lesion measures up to 8 mm, previously 6 mm. However, some lesions are unchanged or slightly smaller, such as a punctate lesion in the medial right occipital lobe. Furthermore, there is no evidence of residual cerebellar lesions. There is no evidence of intracranial hemorrhage or acute infarct. 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: Interval increase in size of several enhancing supratentorial lesions. Other lesions are not significantly changed or smaller.


Instruction: Generate impression based on findings.

Input: Medial meniscal injury. Pain MENISCI: No significant abnormality noted. Specifically the medial meniscus appears intact and both menisci are well anchored posteriorlyARTICULAR CARTILAGE AND BONE: Minimal inhomogeneity of the patellar cartilage compatible with mild chondromalacia and an additional full thickness defect in the trochlear groove involving the lateral surface (image 13 series 3). Marrow signal otherwise unremarkableLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Focal cartilaginous defect in the trochlear groove with more minimal changes involving the undersurface of the patella.


Instruction: Generate impression based on findings.

Input: Female 52 years old with a history of bladder cancer status post exenteration with Indiana pouch, evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology without focal lesion or biliary ductal dictation. There is loss of signal on out of phase imaging indicating hepatic steatosis. Status post cholecystectomy. The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No suspicious renal lesion. Improvement in hydroureter with resolution of ureteral enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post Indiana pouch. No evidence of bowel obstruction or inflammation.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Stable findings related to anterior pelvic exenteration.BLADDER: Stable findings related to anterior pelvic exenteration.LYMPH NODES: No enlarged pelvic lymph nodes.BOWEL, MESENTERY: Status post Indiana pouch. No evidence of bowel obstruction or inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: History of bilateral anal cutaneous fistula and perirectal abscesses. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: The bladder is contracted with suggestion of diffuse bladder wall thickening.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Presacral loculated fluid collection extending anteriorly around the rectum measuring 8.3 x 3.3 cm (series 901/46) with very low intensity foci compatible with gas. There is associated presacral edema.Additional prevesicular left-sided loculated fluid collection measuring 5.5 x 3.2 cm (series 9 and 1/55).Additional free pelvic ascites is noted.BONES, SOFT TISSUES: Originating at the 6:00/posterior anal canal is a fistula tract which bifurcates and progresses dorsally in the bilateral gluteal subcutaneous fat. On the right the tract bifurcates with one component terminating along the medial right gluteal cleft (series 901/17). The other component on the right progresses dorsally and terminate at an additional paramedial site on the skin. The left sided fistulous tract terminates along the left medial gluteal fold. No associated drainable fluid collection. OTHER: No significant abnormality noted.

Output: 1.Complex fistulous tract originating at the 6:00/posterior aspect of the anal canal with 2 right-sided and one left-sided gluteal fold insertions onto the skin surface.2.Two pelvic abscesses one in the presacral space and left prevesicular space.3.Trace free pelvic fluid.


Instruction: Generate impression based on findings.

Input: 11-year-old male patient with right knee injury with pain for 10 days. Radiograph is normal. Question of ligament injury. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: A minimal amount of edema seen within the posterior aspect of the medial tibial plateau and medial aspect of the medial femoral condyle. The articular cartilage of all three compartments is intact without focal chondral defect.LIGAMENTS: There is slightly increased signal surrounding the medial collateral ligament without thickening compatible with a grade I strain. The lateral collateral ligament complex and the cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Medial compartment bone contusions with grade I strain of the MCL.


Instruction: Generate impression based on findings.

Input: Female 21 years old Reason: abscess, worsening perianal disease History: pain, h/o perineal CD PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileostomy.BONES, SOFT TISSUES: Induration and edema of the soft tissues of the ischioanal fossae bilaterally.OTHER: Postsurgical changes. Previously described rim enhancing collection posterior to the vagina is again identified. This measures 2.3 x 2.7 cm (series 501, image 47), previously 2.5 x 1.3 cm. This communicates with a smaller perianal collection which measures 1.8 x 0.9 cm (series 501, image 30), previously 1.5 x 1.1 cm. There is a complex network of fistulous tracts extending from the collection. A thin tract extends from the collection to the left gluteal cleft (series 501, image 27). A second tract extends laterally into the left medial soft tissues of the ischioanal fossa (series 501, image 21). The collection also communicates with posterior wall of the vagina (series 501, image 32). Trace pelvic free fluid.

Output: 1. Perianal/perineal collections with complex network of fistulas tracts as detailed above. Overall the appearance has not significantly changed compared to prior CT 10/29/14.


Instruction: Generate impression based on findings.

Input: History of hepatitis C cirrhosis with HCC status post TACE RFA 3/28/2016 of marginal disease. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic fibrotic liver morphology.The segment 2/3 ablation cavity measures approximately 3.4 x 2.8 cm (series 1 301/2 39), compatible with an interval ablation. No residual arterial enhancing lesion to suggest marginal residual or recurrent disease.Several punctate transient hepatic intensity differences. No new suspicious arterial enhancing and washing out lesion.No biliary ductal dilatation or vascular abnormality.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: Gastric and esophageal varices appearing similar to prior.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval re-ablation of segment 2/3 without evidence of residual or recurrent disease.Cirrhosis with gastroesophageal varices without ascites.


Instruction: Generate impression based on findings.

Input: 87-year-old man with history of chronic cholecystitis. ABDOMEN:LIVER, BILIARY TRACT: There is diffusely decreased signal in the liver, however there is no focal hepatic lesion. The gallbladder is nearly collapsed but contains stones (5/31). Additionally, there is thickening and edema of the gallbladder wall. There is significant extrahepatic and mild intrahepatic biliary ductal dilatation with a large amount of pneumobilia. The common bile duct measures up to 18 mm in diameter (5/32). Additionally, there is an approximately 8 mm round filling defect in the distal common bile duct (12/47) which appears very similar in morphology to that seen on ERCP from 8/26/2016.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is nondilated. There is no focal pancreatic parenchymal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are atrophic with multiple large, simple cortical cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Filling defect in the distal common bile duct, similar in appearance to ERCP from 8/2016 and probably a stone.2.Intra and extrahepatic biliary ductal dilatation with pneumobilia.3.Findings of chronic cholecystitis.


Instruction: Generate impression based on findings.

Input: 37 years Female (DOB:9/11/1979)Reason: ms activity? History: 4 Gd+ lesions in AprilPROVIDER/ATTENDING NAME: ANTHONY T. REDER ANTHONY T. REDER There is redemonstration of multiple periventricular and subcortical white matter lesions some which are perpendicularly oriented to the lateral ventricles one in the left centrum semiovale appears larger on the current exam measuring approximately 11 x 6 mm axial dimensions on the current exam and 4 x 4 mm on the prior exam. It is not associated with contrast enhancement. Another one in the root entry zone of the right trigeminal nerve appears to be absent on the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Since the previous examination the patient is developed a new lesion in the posterior fossa related to the trigeminal ganglion and enlargement of another lesion in the left centrum semiovale only. No abnormal enhancing lesions are appreciated to suggest acute lesions. These are consistent with the patient's multiple sclerosis history.


Instruction: Generate impression based on findings.

Input: Low back pain. Evaluate for cord compression. Cervical spine: The bone marrow signal is diffusely low on the T1-weighted sequence and heterogeneous, with multiple focal lesions suspicious for osseous metastases. Degenerative changes in the cervical spine including small disc osteophyte complexes, particularly at the C3-C4, C4-C5, C5-C6, and C6-C7 levels with up to moderate spinal canal stenosis at this level. There is no definite cord signal abnormality. Vertebral body heights are grossly maintained. No gross evidence of epidural tumor.Thoracic and lumbar spine: The bone marrow signal is diffusely low on the T1-weighted sequence and heterogeneous, with multiple focal lesions suspicious for osseous metastases. Vertebral body heights are grossly maintained. Alignment is grossly maintained aside from grade 1 retrolisthesis of L5 on S1. There are multilevel disc bulges throughout the lumbar spine but without high-grade spinal canal stenosis at any level. There is mild or mild to moderate multilevel neural foraminal stenosis without evidence of higher grade foraminal stenosis on the sagittal images. No evidence of acute cord or cauda equina compression.

Output: 1.Diffuse osseous metastatic disease without evidence of acute cord or cauda equina compression.2. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol, details are not as evident on imaging as dedicated protocols of the spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Preoperative planning for seizures. Limited planning MRI demonstrates continued evolution of laser ablation effects in the right parietal lobe with decreased enhancement in the ablation zone. There are also postoperative findings related to partial right temporal lobe lobectomy with confluent T2 hyperintensity along the surgical margins. There is no mass effect. The ventricles and basal cisterns are unchanged in size and configuration. There are subcentimeter left choroid plexus xanthogranulomas. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a small encephalocele through the right occipital burr hole. There is a fluid level in the left maxillary sinus.

Output: 1. Examination is obtained for operative planning. Continued evolution of laser ablation effects in the right parietal lobe.2. Postoperative findings related to partial right temporal lobe lobectomy with probable gliosis along the surgical margins.3. Small encephalocele again seen through the right occipital burr hole.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with multiple sclerosis, assess for progression. Multiple T2 hyperintense lesions are redemonstrated predominantly within the corpus callosum and periventricular white matter of the cerebral hemispheres. There may be a few punctate lesions within the pons, but this is equivocal. Accounting for substantial differences in technique on the prior comparison examination, no definite change is seen in lesion size or number. These lesions demonstrate moderate T1 hypointensity which is also unchanged from prior. No definite lesional enhancement is seen.No edema or mass effect is detected. No abnormal extra-axial collections. Volume of the corpus callosum and brain is preserved and typical for the stated age. The ventricular system is stable and normal in size. Incidental note is made of edema within the right mandibular condyle, and enhancement of the right temporomandibular joint capsule.

Output: 1.Multiple white matter lesions are redemonstrated compatible with multiple sclerosis. Accounting for substantial technical differences on the comparison examination, no definite or significant interval change in lesion size or number is seen. No enhancing lesions are evident to suggest active demyelination.2.Findings are seen which may reflect right TMJ arthropathy.


Instruction: Generate impression based on findings.

Input: Lumbago status post LP.Clinical question: abscess? 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. The pedicles are short and the spinal canal is small on a congenital basis.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.The lumbar spinal canal is small on a congenital basis.3.No evidence for abscess


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact.BRAIN: There are scattered patchy foci of T2 hyperintensity within the periatrial white matter, thalami, cerebral peduncles, midbrain, pons, medulla, middle cerebral peduncles, and cerebellar white matter. There is more prominent focal T2 hyperintensity within the posteromedial left thalamus with slight mass-effect. In addition there is mild expansion and T2 hyperintensity within the mesial left temporal lobe. Of note, the above lesions do not enhance.There is abnormal thickening, T2 hyperintensity, and pathologic enhancement within the bilateral optic nerves involving the intraorbital, intracanalicular, and right intracranial segments. The intraorbital segments measure up to 6 mm on the left and 5 mm on the right. There is no evidence of acute infarct. 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, paranasal sinuses, and scalp soft tissues are unremarkable. CERVICAL SPINE: At C1-C2 there is mild ill-defined T2 hyperintensity and slight cord expansion without definite enhancement on this motion degraded exam. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There is mild prominence of the exiting nerve roots of the lower cervical spine bilaterally. There are slightly prominent lymph nodes vs. neurofibromas within the bilateral jugular chains and lateral retropharyngeal spaces.

Output: 1.Scattered patchy foci of T2 hyperintensity within the thalami and posterior fossa are compatible with lesions related to NF1. Close attention on follow up exams is suggested for two regions of more prominent T2 hyperintensity and slight mass effect within the left thalamus and medial left temporal lobe which may represent low grade gliomas. 2.Bilateral optic nerve gliomas extending to but not involving the optic chiasm. 3.Upper cervical spinal cord lesion, non specific but given the context, suspicious for low grade glioma. 4.Borderline lymph nodes vs. small neurofibromas in the retropharyngeal spaces and bilateral jugular chains. 5.Questionable small neurofibromas involving the exiting nerve roots at the lower cervical levels bilaterally.


Instruction: Generate impression based on findings.

Input: Dizziness and headache with vomiting. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific periventricular white matter T2 hyperintensity. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There is a prominent left retrocerebellar cerebrospinal fluid space. The ventricles and basal cisterns are otherwise 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.Interval Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Neck pain, pain between shoulders, right arm neuropathy Examination slightly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Bone marrow signal appears heterogeneously low which is nonspecific and may be technique related. Small foci of low T1 and T2 signal are noted along the posterior superior corners of the vertebral bodies from C3 to T1 and may represent sclerosis on a degenerative basis. No suspicious osseous lesions are demonstrated. There is mild loss of cervical lordosis as well as mild retrolisthesis of C5 on C6.The cervical spinal cord has normal signal characteristics and overall morphology.Minimal disc bulges and disc protrusions are present at C2-C3, C3-C4, C4-C5, C5-C6, and C6-C7 along with small endplate osteophytes. Relatively more prominent anterior osteophytes are present at C5-C6. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild degenerative changes are seen throughout the cervical spine which appear slightly advanced for patient's age. There is however no significant spinal canal or neural foraminal stenosis at any level. No cord signal abnormality.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 16 ml of a 50/50 mixture of Omnipaque 240 and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. 0. 5 cc of Kenalog was also injected. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 26 seconds

Output: Successful right hip injection.


Instruction: Generate impression based on findings.

Input: 2-year-old male with history of hepatoblastoma. Evaluate middle hepatic vein. The liver measures approximately 14 cm. The main portal vein is patent, with normal hepatopetal flow. The right hepatic vein is normal. Left hepatic vein is only partially visualized, due to involvement with the hepatic mass. The middle hepatic vein has blood flow distally, but no flow in the proximal middle hepatic vein which could be due to tumor invasion or compression. Additionally, the middle hepatic vein is laterally displaced to the right by a hepatoblastoma.

Output: Hepatic tumor again visualized, with middle hepatic vein distal patency as above. Proximal middle hepatic vein blood flow cannot be confirmed. The findings were discussed with Dr.Mak at the time of dictation.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, with neurofibromatosis type I and a long-standing temporal lobe lesion, who recently had a seizure after being controlled for a few years. A multicystic lesion involving the left cavernous and choroidal fissure is redemonstrated showing no significant interval change in size, morphology or signal characteristics, comparing to exams dating back to 2007. The posterior component of the lesion continues to measure 18 x 11 mm (image 14 series 401), previously 18 x 11 mm. As before, no associated lesional enhancement is seen. There is a small vessel looping around and within the lesion, but this is unchanged.Brain parenchymal morphology is otherwise unremarkable. No areas of significant edema or mass effect is detected. At most, a punctate focus of T2 hyperintensity is seen within the right inferior parietal lobule, unchanged. No pathologic parenchymal or extra-axial enhancement is detected. No findings to suggest intracranial hemorrhage are seen. The ventricular system is normal in size and morphology.An ill-defined, enhancing cutaneous lesion is seen within the medial left periorbital soft tissues, unchanged. As before, vascular prominence is noted within the left masticator space. A chronic deformity of the left lamina papyracea is unchanged.

Output: 1.No change in size or morphology of a nonenhancing multicystic lesion involving the left hippocampus and choroidal fissure. The lesion is unchanged when compared to an examination dating back to 2007.2.No new intracranial lesions are seen to account for the patient's seizure.3.A left periorbital cutaneous lesion is unchanged perhaps representing a plexiform neurofibroma.


Instruction: Generate impression based on findings.

Input: History of poorly differentiated sinonasal carcinoma SNUC s/p CRT. The patient also has a history of ankylosing spondylitis with sacro-iliac fusion and evidence of a C5-6 impingement. MRI Face/Sinuses: There are postoperative findings related to sinonasal tumor excisional biopsy with resection of the left ostiomeatal complex and left middle and superior turbinates. No evidence of recurrent or residual tumor is noted. There is persistent mucosal and secretions that completely fill the left sphenoid sinus. There is persistent moderate mucosal thickening in the left maxillary sinus and mild mucosal thickening within the right maxillary, right sphenoid, and right ethmoid sinuses. There is a mildly prominent left level 2A lymph node that measures 8 mm in short axis, but otherwise, there no evidence of significant cervical lymphadenopathy. The salivary glands are unremarkable. There is encephalomalacia in the inferior right cerebellar hemisphere and diffuse volume loss of the imaged brain. There are bilateral lens implants. MRI Cervical Spine: There is diffuse mild congenital narrowing of the cervical spinal canal. There is mild anterior syndesmophyte formation at multiple lower cervical and imaged thoracic vertebrae. There is degenerative spondylosis of the cervical spine that is most pronounced at the C5-6 level with areas of uncovertebral and facet hypertrophy. There is also a mild disc-osteophyte complex with resultant moderate to severe right-sided and moderate left-sided neuroforaminal stenosis at this level, as well as mild indentation upon the spinal cord. The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. Post-treatment findings in the sinonasal region with persistent diffuse mucosal inflammatory changes, but no convincing evidence of gross tumor recurrence, although the images are degraded by patient motion. 2. Stigmata of ankylosing spondylitis, a congenitally narrow spinal canal and superimposed cervical spine degenerative spondylosis that is most severe at the C5-6 level where uncovertebral/facet hypertrophy causes moderate to severe right and moderate left neuroforaminal stenosis. 3. Chronic right PICA territory infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 47-year-old female with highly suspicious left breast mass and enlarged left axillary lymph node with indeterminate right breast lesion on research MRI. Preliminary targeted right breast ultrasound was performed for the MRI area of concern. At the 3 o'clock position of the right breast, 3 cm from the nipple there is a 0.6 x 0.3 x 0.5 cm hypoechoic partially circumscribed mass with mild surrounding vascularity. This is located approximately 1.4 cm inferior to a complicated cyst, and corresponds to the enhancing lesion within the right breast on MRI. Ultrasound-guided biopsy of this lesion was recommended and subsequently performed. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 0.6 cm at the 3 o’clock position with mild surrounding increased vascularity, 3 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. No specimens were fragmented. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location at the biopsy site. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Happ. Dr. Kulkarni was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of the right breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Neck and back pain, involved in MVA on 1/21/2016 Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild loss of cervical lordosis. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge. No significant compromise to the spinal canal. Minimal neural foraminal narrowing. C4-5: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Thoracic: Thoracic sequences are slightly motion degraded. There is however no evidence of intraspinal hematoma or ligamentous injury. Thoracic vertebral body heights are maintained. Alignment is maintained. Minimal degenerative changes are seen including trace disc bulges in the lower thoracic spine. No significant spinal canal or neural foraminal stenosis is seen. Thoracic cord is normal in signal and contour. Bone marrow signal is benign. Paraspinous soft tissues are unremarkable.

Output: 1. No findings to suggest traumatic injury in the cervical or thoracic spine. Specifically, no cord signal abnormality, intraspinal hematoma, or evidence of ligamentous injury.2. Minimal degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: Reason: severe pain r/o foreign body History: as above with crepitance and locking Secondary to patient body habitus high definition coil could not be used. Alternative coil was used, which results in slightly suboptimal images.MENISCI: Complex tearing/fragmentation of the body and posterior horn of the lateral meniscus with both vertical and horizontal tear components. Lateral extrusion of the body of the lateral meniscus. Horizontal tearing of the anterior horn of the lateral meniscus with extension into the tibial articular surface. Near fluid signal intensity adjacent to the anterior horn of the lateral meniscus may represent parameniscal cyst. Medial meniscus is slightly attenuated but is intact.ARTICULAR CARTILAGE AND BONE: Full-thickness degeneration of the lateral tibial plateau articular cartilage, particularly beneath the posterior horn of the lateral meniscus with underlying subchondral cyst. Full-thickness degeneration along the posterior aspect of the lateral femoral condyle. Full-thickness focal cartilage defect along the femoral trochlea centrally. Subjective mild degeneration of the articular cartilage of the medial and patellofemoral compartment. Tricompartmental osteophytes, most prominent in the lateral compartment.LIGAMENTS: ACL and PCL are unremarkable. Medial collateral ligament appears thickened with ossification along the medial femoral epicondyle, likely reflecting old injury to the ligament. Lateral collateral ligament is unremarkable.EXTENSOR MECHANISM: Patellar and quadriceps tendons are intact.ADDITIONAL

Output: 1.Extensive complex tearing/fragmentation of the lateral meniscus.2.Osteoarthritis most severe at the lateral compartment.3.Small joint effusion.4.Findings indicative of old injury to medial collateral ligament.5.No foreign body is evident. If strong clinical suspicion of superficial foreign body, targeted ultrasound can be consider for further evaluation.


Instruction: Generate impression based on findings.

Input: 51-year-old female for evaluation of breast and lymph nodes. History of IDC with 3/3 LN positive on Bx. Scattered fibroglandular parenchyma noted in both breast. On postcontrast images, moderate parenchymal enhancement is seen bilaterally.There are postsurgical changes in the left lower axilla and left upper outer quadrant without suspicious enhancement to suggest residual or recurrent tumor. No residual postsurgical fluid collections. There is small enhancing lymph node identified 1.3 cm posterior to the postsurgical change. No abnormal enhancement is seen in the right breast or bilateral axillary regions.There is a benign morphology focus in the left central breast at the 9:00 position with an internal septation which likely represents a fibroadenoma.Right chest port is identified.

Output: 1.Postsurgical change in the left upper outer quadrant. No residual enhancement identified.2.Benign enhancing focus in the left central breast likely represents a fibroadenoma.3.No abnormal enhancement in the right breast or bilateral axillary region.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Epilepsy, unspecified, not intractable, without status epilepticus [G40.909], Reason for Study: ^Reason: Evaluate for seizure activity, MRI Seizure 2 protocol without contrast please History: History of GTCs No evidence of acute ischemic or hemorrhagic lesion on this scan.Bilateral hippocampi appears to be normal in configuration and signal intensity.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. 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: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Low back pain with right-sided radicular pain, status post motor vehicle collision. There is degenerative mild grade 1 anterolisthesis of L4 on L5. The vertebral column alignment is otherwise within normal limits. There is a prominent Schmorl's node in the superior endplate of L3 without significant edema, suggesting that this is a chronic lesion. The vertebral body heights are otherwise preserved. The vertebral bone marrow signal is unremarkable. There is prominent epidural fat distally, especially at the L5-S1 level. There is a perineural cyst that measures up to 15 mm to the right of the midline at the level of S2. The imaged portion of the spinal cord displays normal signal and morphology. There is multilevel facet arthropathy most prominent at L4-L5. There is a mild disc bulge at L2-3, without significant spinal canal or neural foraminal stenosis. There is mild spinal canal stenosis at L4-5 and neural foraminal narrowing related to the retrolisthesis, pseudobulge, and marked facet arthropathy. There is a lobulated contour of the uterus with multiple low T1 and T2 signal tumors, measuring up to 2.6 cm.

Output: 1. Degenerative lumbar spondylosis predominantly at the L4-5 level with grade 1 degenerative anterolisthesis, mild spinal canal stenosis, and mild bilateral neural foraminal narrowing.2. Multiple probable uterine fibroids. Correlation with dedicated ultrasound examination may be useful.


Instruction: Generate impression based on findings.

Input: Postoperative changes from previous left parietal craniotomy are again seen, with a rounded resection cavity which communicates with the left atrium. Small lateral cystic cavity along the resection cavity margin corresponds to previous biopsy, with persistent susceptibility likely relating to chronic blood products. There is increased susceptibility within the adjacent posterior lateral left thalamic region.Following contrast, there is again progression of areas of somewhat nodular enhancement, with areas of enlarging as well as new enhancement. This is most conspicuous along the medial aspect of the posterior body of the left lateral ventricle, with the area of enhancement now measures 11 mm in greatest thickness on 3/117, previously only 6 mm. Exam also demonstrates more confluent enhancement as compared to a somewhat more peripheral pattern on the prior exam. The previously referenced left periatrial white matter lesion measures 20 x 10 mm on 3/141 as compared to previous 18 x 10 mm, although there are tiny exophytic components not included within the measurement which are now more conspicuous. In addition, there are numerous additional punctate foci of enhancement scattered throughout the left parietal lobe. Several of these are quite remote from the previously seen areas of enhancement, for example near the parietal apex on 3/80 and 3/90. There is also progressive nodular enhancement throughout the left temporal lobe.The extent of FLAIR abnormality is overall similar in distribution compared to the most recent exam, although the component along the right splenium has further increased in thickness. Compared to more remote exams, there is gradual progression of FLAIR abnormality. On diffusion-weighted images, there is punctate mild diffusion restriction along the lateral aspect of the left atrium as well as along the posterior left corona radiata, without definite susceptibility or enhancement in these locations. These are nonspecific but could represent recent punctate foci of ischemia or possibly not yet enhancing hypercellular tumor.There is also redemonstration of a stable heterogeneous lesion in the central pons with central T1 hyperintensity and blooming on susceptibility, consistent with a cavernoma with associated developmental venous anomaly. There is no surrounding abnormal T2 hyperintensity in the pons. The ventricles and sulci are stable. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a mucosal retention cyst within the right maxillary sinus. Mild mucosal thickening is noted in the right sphenoid sinus.Perfusion imaging was not performed as this was a concurrent exam with a dynamic liver MRI.

Output: 1. Interval progression of areas of nodular enhancement along the resection cavity margins as well as subtle thickening of rightward extension of FLAIR abnormality across the splenium. Increased conspicuity and size of gadolinium punctate foci of more remote enhancement, as well as new foci identified. Findings are again concerning for tumor progression.2. Two punctate foci of mild diffusion restriction along the left periventricular white matter without definite corresponding enhancement. Differential diagnosis includes evolving areas of nonenhancing hypercellular tumor versus trace petechial blood products or punctate infarcts.3. Stable appearance of incidental pontine cavernoma with developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Dysphagia, recurrent vallecular cyst. There is a cystic lesion near the midline of the tongue base, slightly eccentric to the right, which measures up to approximately 25 mm. The lesion also extends into the root of the tongue. There is no significant airway narrowing. The cervical lymph nodes are not particularly enlarged. The thyroid and salivary glands are unremarkable, The osseous structures are intact. The orbits and imaged intracranial structures are unremarkable.

Output: Findings compatible with a vallecular cyst that measures up to approximately 25 mm, with extension in to the root of the tongue.


Instruction: Generate impression based on findings.

Input: Possible hemorrhagic stroke. History of kidney disease as an adult. 50 sutural female Since the exam of 2008 the patient has developed hypodense foci in the medial anterior aspect of the left thalamus and the superior aspect of the right thalamus anteriorly and in the right caudate nucleus. These are identified on an MRI of 8/19/09 . There is redemonstration from that time of focus of encephalomalacia in the inferior aspect of the left cerebellar hemisphere also identified and exams dating back to 2006 and the identified during the acute stage on 11/12/05.A focus of encephalomalacia is also present along the left temporal lobe identified on an MRI of 8/19/09. A focus of encephalomalacia is present along the right thigh medial parietal lobe and on either side of the intra-parietal sulcus involving superior parietal lobule, small portion of the precuneus and a small portion of the right inferior parietal lobule. There is also involvement of a small focus along the left cuneus.There is atrophy of the brain a somewhat early for this age.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Multiple foci of encephalomalacia as indicated above most of which are in the posterior circulation however there are a few in the anterior circulation bilaterally. These have developed over time and appeared many of these were not present on 2/25.08 right MRI from 8/19/09 identified. The distribution of the anterior circulation lesions suggests watershed distribution.


Instruction: Generate impression based on findings.

Input: Suspicion of an infarction or inflammatory lesion causing paraplegia. Many of the images are degraded by patient motion. There is no evidence of abnormal signal or restricted diffusion in the spinal cord, within the limits of artifact. There is degenerative cervical spondylosis, However, there does not appear to be extrinsic compromise of the spinal cord. There is a subcentimeter sacral perineural cyst. There is no evidence of abnormal enhancement within the spinal canal. The vertebral bodies are intact and the vertebral column alignment is anatomic. The treated aortic dissection and bilateral pleural effusions are partially imaged. The left internal jugular vein flow void appears to be lacking. There is an incisive canal cyst.

Output: 1. No evidence of acute spinal cord infarction or extrinsic compression of the spinal cord or cauda equina.2. The treated aortic dissection and bilateral pleural effusions are partially imaged. 3. Findings suggestive of left internal jugular vein thrombosis.


Instruction: Generate impression based on findings.

Input: 15 year-old male with history of infiltrating cerebellar astrocytoma status-post subtotal resection, here with headache. Evaluate for ICH. A right frontal shunt catheter has its tip in the left lateral ventricle. There is no significant ventricular dilation. The ventricular size is unchanged since the recent MRI.There is deformity of the cerebellar vermis with foci of calcification. This is compatible with residual tumor. However, evaluation of this is limited due to the lack of intravenous contrast.There is no evidence of intracranial hemorrhage.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of intracranial hemorrhage. 2. Partially calcified mass is again seen in the posterior fossa. This is incompletely evaluated due to lack of intravenous contrast.3. Unchanged right frontal shunt catheter with no evidence of hydrocephalus.


Instruction: Generate impression based on findings.

Input: For the purposes of numbering, there are 5 lumbar type vertebral bodies with the most inferior well-defined disc space labeled L5-S1. There is normal alignment of the vertebral bodies. Vertebral body heights are normal. Bone marrow signal is benign. Fat density is seen in the vertebral body of L1 compatible with focal fat or a small hemangioma. No enhancing lesions in the vertebral bodies. Small intraosseous lipoma is noted within the left iliac wing. The conus medullaris terminates at the lower L1 level.Mild degenerative changes, with individual levels as below:At the level off T12-L1 there is no spinal or neural foramina compromise.At the level of L1-L2 there is no spinal or neural foraminal compromise.At the level of L2-L3 minimal disc bulge with no spinal or neural foraminal compromise. At the level of L3-L4 there is mild disc bulge with no bilateral or neural foraminal compromise. There is mild facet hypertrophy bilaterally.At the level of L4-L5 there is mild disc bulge with small central protrusion and facet arthropathy on the left. There is also prominence of the epidural fat at this level as well. There is no significant spinal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.At the level of L5-S1 there is epidural fat without significant spinal canal stenosis. There is facet arthropathy, worse on the right and small right-sided annular fissure. There is mild right-sided neural foraminal stenosis. No significant left neural foraminal stenosis.

Output: 1. Mild degenerative changes in the lumbar spine with neural foraminal narrowing bilaterally at L4-L5 and and on the right at L5-S1 as detailed above.2. No suspicious lesions in the lumbar spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There are nonspecific scattered foci of FLAIR signal superficially in the frontal lobe (series 4, images 8, 10, and 11) with the one in the left middle frontal gyrus more prominent compared to previous examination and the one in the left precentral gyrus new from previous exam. No abnormal enhancement within the brain parenchyma. No masses, mass effect, or midline shift. No evidence of acute intracranial hemorrhage. No extra-axial fluid collections or hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1.No evidence of acute intracranial enhancing mass.2.Small lesions in the left precentral gyrus and left middle frontal gyrus are most likely vascular related. The left middle frontal gyrus lesion is suspected to have been present in 2005 whereas the left precentral gyrus lesion is new.


Instruction: Generate impression based on findings.

Input: Brain MRI:There are scattered foci of T2 hyperintensity within the white matter without associated mass effect, restricted diffusion, or susceptibility abnormality. 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. Cervical spine MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: Ligament thickening both anteriorly and posteriorly encroached central canal, however without resulting stenosis.C2/3: Mild left facet hypertrophy, moderate right facet hypertrophy and ligamentum flavum thickening. There is mild right neural foraminal stenosis.C3/4: Minimal posterior osteophyte disc complex, severe left facet hypertrophy, and mild right facet hypertrophy. There is mild-to-moderate left neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, ligamentum flavum thickening thickening, moderate left facet hypertrophy, and mild right facet hypertrophy. There is mild to moderate left neural foraminal and mild right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is mild central, severe left neural foraminal, and moderate right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild bilateral neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.Mild chronic small vessel ischemic disease of the brain.2.C2/3: Mild right neural foraminal stenosis.3.C3/4: Mild-to-moderate left neural foraminal stenosis.4.C4/5: Mild to moderate left neural foraminal and mild right neural foraminal stenosis.5.C5/6: Mild central, severe left neural foraminal, and moderate right neural foraminal stenosis.6.C6/7: Mild bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: assess ETT, lung fields History: R mainstem intubation now pulled back tubeVIEW: Chest AP (one view) obtained portably time stamped at 21:21. The endotracheal tube tip has been retracted and is now at the level of the carina. There are small lung volumes. The left lung collapse has slightly improved with minimal aeration of the left lung base. There is significant soft tissue edema and abdominal distention. The umbilical venous catheter tip is at the level of the left hepatic vein. The umbilical artery catheter terminates at T8. The NG tube is in the stomach. There is an overall paucity of abdominal gas with peripherally displaced bowel gas, consistent with the abdominal mass identified on the MRI. A catheter seen within the urinary bladder.

Output: Endotracheal tube tip at the level of the carina. Mildly improved aeration of the left lung base. Please refer to the MRI for details regarding the abdominal mass.


Instruction: Generate impression based on findings.

Input: 42 year old with dense breasts and family history of breast cancer in 2 aunts and her maternal grandmother. The MRI technologist notes that the patient had difficulty staying still and moved after contrast injection. This is not a significant limitation to this study however.There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, which is a limitation to the sensitivity of this study.No suspicious enhancement is seen in either breast. There are a few scattered enhancing foci in each breast, none uniquely suspicious. A normal sized left upper outer breast intramammary lymph node correlates to the node that can be seen on prior mammograms. No abnormal lymph nodes are identified in either axillary region.A fat density area in the superficial right axilla may represent the fat pad versus lipoma noted on the most recent mammogram and ultrasound.

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


Instruction: Generate impression based on findings.

Input: Five lumbar type vertebral bodies are presumed to be present. The patient is status post fusion with integrated anterior plate, screw, and intervertebral spacer devices at L3/L4 and L4/L5. Additionally, there is spinous process fixation of L3/L4 and L4/L5. Vertebral body heights are preserved. There is straightening of the lumbar spine. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. There is slight increase T2 signal in the paraspinal muscles and subcutaneous tissues posteriorly, expected in the postoperative setting. The visualized intra-abdominal and paraspinal contents are unremarkable. Vertebral body heights are within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.L1/2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2/3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3/4: Minimal disc bulge. Spinal canal and the neural foramina are patent.L4/5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5/S1:No significant disc disease. No spinal canal or neural foraminal stenosis.Mild multilevel facet arthropathy. The sacroiliac joints demonstrate mild degenerative changes but are otherwise unremarkable.

Output: Postsurgical changes of L3 to L5 fusion without significant spinal canal or neural foraminal stenosis at any level. Hardware integrity may be better assessed with radiography or CT.


Instruction: Generate impression based on findings.

Input: 17 years Female (DOB:12/24/1998)Reason: compare to immediate post op scan; has the cyst reaccumulated in the brainstem? History: girl with NF2 who had brainstem ependymoma and surgery in Feb.PROVIDER/ATTENDING NAME: JAMES H. TONSGARD JAMES H. TONSGARD The patient is status post suboccipital craniotomy. There is a 32 x 21 mm sagittal dimension partially cystic mass located at the cervical medullary junction which measured 24 x 36 mm sagittal dimensions on the 2/3/2016 exam.. There is redemonstration of an enhancing nodule measuring 9 x 7 mm sagittal dimensions located at the cervical spinal cord at the C3 vertebral level. This is unchanged since previous exams.There is redemonstration of an enhancing mass within the left internal auditory canal measuring 9 x 6 mm mm axial dimensions which previously measured approximately the same. There is redemonstration of a right internal auditory canal measuring measuring 12 x 7 mm axial dimensions previously measuring 11 x 7 mm axial dimensions.The left cavernous sinus is larger than the right cavernous sinusThere is redemonstration of a mass in the left orbit currently which surrounds the left optic nerve and measures 19 x 29 mm axial dimensions and previously measured approximately the same. It is associated with mild exophthalmos.There is redemonstration of a left suprasellar mass medial to the left temporal lobe measuring 14 x 10 mm axial dimensions which previously measured the same. There are small dural based nodules along the falx cerebri which are stable since prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are suggestive of neurofibromatosis type II. 2.Since the prior exam a mass at the cervical medullary junction has mildly decreased in size. Suspected represent an ependymoma.3.There are multiple extra-axial nodules suspected to represent schwannomas with bilateral acoustic schwannomas in the schwannoma in the left suprasellar cistern possibly third fourth or sixth nerve and possibly one in the left cavernous sinus which could also represent a meningioma..4.There is a stable mass located in the left orbit suspected represent a meningioma. There are additional extra-axial nodules identified along the dura which are also stable and likely represent small meningiomas.5.There is a spinal cord lesion present at the C3 level which is stable since the prior exam and is suspected to represent ependymoma based on clinical history.


Instruction: Generate impression based on findings.

Input: 20-year-old male with wrist pain. LIGAMENTS: Intra-articular contrast is identified within both the midcarpal and radiocarpal joints. Intra-articular contrast traverses the scapholunate ligament indicating a tear. The lunotriquetral ligament appears intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact. No intra-articular contrast is identified within the distal radioulnar joint.TENDONS: The flexor and extensor tendons appear intact. BONES: There is increased bone marrow signal abnormality on fluid sensitive sequences within the triquetrum which may represent a direct bone contusion. No linear signal abnormality is identified to suggest an acute fracture.ADDITIONAL

Output: 1. Findings consistent with disruption of the scapholunate ligament as described above. The triangular fibrocartilage complex appears intact.2. Bone contusion of the triquetrum.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease with high ostomy output The study is limited secondary to motion artifact.ABDOMEN:LIVER, BILIARY TRACT: 9 mm segment 6 liver cyst is unchanged. No suspicious liver lesion is identified. No biliary duct dilation.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: Right lower quadrant ileostomy is seen in place. Status post sigmoid resection, small bowel resection, and ileocecectomy. No definite bowel wall thickening or dilated bowel loops are seen. BONES, SOFT TISSUES: T2 hyperintense, nonenhancing, diffusion restricting lesions in the left paracolic gutter likely represents abscesses (favored over collapsed laterally displaced small bowel loops). The largest of the abscesses measures 2.5 x 1.0 cm (image 66, series 2601). A network of sinus tracts is seen connecting the abscesses with stellate appearance noted and there is also fistulous communication to the residual rectum. There is surrounding edema and inflammation extending into the adjacent left iliacus muscle. These findings are new compared to the prior CT of 12/4/2014.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left paracolic gutter abscesses and sinus tracts as described above.

Output: 1.Limited exam secondary to motion artifact.2.Left paracolic gutter abscesses and sinus tracts with fistulous communication with the rectal stump. 3.No definite evidence of enteritis.


Instruction: Generate impression based on findings.

Input: lower back and buttock pain. There is multilevel degenerative spondylosis. In particular, there is moderate bilateral neural foraminal stenosis at L3-4 bilaterally and mild neural foraminal stenosis at L2-3 and L4-5 bilaterally. There is also mild spinal canal narrowing at L2-3 through L4-5. There are small sacral perineural cysts. There is straightening of lumbar lordosis without subluxation. There is redemonstration of chronic appearing compression fractures of the T12, L2, and L4 vertebral bodies with associated expansion of the disc space and degenerative endplate marrow signal changes. The conus is normal in signal and morphology and terminates at L1/2 level. There is no intraspinal hematoma or mass. There is a probable left renal cyst.

Output: 1. Multilevel degenerative spondylosis, including moderate bilateral neural foraminal stenosis at L3-4 bilaterally and mild neural foraminal stenosis at L2-3 and L4-5 bilaterally, as well as mild spinal canal narrowing at L2-3 through L4-5. 2. Chronic appearing compression fractures of the T12, L2, and L4 vertebral bodies. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness and dizziness. There is extensive encephalomalacia in the left middle cerebral artery, predominantly involving the inferior left frontal lobe, with associated regional gyriform susceptibility effect and ex vacuo dilatation of the left lateral ventricle. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal mucosal thickening int he right ethmoid sinuses.

Output: Chronic left middle cerebral artery territory infarct, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 42-year-old male 3 months postoperative resection of a left cerebellar pontine angle epidermoid. Redemonstrated is a nonenhancing cystic lesion in the left cerebellopontine angle cistern that measures up to 29 mm in maximal transaxial dimension (as measured on diffusion imaging), unchanged. As before, the lesion is isointense to CSF on T1 and T2 technique, demonstrating some elevated signal on FLAIR. Its overall size and morphology are unchanged. There is associated posterior deviation of the left 7th and 8th cranial nerve complex as well as mass effect upon the brainstem, pons, left middle cerebellar peduncle, and left cerebellar hemisphere. As before, there is a small developmental venous anomaly in the right inferior frontal gyrus. There is scattered mild mucosal thickening in the paranasal sinuses. There is a small amount of fluid signal in the right mastoid air cells. The major cerebral flow voids are intact. Left posterior calvarial changes are consistent with the previously demonstrated biopsy injury site. There has been interval resolution of postprocedural pneumocephalus.

Output: Stable left cerebellopontine angle epidermoid. Resolution of previously demonstrated postprocedural pneumocephalus.


Instruction: Generate impression based on findings.

Input: left side weakness, dysarthria There are focal restricted diffusion on the mid pons (around the right middle cerebellar peduncle) and upper medulla indicating acute ischemic infarction.There are multiple bilateral thalamic susceptibility artifacts on gradient echo images indicating possible microcalcifications or likely chronic petechial hemorrhages. On FLAIR images, there are patchy high signal intensities on bilateral periventricular white matter indicating non specific small vessel disease. Although these patchy high signal intensity lesions are a bit more extensive especially bilateral trigone area, the possibility of white matter disease such as MS is low.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses are clear.The right mastoid air cells show opacification.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal bilateral ICAs, MCAs and ACAs. Bilateral PCAs are fetal origin. Vertebrobasilar system shows irregularity of proximal basilar artery without significant luminal stenosis. The left vertebral artery ends up with PICA. The right VA is dominant.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left vertebral artery origin appear to be stenotic about 50% but the right vertebral artery appears to be normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Acute ischemic infarction without hemorrhagic conversion on the right mid pons and upper medullar as described above.2. Irregular proximal basilar artery without significant luminal narrowing.3. Hypoplastic left VA with about 50% luminal narrowing on the left vertebral artery origin. Otherwise unremarkable extracranial cervico-carotid arterial system.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 37 year old status post cerebellar biopsy. A small focus of blood with surrounding edema is present in the left cerebellar hemisphere. The fourth ventricle is slightly displaced by related mass effect and the left quadrigeminal cistern is effaced. Accounting for differences in technique, the right frontal region of encephalomalacia appears unchanged from the MRI dated 4/22/2008. The anterior horn of the right lateral ventricle is mildly enlarged, likely reflecting adjacent volume loss. A surgical bony defect is present in the left aspect of the occipital bone. The patient is status post right frontoparietal craniotomy.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.High attenuation structure noted near the roof of the left orbit may be related to previous ocular procedure -- correlate with history.

Output: 1. Postoperative findings of cerebellar biopsy with minimal mass effect.2. Unchanged right frontal encephalomalacia.3. Additional abnormalities as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: ms evaluate for progression History: R trigeminal neuralgia and R sided weakness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple periventricular and subcortical white matter lesions which are hyperintense on T2 and flair MRINo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is redemonstration of T2 signal hyperintense lesions within the cervical spinal cord without any significant mass-effect. One is located along the right posterolateral spinal cord at the C2-3 level another is located along the right lateral spinal cord at the C3-4 level and other ones are located in the lower cervical cord. These can also be identified on the prior exam. No abnormal enhancing lesions are identified in the cervical spine.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 is a disk bulge at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is loss of disk space height associated with a disk bulge and endplate and uncovertebral osteophytes. There is partial effacement of the spinal fluid surrounding the cervical spinal cord at this level when compared to the prior exam.At C5-6 there is no significant compromise to the spinal canal. There is some narrowing of the neural foramina present at the C5-6 level left more than right due to uncovertebral osteophytes and disk materialAt C6-7 there is no significant compromise to the spinal canal or neural foramina. There are endplate and uncovertebral osteophytes present at this levelAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Postcontrast examination is somewhat compromised by patient motion.

Output: 1.There is redemonstration of numerous periventricular and subcortical white matter lesions which are stable compared to the prior exam.2.There is redemonstration of multiple cervical spinal cord lesions which are also stable when compared to the prior exam.3.Some imaging is degraded due to motion artifact4.There are degenerative changes present in the cervical spine, worse at C4-5, where there is a mild degree of spinal stenosis and some neural foraminal encroachment of exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Right lumpectomy and sentinel lymph node biopsy in February 2008 status post radiation for IDC ER/PR positive, HER-2 negative T1 cN0 N0. She was on arm index for 4 years which D she discontinued due to joint pain. She has been on oral medicine since June 20, 2012 and tolerating it okay but discontinued on her own since she has completed 5 years. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Bilateral silicone/gel retroglandular implants are intact. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Male 62 years old Reason: eval noted HCC from 9/11/14, 2.1cm lesion liver, pancreas lesion 1.3 History: HCC, HCV, pancreatic lesion ABDOMEN:LIVER, BILIARY TRACT: Signal dropout on in phase images suggestive of iron deposition. Hepatic cirrhosis as evidenced by left lobe hypertrophy and nodular hepatic contour. Heterogeneous T2 hyperintensity suggestive of hepatic fibrosis. Stable appearance of right hepatic lobe cysts.The previously described arterially enhancing lesion in segment 3 now measures 2.4 x 2.0 cm (series 13, Image 67), enlarged from previous study where it measured 1.8 x 1.7 cm. There is no convincing washout. It demonstrates mild T2 hyperintense signal and is bright on diffusion images. This is highly suspicious for hepatocellular carcinoma however it does not meet strict criteria in the absence of washout.Patent hepatic vasculature.Cholelithiasis. No intra-or extrahepatic biliary dilatation.SPLEEN: Severe splenomegaly measuring 21.1 cm.PANCREAS: Multiple T2 hyperintense lesions within the pancreas, which appear to communicate with the main pancreatic duct. The largest lesion in the pancreatic body/tail measures 1.3 x 0.9 cm (series 9, image 17), previously 1.3 x 1.2 cm. These likely represent side branch IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: BIlateral renal cysts, unchanged. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild thickening and prominence of small bowel loops, likely secondary to chronic liver disease.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Enlarging segment 3 lesion as detailed above which is highly suspicious hepatocellular carcinoma however it does not meet strict criteria in the absence of washout.2.Liver cirrhosis with evidence of portal hypertension.3.Multiple T2 hyperintense pancreatic lesions, likely representing sidebranch IPMNs.


Instruction: Generate impression based on findings.

Input: Right lumbar back pain radiating to the foot, not improving with PT. There is an eccentric right disc extrusion at L5-S1 that measures up to 2 cm in the anteroposterior dimension and is associated with compression of the cauda equina nerve roots in the right lateral recess and mild right L5-S1 neural foramen stenosis. There is no significant disc disease involving the other levels of the lumbar spine. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Large eccentric right disc extrusion at L5-S1 associated with compression of the adjacent cauda equina nerve roots.


Instruction: Generate impression based on findings.

Input: Low back pain, left leg pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is grossly maintained aside from perhaps minimal L2 on L3 and L5 on S1 retrolisthesis. Bone marrow signal is benign. The conus medullaris is normal in position.There is mild disc desiccation throughout the lumbar spine without significant height loss at any level. There is mild generalized facet arthropathy, relatively worse at the L4-L5 and L5-S1 levels. Additional details as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild diffuse disc bulge. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge eccentric to the left. No spinal canal or right neural foraminal narrowing. There is minimal narrowing of the left neural foramen and contact of the left exiting L3 nerve root.L4-L5: There is mild disc bulge with dorsal annular fissure and small central protrusion component. There is no significant spinal canal stenosis. There is mild to moderate right neural foraminal stenosis. Minimal narrowing of the left neural foramen. Mild facet arthropathy.L5-S1: Minimal disc bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits. There is left-sided hydronephrosis and hydroureter which can be further assessed with ultrasound as clinically indicated.

Output: 1. Fairly mild multilevel degenerative changes throughout the lumbar spine as described above. There is no spinal canal stenosis or high-grade neural foraminal narrowing at any level. There is minimal narrowing of the left L3-L4 and L4-L5 neural foramen and relatively greater narrowing at the right L4-L5 level. Additional details as above.2. At least moderate degree of left-sided hydronephrosis and hydroureter. Ultrasound can be considered for further evaluation as clinically indicated.


Instruction: Generate impression based on findings.

Input: 20-year-old male with medial pain following valgus blow. Suggestion of MCL laxity and patellar apprehension. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is edema along the anterolateral aspect of the lateral femoral condyle and a small focus of edema within the medial aspect of the patella, suggesting prior lateral dislocation of the patella. We see no full-thickness articular cartilage defects.LIGAMENTS: There is edema along the superficial band of the MCL that may represent a sprain. The meniscofemoral coronary ligament appears thickened and may be sprained as well. There is edema along the medial retinaculum as well as anterior to the MCL. The femoral attachment of the medial patellofemoral ligament is not well visualized suggesting a tear. There is also focal edema at the patellar insertion of the retinaculum likely representing additional tearing. The lateral retinacular structures appear intact. The LCL appears intact. The cruciate ligaments appear intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact. The Insall Salvati ratio is between 1.4 and 1.5 indicating patella alta. ADDITIONAL

Output: 1. Findings indicating recent transient lateral patellar dislocation with injury to the medial retinacular structures. There is a patella alta deformity.2. MCL sprain without discrete tear.


Instruction: Generate impression based on findings.

Input: Reason: liver mass History: liver mass ABDOMEN:LIVER, BILIARY TRACT: There is a large heterogeneous mass arising from the right hepatic lobe, measuring approximately 15 x 11 x 13 cm (AP by ML by CC; series 3, image 57; series 3, image 22). This results in marked hepatomegaly with displacement of the central vasculature, left kidney, and pancreas, all located left of midline. The lesion is mostly isointense on T2 and postcontrast images, with T2 hyperintense septae and cystic/necrotic areas centrally which are hypoenhancing compared with the remainder of the lesion and normal liver parenchyma. The left, right, and main portal vein are patent.SPLEEN: No significant abnormality noted.PANCREAS: Displaced, limiting evaluation.ADRENAL GLANDS: The right adrenal gland is not well seen due to displacement. Left adrenal gland is unremarkable.KIDNEYS, URETERS: The right kidney is displaced, as above. No suspicious renal lesion is identified. No significant hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large heterogeneous right hepatic lobe lesion of unclear etiology. We favor either atypical variant of hepatocellular carcinoma or sarcoma as etiology.