Instruction: Generate impression based on findings.

Input: 33 years Female (DOB:10/18/1982)Reason: eval for pathology, OSH imaging reports pineal mass with hydrocephalus History: eval for pathology, OSH imaging reports pineal mass with hydrocephalusPROVIDER/ATTENDING NAME: KRUPA G ANDALKAR BAKHTIAR A YAMINI There is a cystic-appearing mass present in the pineal region measuring 17 x 24 mm in sagittal dimensions associated with a peripherally enhancing component. It measures approximately 21 x 18 mm coronal dimensions.There is associated ventriculomegaly present with dilation of the temporal horns of the lateral ventricles. The third ventricle measures approximately 15 mm in diameter where as the biventricular diameter is approximately 44 mm. There is a small amount of T2 and FLAIR signal hyperintensity surrounding the lateral ventricles.There is associated T2 and FLAIR signal hyperintensity within the medial aspects of the thalami as well as the tectal plate and the posterior aspect of the midbrain.. This signal hyperintensity is worst on the right compared to the left side. The internal cerebral veins and basal veins are both identified.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.There is a pineal region mass present which is associated with findings suggesting that it infiltrates adjacent brainstem and thalami. This is suspected to represent a neoplasm such as a pineal parenchymal tumor. Other differential diagnoses include germ cell tumor, astrocytoma and metastases.2.Ventriculomegaly.


Instruction: Generate impression based on findings.

Input: New onset double vision, rule out intracranial mass History: new onset double vision. The left maxillary sinus is relatively small and there is a low-lying left orbital floor. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable.

Output: 1. The left maxillary sinus is relatively small and there is a low-lying left orbital floor, which may be developmental or post-traumatic in nature. Dedicated maxillofacial imaging may be useful for further evaluation.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 65-year-old male patient with history of HCC status post Intra-Op RFA. Assess for liver lesions. Please note that this is a technically limited exam secondary to multiple technologist-related errors including partially unplugged coil leading to extensive signal loss (most pronounced anteriorly and affecting left liver lobe) and failure to acquire appropriate arterial or portal venous and delayed postcontrast imaging sequences. Patient to be contacted for reimaging and acquisition of additional sequences. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Findings concerning for new and enlarging hepatic lesions with corresponding restricted diffusion. Again visualized postablation cavities hepatic segment 7/6 on image 110 series 1401 and in segment 5 on image 92 series 1401. Unable to assess for arterially enhancing lesion along the caudal/medial aspect of the hepatic segment 7/6 ablation cavity as a reliable postcontrast arterial sequence was not acquired by the technologist. But the corresponding site of signal abnormality appears increased in size and shows restricted diffusion, lesion measures approximately 2.6 x 2.5 cm on image 101 series 1401 and on image 464 series 1308, previously measured 1.5 x 1.4 cm. Previously visualized focal arterial enhancement along anterior/lateral aspect of segment 5 cavity also unable to be evaluated for reasons above and again site of signal abnormality shows increased size now measuring approximately 2.5 x 1.5 cm on image 43 2 series 1/3/2008, previously measured 1.8 x 1.1 cm. There are additional more pronounced than on earlier exam focal ill-defined sites of apparent restricted diffusion, for example, in inferior pole of liver on image 288 series 1/3/2008, new sites of disease cannot be excluded.Postablation cavity in hepatic segment 2/3 stable to mildly increased in size.Subcentimeter previously seen hepatic segment 8 of arterially enhancing lesion not reliably seen.On submitted imaging sequence labelled arterial phase there are multiple peripherally based enhancing foci seen that are favored to be perfusional in etiology.Accounting for differences in technique stable to mildly increased in size subcentimeter simple appearing T2 hyperintense focus at level of dome on image 34 series 901, may reflect a cyst. Small perihepatic fluid.SPLEEN: Splenomegaly measuring 19.1 cm in longitudinal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Splenorenal shunting present.RETROPERITONEUM, LYMPH NODES: Small porta hepatis and cardiophrenic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously alluded to punctate vertebral body enhancing focus not visualized, again likely technical.OTHER: No significant abnormality noted.

Output: Very limited exam due to technical errors made, see above. Patient to return and be re-imaged, please await report or addendum for that exam.Within limitations of study findings concerning for new and enlarging hepatic lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Non-small cell lung cancer with brain metastasis. Nausea and left more than right with weakness. Since the prior examination, there has been slight overall increase in the size of the multiple supratentorial and infratentorial contrast-enhancing brain metastatic lesions. For example, the largest lesion involving the right left cerebellum now measures 2.9 cm x 2.4 cm compared to 2.6 cm x 2.1 cm previously. The perilesional edema has also increased with increased involvement of the left brainstem and right cerebellar hemisphere. The associated compression of the fourth ventricle and midline shift in the posterior fossa are also increased as well as the downward herniation of the left cerebellar tonsil. The second largest lesion involves the posterior paracentral lobule and measures 2.8 cm x 2.6 cm, compared to 2.4 cm x 2.1 cm previously. There is a punctate focus of diffusion restriction adjacent to the metastatic lesion in the left frontal lobe. Otherwise, the diffuse background of T2-hyperintensity involving the cerebral white-matter has not significantly changed. Punctate foci of susceptibility effect remain unchanged. There are subcentimeter chronic lacunar infarcts in the bilateral thalami. Although the mass-effect on the fourth ventricle has increased, dilatation of the lateral and third ventricles remains unchanged. The skull and orbits appear to be unchanged.

Output: 1.Increase in the size of the multiple brain metastasis since the fairly recent examination of May 27, 2016. Progression of the largest lesion and the associated edema in the left cerebellar hemisphere result in increased compression of the fourth ventricle and left cerebellar tonsillar herniation. 2.Punctate focus of diffusion restriction in the left frontal lobe adjacent to the second largest metastatic lesion may represent a tiny recent infarct or may relate to the metastasis itself, such as a tumor embolus, or small vessel ischemic disease. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pain/swelling after basketball injury. MENISCI: We see no meniscal tear.ARTICULAR CARTILAGE AND BONE: There is edema within the anterolateral aspect of the distal femur suggesting transient patellar dislocation. There is extensive full thickness cartilage loss along the patella centrally, most severely affecting the inferior aspect of the patella, with fissuring and delamination of the adjacent articular cartilage. This has progressed compared to the prior study. There is edema of the underlying bone with mild depression of the articular surface. There is mild deformity of the inferior pole of the patella which may represent an old healed fracture. There is superficial fraying of the articular cartilage of the lateral facet of the femoral trochlea. There is also edema within the posterior aspect of the medial tibial plateau which may represent a contusion.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact. Thickening of the medial retinaculum likely represents chronic injury with a likely chronic tear of the medial patellofemoral ligament at its attachment.ADDITIONAL

Output: 1. Large cartilage defect along the patella, progressed from the prior study, is likely post-traumatic in etiology related to prior transient patellar dislocations with mild underlying subchondral bone changes in the patella and edema in the lateral femur.2. Femoral trochlear dysplasia and lateralization of the tibial tuberosity as described above.3. Joint effusion with probable intra-articular loose bodies.


Instruction: Generate impression based on findings.

Input: Comatose status post PEA arrest on 12/14/2015. Evaluate anoxic brain injury. Prominent restricted diffusion involving the gray matter and to lesser extent subcortical white matter of the entire cerebral cortex. There is also restricted diffusion within the caudate heads bilaterally. Pattern is compatible with an acute to subacute anoxic brain injury.There is only mild associated edema and no significant mass effect. The lateral ventricles and basal cisterns remain widely patent. Scattered foci of periventricular white matter T2 hyperintensity compatible with chronic small vessel ischemic changes.The expected intracranial vascular flow voids are present.No intracranial hemorrhage. Prominent opacification of the paranasal sinuses as well as the bilateral mastoid air cells. Postoperative changes from a left cataract removal.

Output: Findings compatible with acute to subacute anoxic brain injury involving the near entirety of the cerebral cortex as well as partial involvement of the basal ganglia. No significant associated mass effect or herniation.


Instruction: Generate impression based on findings.

Input: Comparison with prior MRI is limited by differences in technique and slice thickness. Possible mild interval increase in the cystic lesion component in the right suprasellar region, at the level of the carotid terminus, now measuring 1.9 x 1.5 cm (image 43) previously 1.5 x 1.4 cm. Otherwise, the number of cysts and their morphology are grossly unchanged. No new lesion is evident.

Output: Comparison with prior MRI is limited by differences in technique and slice thickness. Possible interval increase in the cystic mass in the right suprasellar region extending along the anterior cranial fossa skull base and superiorly into the right inferior frontal lobe, now measuring 1.9 x 1.5 cm (image 43) previously 1.5 x 1.4 cm. Otherwise, the number of cysts and morphology are grossly unchanged.


Instruction: Generate impression based on findings.

Input: There are low signal intensity metastatic lesions in L1, L2, L4, and L5 vertebra, as well as in the left sacrum and right iliac bone. In particular, the L2 lesion occupies much of the vertebral body, where there are mild superior and inferior endplate deformities. There also appears to be extravertebral extension anteriorly into the paraspinous space, but no gross epidural extension of tumor. There is sacralization of the L5 vertebra. The spinal cord signal appears unremarkable and there is no significant thoracic and lumbar spinal canal stenosis. However, there is sacral lipomatosis, with narrowing of the spinal canal. The vertebral column alignment is grossly anatomic. There are partly imaged liver, lung, renal and lymph node metastases. In addition, there is a partly imaged nodular lesion in the deep subcutaneous tissues overlying the left iliac fossa.

Output: 1. Metastatic lesions in T11, L1, L2, L4, and L5 vertebra, as well as in the left sacrum and right iliac bone, with mild superior and inferior endplate deformities of the L2 vertebral body. While tumor in the L2 vertebra appears have mild extravertebral extension anteriorly into the paraspinous space, no gross epidural extension of tumor is evident. 2. Sacral lipomatosis with narrowing of the spinal canal. 3. Partly imaged liver, lung, renal and lymph node metastases. A partly imaged nodular lesion in the deep subcutaneous tissues overlying the left iliac fossa also likely represents a metastasis. Please refer to the recent body CT report for additional details.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Possible transient global amnesia. There is a punctate focus of restricted diffusion in the right hippocampus, with apparent high T2 signal. The rest of the brain parenchyma, brainstem, and cerebellum appear unremarkable. There is no evidence of intracranial hemorrhage or tumor. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: There is a punctate focus of restricted diffusion in the right hippocampus, which can be associated with transient global amnesia.


Instruction: Generate impression based on findings.

Input: 40 year-old female with history of sinus congestion. Sinusitis, head pain. The paranasal sinuses are well pneumatized and demonstrate no evidence of acute or chronic inflammatory sinus disease. The OMUs of the maxillary sinuses are patent bilaterally. The bony density of area of exam is unremarkable. There is prominence of subarachnoid space in the bifrontal region (left greater than right). This is more than is expected for patient's stated age of 39. This examination utilizes bone algorithm for study of the sinuses and is not proper test for evaluation of soft tissues of intracranial content. The above findings are concerning for possible parenchymal volume loss or small chronic subdurals, dedicated CT of brain or an MRI is recommended.These findings were relayed to Anne Forsythe number 8158. The findings are also left on an answering machine at the level number 24851 at the time of interpretation.

Output: 1.No evidence of acute or chronic sinus disease.2.Prominence of the subarachnoid space in bifrontal region left greater than right as detailed. 3.4.


Instruction: Generate impression based on findings.

Input: Left knee pain and swelling MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the patellofemoral joint appearing similar to the prior examination. There has been slight progression of cartilage loss of the medial femoral condyle above the posterior horn of the medial meniscus with small full-thickness defects now evident. There is increased signal intensity of the articular cartilage of the medial femoral condyle anteriorly which appears similar to the prior exam and likely indicates mild degeneration. There is a small subchondral cyst posteriorly within the medial tibial plateau with adjacent edema appearing more prominent on the current exam. There is mild heterogeneity of the articular cartilage of the lateral compartment suggesting mild degeneration, the extent of which appears similar to the prior exam.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. No evidence of meniscal tear or Baker's cyst.2. Articular cartilage degeneration further detailed above which has progressed slightly along the medial femoral condyle.3. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Female; 51 years old. Reason: history metastatic renal cancer. presumed RT induced esophageal ulcer, with esophageal stent, assess for cancer progression History: upper back pain CHEST:LUNGS AND PLEURA: Interval decreased left pleural effusion.MEDIASTINUM AND HILA: Reference left para-aortic lymph node measures 1.3 x 1 cm, not significantly changed since prior study when it measured 1.2 x 0 .9 cm (series 10/26). CHEST WALL: Surgical changes above the xiphoid process.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Mild diffuse hepatic steatosis. There are postsurgical changes in the caudate. Stable hypoenhancing lesion in the right hepatic lobe measures 1 cm, previously 1 cm (series 10/135). There is mild intrahepatic biliary ductal dilatation, unchanged. The hepatic and portal veins are patent.SPLEEN: The spleen is absent.PANCREAS: The pancreatic body and tail are severely atrophic, unchanged and possibly due to radiation. Pancreatic duct is mildly prominent but not dilated, unchanged.ADRENAL GLANDS: Right adrenal gland is unremarkable. Left adrenal gland has been resected.KIDNEYS, URETERS: Status post left nephrectomy. Stable 7-mm enhancing nodule near the left nephrectomy bed (series 10/42), which may be a small splenule. Right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: Stable postsurgical changes near the gastroesophageal junction. Stable enlarged gastrohepatic lymph node (series 10/43).BOWEL, MESENTERY: Stable diffuse circumferential wall thickening of the distal esophagus and GE junction. No significant interval change in focal gastric wall thickening about the GE junction measuring 2.5 x 2.1 cm, previously 2.5 x 2.4 cm (series 10/38). BONES, SOFT TISSUES: Postsurgical changes in the intra-abdominal wall and chest wall, chest wall Port-A-Cath that causes artifact on some of the sequences.OTHER: No upper abdominal fluid collections.

Output: 1.Stable diffuse distal esophageal and GE wall thickening with stable enlarged left para-aortic and gastrohepatic lymph nodes.2.Stable right hepatic lobe lesion, remains suspicious for a metastatic focus.3.No new sites of disease.


Instruction: Generate impression based on findings.

Input: Again seen are postoperative findings related to right transfrontal laser ablation of tumor centered at the right thalamus and midbrain. Lack of contrast limits comparison however there appears to be minimal increase in size of the tumor, for example measuring approximately 3.1 cm in the transverse dimension on the coronal T2 sequence, previously 2.8 cm, and 3.0 cm in the craniocaudal dimension, previous 2.4 cm. The tumor enlargement is more notable when compared to prior MRI from 4/3/2016 when the lesion measured approximately 2.0 x 1.8 mm cm the transverse and craniocaudal dimensions measured with a similar technique on the coronal T2 sequence. Extent of surrounding vasogenic edema extending to the brainstem and cerebellum as well as the right temporal and parietal lobes is mildly decreased. There is effacement of the third ventricle and leftward displacement measuring approximately 7 mm and similar to prior. No significant midline shift more superiorly. No uncal herniation. Blood products within the tumor are again evident with evolution and slight decrease in conspicuity. No evidence of acute infarct. There is layering debris in the right occipital horn most evident on the diffusion sequence which while nonspecific may represent pus. Foci of susceptibility in the left occipital horn are compatible with blood products. Periventricular FLAIR hyperintensity reflecting transependymal CSF flow is much improved since prior MRI. Ventricular dilatation is similar to prior MRI from 5/21/2016, but note ventricular dilatation on CT from same day was worse since CT from 6/8/2016. Left frontal EVD in place.CSF flow sequence demonstrates biphasic flow anteriorly in the prepontine cistern which extends to the suprasellar cistern but without evidence of flow extension into the third ventricle through the third ventriculostomy. 3-D T2 sequence demonstrates dilated third ventricular recesses. Partially empty sella.

Output: 1. Right thalamic/midbrain metastasis is suboptimally evaluated without contrast but appears minimally larger than 5/21/2016 and more clearly larger compared to 4/3/2016. Surrounding vasogenic edema is improved. Ventricle size is similar to same-day CT but larger since CT dated 6/8/2016. Left transfrontal EVD in place. Third ventriculostomy does not appear to be patent.2. Lack of contrast limits evaluation for intracranial infection. There is layering debris with restricted diffusion in the right occipital horn, which is nonspecific in the setting of intraventricular blood products, but may represent pus and can be correlated with CSF analysis. No evidence of intracranial abscess or empyema.


Instruction: Generate impression based on findings.

Input: Patient with chronic maxillary sinus pressure. Please evaluate for sinusitis. CT of paranasal sinuses:Extensive opacification of bilateral maxillary sinuses with mixed high and low density material. This is believed to be secondary to long-standing chronic sinus disease. No definite evidence of any associated bony changes. Less likely possibility of fungal sinusitis cannot be entirely ruled out due to high density of the sinuses.Complete occlusion of bilateral ostiomeatal units.Extensive sinus disease of bilateral ethmoid air cells. Mucoperiosteal thickening in bilateral chambers of the sphenoid sinus.Mucoperiosteal thickening of bilateral frontal sinuses.Images through the nasal cavity demonstrate increased soft tissue density within the nasal cavity which is believed to be secondary to mucoperiosteal thickening. No bony abnormalities detected. Possibility of polyp in particular within the left nasal cavity cannot be entirely ruled out.The osseous structures of the area of the study are unremarkable. Images through the orbits are grossly within normal limits.Visualized mastoid air cells and medullary cavities are within normal limits.MRI examination of brain from 2006 is also reviewed which also demonstrated extensive chronic pansinusitis with more severe involvement of bilateral maxillary sinuses.

Output: 1.Extensive pansinusitis and with more significant involvement of bilateral maxillary sinus.2.Extensive soft tissue density within the nasal cavity as detailed.3.No definitive osseous abnormality.4.High density content of maxillary sinuses could be secondary to chronic long-standing sinus disease however possibility of fungal sinusitis cannot be entirely ruled out.


Instruction: Generate impression based on findings.

Input: History of low risk prostate cancer, please evaluate for high-risk features. Gleason score 6 right base and right mid. Examination limited by use of body coil.PELVIS:PROSTATE:Prostate Size: 3.5 x 4.6 x 3.6 cmPeripheral Zone: The peripheral zone is thinned and demonstrates diffusely decreased T2 signal without focal lesions identified. No focal lesions are seen on the ADC images.Central Gland: There is a focus of increased T2 signal within the transition zone which is most likely postprocedural (e.g.,TURP). Additional differential considerations include a utricle cyst or cystic BPH.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No significant abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Patient unable to tolerate endorectal coil which limits sensitivity of examination. Thinned and diffusely T2 hypointense peripheral zone bilaterally, no focus of abnormal ADC signal identified. Within imitations, no focal suspicious lesion identified.


Instruction: Generate impression based on findings.

Input: Unspecified visual loss [H54.7], Reason for Study: ^Reason: embolic stroke History: left weakness acute onset with hypodensity on CT Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There is focal FLAIR high signal intensity on the right external capsule anterior aspect, which is non specific but could be small vessel ischemic disease. Suspicious low attenuation seen on the right parietal lobe on CT scan is not seen on this scan, thus was an artifact.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Right Pcom artery and Acom artery are patent.There is no intracranial aneurysm. No intracranial arterial luminal stenosis.Neck MRA3D 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 vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. There is no evidence of arterial luminal stenosis or irregularity.C-Spine MRIThere is normal cervical lordosis. The cranial-cervical junction is normal. Spinal cord signal intensity is normal. Surrounding soft tissue appears to be normal.There is diffuse bulging of disc with moderate right side neuroforaminal stenosis at the level of C34. There is central focal bulging of disc at the level of C56. Otherwise no remarkable finding.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Focal FLAIR high signal intensity lesion on the right external capsule anterior aspect is non specific.3. Normal brain and neck MRA.4. Normal spinal cord signal intensity.5. Diffuse bulging of disc with moderate degree right side neuroforaminal stenosis at the level of C34.


Instruction: Generate impression based on findings.

Input: 41-year-old man with history of headache and incidentally noted cerebellar tonsillar lesion. There is a T2 hyperintense, T1 isointense, heterogeneously enhancing lesion with scattered foci of susceptibility artifact corresponding to calcification in the vermis and inferior fourth ventricle, which measures up to 31 mm. This lesion displaces the medulla anteriorly and extends inferiorly through the foramen magnum. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no evidence of intracranial hemorrhage or acute infarct. There are minimal nonspecific foci of cerebral white matter T2 hyperintensity bilaterally, which may represent prominent perivascular spaces. 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: A heterogeneously enhancing and partly calcified lesion in the inferior vermis and fourth ventricle measuring up to 31 mm likely represents a subependymoma, without evidence of hydrocephalus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of cerebral meningesClinical question: h/o meningioma s/p resection in 2012Signs and Symptoms: surveillance The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status-post right-sided craniotomy for removal of an extra-axial mass adjacent to the right frontal lobe. Although there is a minor dural thickening present at the craniotomy site this remains stable when compared to the prior exam. There is redemonstration of some minor signal changes within the brain parenchyma adjacent to the prior tumor bed which also remained stable since previous exams but have regressed since the preoperative exam.There are several subcortical punctate white matter lesions which are high signal on T2 and FLAIR MR present which are unchanged since the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Stable exam without evidence for tumor recurrence. Some residual dural thickening at the prior tumor bed may represent post treatment change and is stable.


Instruction: Generate impression based on findings.

Input: Male, 72 years old, bilateral leg pain. Alignment is grossly anatomic. Vertebral body heights are preserved. No worrisome marrow signal abnormality is seen.The visualized spinal cord and conus are unremarkable. The cauda equina is discussed below.Loss of disk height is evident at L1-2, L2-3 and to a lesser degree at L3-4. Schmorl's nodes are present at L1-2 and L2-3. Additional level specific findings are as follows:T11-12: Central disk protrusion which mildly flattens the ventral cord. No cord edema. No significant generalized canal stenosis. The neural foramina are patent.T12-L1: No spinal canal stenosis or neuroforaminal narrowing. L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk with a small central protrusion. Moderate generalized spinal canal stenosis. No significant foraminal narrowing.L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Bulging disk. Moderate generalized spinal canal stenosis with some crowding of the cauda equina. Moderate right and mild left foraminal narrowing.L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Bulging disk. Moderate to severe generalized spinal canal stenosis with some crowding of the cauda equina. Severe left and moderate right foraminal narrowing. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disk. Severe spinal canal stenosis with impingement of the cauda equina. Moderate bilateral foraminal narrowing. There is likely a small synovial cyst projecting posteriorly from the right facet joint.L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk with a left paracentral annular fissure. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. Small renal cystic lesions are seen.

Output: Multilevel degenerative findings result in variable spinal canal stenosis, most severely affecting L4-5 where there is a high-grade stenosis with impingement of the cauda equina. Severe foraminal narrowing is seen on the left at L3-4.


Instruction: Generate impression based on findings.

Input: There is straightening of the cervical spine which is likely positional. 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. Patchy foci of T2 hyperintensity are present within the pons without associated mass effect.C2/3: UnremarkableC3/4: Left facet hypertrophy causes mild left neural foraminal stenosis.C4/5: Mild posterior osteophyte disc complex without significant associated mass effect or stenosis.C5/6: Posterior osteophyte disc complex asymmetric to the right causes anterior right hemicord flattening without intrinsic cord signal abnormality. There is also ligamentum flavum thickening and bilateral uncinate hypertrophy. There is mild rightward central, moderate left neural foraminal, and mild right neural foraminal stenosis.C6/7: Mild posterior osteophyte disc complex and left uncinate hypertrophy. There is mild left neural foraminal stenosis.C7/T1: Bilateral endplate spurring, worse on the left, causing moderate left neural foraminal stenosis.

Output: 1.Patchy foci of T2 hyperintensity are present within the pons without associated mass effect. Given patient age 58 years, this MRI appearance is most suggestive of chronic small vessel ischemic disease. This could be more completely characterized and confirmed with brain MRI if deemed clinically beneficial.2.C3/4: Mild left neural foraminal stenosis.3.C5/6: Mild rightward central, moderate left neural foraminal, and mild right neural foraminal stenosis.4.C6/7: Mild left neural foraminal stenosis.5.C7/T1: Moderate left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Male 55 years old Reason: R/o CBD stones History: GB stones, elevated LFT and continued abd pain. Hx of pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is diffuse fatty infiltration of the hepatic parenchyma. No suspicious hepatic lesions. Hepatic and portal veins are patent.Gallbladder wall is thickened without pericholecystic fluid. There are multiple stones within the gallbladder lumen and possibly within the cystic duct. The common bile duct, common hepatic duct and intrahepatic bile ducts are normal in caliber. No choledocholithiasis is evident.There is hyperemia in segment 5 of the liver near the gallbladder fossa.SPLEEN: Pancreas is normal in morphology. No evident interstitial or peripancreatic fluid.Duct is normal in caliber and morphology.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple small mesenteric pericolonic lymph nodes.BOWEL, MESENTERY: Nonspecific mild hyperemia of the colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis with gallbladder wall thickening and mild gallbladder distention. Imaging features most suggestive of acute on chronic cholecystitis.2.No evidence of choledocholithiasis or acute pancreatitis.3.Fatty infiltration of the liver.4.Findings suspicious for a nonspecific colitis.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no significant brainstem or cerebellar atrophy. The basal ganglia are within normal limits with no significant putaminal volume loss, or decreased putaminal T2 signal relative to the globus pallidus. There is no midline shift or herniation. There is mild nonspecific prominence of the central canal in the upper cervical cord.

Output: Unremarkable exam.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42] / Migraine without aura, not intractable, without status migrainosus [G43.009], Reason for Study: ^Reason: Reason for headache and dizziness first degree relative with aneurysm History: Headaches and dizziness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion. There is no evidence of abnormal enhancement. 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, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.About 5mm downward herniation of cerebellar tonsil through the foramen magnum.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. Normal brain MRI.2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Reason: Prostate cancer-Biopsy of lumbar vertebral body lesion from metastatic prostate for research requirement History: none Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: L1 vertebral bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: 80-year-old male with bilateral lower extremity weakness with history of metastatic prostate cancer. There is no evidence of acute spinal cord compression. No definite cord signal abnormality is identified. There are multiple levels of moderate to severe spinal canal stenosis and neural foraminal narrowing suggested in the cervical and lumbar spine on a degenerative basis. These would be better evaluated on complete spine MRI. Abnormal bone marrow signal is demonstrated at multiple levels, compatible with known osseous metastatic disease including C2, T7, and L4. There appears to be transitional anatomy at the lumbosacral junction with lumbarization of S1.

Output: This is a limited exam specific for the exclusion of acute cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No acute cord compression is identified.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


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.The patient was placed supine on the fluoroscopy table. The right wrist was localized fluoroscopically, and a spot radiograph was obtained. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 22-gauge needle was advanced into the joint. Next, 5 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) 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. The needle was withdrawn. Radial and ulnar deviation views were also unremarkable. 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: 41 seconds

Output: Successful right wrist injection and unremarkable arthrogram examination.


Instruction: Generate impression based on findings.

Input: Retinal capillary hemangioma left eye: left eye loss of vision. Orbits: There is a left posterior globe enhancing lesion that measures up to 3 mm in thickness. The rest of the left orbital contents and the entire right orbit are unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is a subcentimeter cystic pineal gland. 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 grossly unremarkable.

Output: 1. A small left posterior globe lesion corresponds to the reported retinal capillary hemangioma.2. No evidence of intracranial hemangioblastomas to suggest associated von Hippel-Lindau disease.


Instruction: Generate impression based on findings.

Input: Reason: Eval autoimmune vs neoplastic lesion. History: abnml brain MRI.. There is a heterogeneous left frontal lesion which exhibits high T2 signal and scattered areas of susceptibility. A small cyst within the lesion is unchanged. T2 abnormality extends across the genu of the corpus callosum and into the left temporal lobe, similar in extent to prior exams. There may be some very mild patchy nonmass-like enhancement within the lesion along with intrinsic T1 hyperintensity, all unchanged. Perfusion imaging shows areas of both elevated and diminished perfusion within the affected parenchyma. A left frontal burr hole is unchanged. 4 mm of left to right shift is unchanged. Mass effect with effacement of the left frontal horn appears similar to the prior exam. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Bilateral mucous retention cysts/polyps.

Output: Heterogeneous, chronically injured parenchyma in the left frontal lobe is not significantly changed from prior exams.


Instruction: Generate impression based on findings.

Input: Multiple vertebral fractures and focal pain in lumbar and thoracic spine and history of multiple myeloma. Thoracic Spine: There appear to be 11 thoracic type vertebrae and a transitional S1 vertebra. There is a T2 and T1 hyperintense lesion in T12 with peripheral enhancement and at least 50% compression deformity with slight focal kyphosis, but no significant retropulsion or neural foramen stenosis. There is diffusely abnormal signal within the bone marrow of the rest of the thoracic vertebral column with multiple small foci of enhancement, but no evidence of associated pathological fractures elsewhere in the thoracic spine. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a septated left renal cyst. Lumbar Spine: There is an unchanged compression fracture of the L1 vertebral body with circumferential cortical step offs and cleft without significant spinal stenosis or neural foraminal compromise. There is unchanged compression fracture of L2 vertebrae with considerable loss of height and approximately 5 mm of retropulsion of the posterior vertebral body as well as contiguous disc material into the spinal canal with focal kyphotic angulation, but no significant spinal stenosis or neural foraminal compromise. The other lumbar vertebrae display heterogeneous signal characteristics, but no evidence of pathologic fracture. There is mild multilevel degenerative spondylosis in the lower lumbar spine and mild lumbosacral epidural lipomatosis without significant spinal stenosis or neural foraminal compromise.

Output: Diffuse involvement of the imaged axial skeleton by multiple myeloma with no significant change in the pathological fractures affecting the T12, L1, and L2 vertebrae, but no evidence of spinal cord or cauda equina compression.


Instruction: Generate impression based on findings.

Input: History of breast cancer in mother diagnosed at the age of 42, maternal aunt diagnosed at the age of 62 and maternal grandmother diagnosed at the age of 62. Patient took tamoxifen. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally. A subcentimeter oval mass seen only on the T2 weighted images at the 9 o'clock position of the right breast is stable. This lesion does not demonstrate contrast enhancement.No abnormal areas of enhancement or uniquely enhancing foci are seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 39 year old female. Pain. Evaluate for meniscal tear. MENISCI: The body of the lateral meniscus is markedly attenuated and deformed compatible with extensive tearing assuming no prior meniscectomy. There is also less severe deformity and attenuation of the posterior horn of the lateral meniscus with intrasubstance signal in the posterior and anterior horns contacting the tibial articular surface suggesting additional tearing. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is near full thickness degeneration of the articular cartilage of the lateral tibial plateau beneath the posterior horn of the lateral meniscus. There is moderate thinning of the articular cartilage of the lateral femoral condyle above the posterior horn of the lateral meniscus. Additional focal degeneration along the far posterior cartilage of the lateral femoral condyle is noted.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Lateral meniscal tear, lateral compartment chondral degeneration, and ossified loose body, as described above.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for any change in side branch IPMN seen on last MRI History: IPMN. ABDOMEN: Slightly limited examination due to motion artifact on multiple sequences.LIVER, BILIARY TRACT: Left hepatic cyst.SPLEEN: Atrophy of the body and tail of the pancreas. Cystic lesion in the distal pancreatic body measuring up to 6 mm is unchanged and may represent a sidebranch IPMN. No pancreatic ductal dilatation.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable 6 mm probable side branch IPMN in the distal pancreatic body. No new lesions.


Instruction: Generate impression based on findings.

Input: CERVICAL: There is minimal 1 mm retrolisthesis of C3 on C4, C4 on C5 and C5 on C6. The osseous marrow is diffusely low on T1 and heterogeneous without associated STIR signal abnormality or enhancement. The vertebral body heights are intact. There is loss of T2 intervertebral disk signal especially at all levels from desiccation. The spinal cord signal is within normal limits. There is no suspicious enhancement.C2-3: Tiny central disk osteophyte complex with no spinal stenosis.C3-4: Small disk osteophyte complex and right uncovertebral hypertrophy with mild spinal canal and right neural foraminal stenosis.C4-5: Posterior disk osteophyte complex causing mild spinal canal stenosis no significant neural foraminal stenosis.C5-6: Disk osteophyte complex, ligamenta flava thickening causing mild spinal canal stenosis. Bilateral uncovertebral hypertrophy causing moderate left and mild right neural foraminal stenosis.C6-7: Small disk osteophyte complex with no spinal stenosis.C7-T1: Small posterior disk osteophyte complex with no spinal stenosis.THORACIC: There is mild motion degradation of some sequences limiting evaluation. There is normal alignment of the thoracic spine. The osseous marrow is diffusely low on T1 and heterogeneous without associated STIR signal abnormality or enhancement. There is loss of T2 signal in multiple thoracic disks from desiccation. The cord signal is within normal limits. There is no suspicious enhancement.There is no significant disk herniation, or spinal stenosis in the thoracic spine.LUMBAR: There is bilateral L4-5 facet facet edema extending into the pedicles, and small facet joint effusions with mild regional enhancement felt to be reactive from facet arthropathy. Elsewhere, the osseous marrow is diffusely low on T1 and heterogeneous without associated STIR signal abnormality or enhancement.The S1 vertebral body is lumbarized with the last well formed disk space being at S1-2. There is exaggerated lumbar lordosis. There is minimal grade 1 anterolisthesis of L4 on L5. The conus terminates at L2, within normal limits. The conus shows normal signal. There is heterogeneous the osseous marrow the sacrum in the bilateral iliac bones. T12-L1: No spinal stenosis or disk herniation.L1-2: No disk herniation or spinal stenosis.L2-3: Mild disk bulge and facet arthropathy with no significant spinal stenosis.L3-4: Mild disk bulge, ligamenta flava thickening and and facet arthropathy with mild right neural foraminal stenosis and no significant left neural foraminal stenosis and mild spinal canal stenosis.L4-5: Diffuse disk bulge asymmetric of the right, moderate bilateral facet arthropathy with small joint effusions, edema in the facets extending to the pedicles and regional enhancement. Mild/moderate bilateral neural foraminal stenosis and moderate spinal canal stenosis.L5-S1: Diffuse disk bulge, bilateral facet arthropathy and ligamenta flava thickening causing mild bilateral neural foraminal stenosis. No spinal canal stenosis.

Output: 1.No definite cord lesion or suspicious enhancement.2.Multilevel lumbar spondylosis with advanced L4-5 degenerative facetitis with small bilateral L4-5 facet effusions, reactive facet marrow edema and enhancement, all felt to be secondary to the patient's facet arthropathy at this level.3.Multilevel cervical spondylosis.4.Heterogeneous and low T1 osseous marrow signal, but without associated STIR signal abnormality or enhancement. This is felt to be a benign process, most likely related to anemia of any etiology or chronic smoking.


Instruction: Generate impression based on findings.

Input: 25-year-old female with FAI, evaluate for labral tear ACETABULAR LABRUM: Increased signal is seen within the anterior superior labrum at the 2:00 position, consistent with a tear.ARTICULAR CARTILAGE AND BONE: Articular cartilage is intact. No abnormal marrow signal. Alpha angle measures 48 degreesSOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Anterior superior labral tear at the 2:00 position.


Instruction: Generate impression based on findings.

Input: 36 year-old female with hematuria. Rule out renal stone. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There are numerous hepatic hypodensities of varying size, most likely cysts. In comparison with a 2006 examination, these appear larger and more numerous. If there is suspicion for a neoplasm with hypodense metastases, dedicated CT or MRI examination of the liver could be obtained. Layering density in the gallbladder suggests sludge.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No definite evidence of obstructing renal stone. No radiodense renal calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Constipation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No acute abnormality to explain hematuria. Enlarging liver cysts. Gallbladder sludge.


Instruction: Generate impression based on findings.

Input: cerebral vascular accident. Lung cancer. Possible metastases There is encephalomalacia present involving the right basal ganglia and much of the right middle cerebral artery territory including predominantly frontal lobe and parietal lobe. There is associated ex vacuo effect on the right lateral ventricle. There is susceptibility effect present in the region of the right basal ganglia and in the region of the right frontal and parietal lobes. There is loss of volume and associated signal change along the right thalamus, right cerebral peduncle and right pons.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There are serpiginous foci of enhancement present in the right hemisphere which are suspected to represent slow flow in the territory of cerebral infarction.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 left vertebral artery is larger than the right vertebral artery. There appears to be fetal origin of the right posterior cerebral artery and a small right A1 segment.The visualized portions of the paranasal sinuses demonstrate opacification of the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.In general the marrow signal is low in intensity but does not appear to enhance.

Output: 1.Findings are compatible with an old right middle cerebral artery territory cerebral infarction. There is associated Wallerian degeneration.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.There is no evidence for brain metastases.4.Examination is degraded by patient motion. This may obscure more subtle abnormalities such as a small metastasis.5.Low marrow signal is a nonspecific finding which can be seen with chronic disease as well as many other entities including myeloproliferative disorder, lymphoproliferative disorder or anemia.


Instruction: Generate impression based on findings.

Input: 51-year-old male with HCV cirrhosis and HCC status post TACE/RFA ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. There is a segment five and segment eight ablation cavity. There is intrinsic T1 and susceptibility artifact within the segment five lesion compatible with postablation changes, appearing similar to the prior exam. Intrinsic T1 hyperintensity is also noted within the segment seven ablation cavity. Re-demonstrated is nodular enhancement along the anterior superior margin of the segment seven of the ablation cavity that is not significantly changed when compared to the prior exam and possibly represents focal perfusion defect.No new suspicious arterial enhancing lesion is identified. There is an intrinsic T1 hyperintense focus in hepatic segment six, immediately posterior to the right hepatic vein (series 13, image 64) without arterial enhancement although there is questionable washout on postcontrast images (series 14, image 254). Additional intrinsic T1 hyperintense focus in hepatic segment four (series 13, image 73) without arterial enhancement may represent a siderotic nodule.Hepatic steatosis is present. Status post cholecystectomy.SPLEEN: Top normal splenic size. Splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts are unchanged.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.No evidence of recurrent or residual disease within the segment five ablation cavity.2.Redemonstration of faint nodular enhancement along the segment 7 ablation cavity without definite washout on delayed sequence. Findings favor a focal perfusion defect. Attention on subsequent imaging is suggested.3.Indeterminant intrinsic T1 hyperintense focus in hepatic segment 6 without arterial enhancement although questionable washout on postcontrast sequence. Findings do not meet criteria for HCC although attention on subsequent surveillance imaging is suggested.


Instruction: Generate impression based on findings.

Input: headache, lymphosarcoma (200.10) follow up Orbit MRI:The left intraorbital optic nerve demonstrate patch intermittent enhancement on post gadolinium imaging associated with about 5 to 6 mm thickening of optic nerve itself. These findings do not show any significant interval change since prior scan.Previously noted pre chiasmatic enhancing lesions (best seen on axial post-Gad images) within the optic canal bilaterally are also similar or slightly decreased since prior scan. However, cisternal segment of prechiasmatic bilateral optic nerves and chiasmatic enhancement are not definitely demonstrated on this scan. Thus, indicating interval improvement.The degree of proptosis appears to be stable.Brain MRI:No evidence of acute ischemic or hemorrhagic lesion on this scan.Linear high signal intensities on bilateral superior frontal gyrus on DWI are likely represent T2 shine through from superior frontal sulcus or an artifacts.There is no other abnormal enhancement except seen on orbit MRI on this scan. The ventricles, sulci and cisterns are symmetric and unremarkable.There is no edema, midline shift, intra- or extra-axial fluid collection, hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Opacifications and mucosal thickenings on the bilateral maxillary sinuses, ethmoid sinus and sphenoid sinus, left maxillary sinus opacification appears to be slightly improved but grossly there is no significant interval change since prior exam.

Output: 1. Interval improvement of pre-chiasmatic optic nerve (cisternal segment before it enters optic canal) and chiasmatic lesion since prior exam.2. No significant interval change of bilateral intra orbital optic nerve enhancement as well as the degree of the thickening of the left optic nerve since prior exam.3. No evidence of acute ischemic or hemorrhagic lesion.4. No abnormal enhancement on brain MRI except lesions seen on orbit MRI. 5. Pansinusitis, as described above.


Instruction: Generate impression based on findings.

Input: Rule out tethered cord: new onset urinary incontinence. There is lack of the usual cervical lordosis. The vertebral column alignment is otherwise 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 or neural foramen stenosis. The spinal cord displays normal signal and morphology. The conus medullaris is positioned at the L1 level. The paravertebral soft tissues are unremarkable.

Output: No evidence of spinal canal stenosis of low-lying conus medullaris


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:3/2/1944)Reason: mass? stroke? History: choreaPROVIDER/ATTENDING NAME: CHRISTINE A. BABCOCK Small focus of diffusion restriction is present along the left basal ganglia.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense lesions basal ganglia and brainstem.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.The visualized portions of the cervical spinal canal or small. There is an MRI from 2/5/2016 which demonstrates a small cervical spinal canal associated degenerative changes.

Output: 1.Findings are compatible with acute or subacute lacunar infarct in the left basal ganglia.2.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 3.Findings are suspicious for possible spinal stenosis ovale current exam. Please correlate with patient's clinical symptoms.


Instruction: Generate impression based on findings.

Input: Metstatic lung cancer treated with WBRT, Erlotinib, and MPDL3280A. There an unchanged enhancing lesion in the right cerebellar hemisphere that measures 2 x 2 mm. There is encephalomalacia within the left gyrus rectus. There is also a chronic lacunar infarct in the left basal ganglia with hemosiderin deposition. There are a few scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute intracranial hemorrhage or acute infarction. There is a an unchanged enhancing extra-axial lesion along the left anterior clinoid process region. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is metal susceptibility effect in the left frontal calvarium.

Output: 1. Unchanged punctate metastasis in the right cerebellar hemisphere.2. Unchanged paraclinoid lesion may represent a meningioma.3. Encephalomalacia in the left gyrus rectus.


Instruction: Generate impression based on findings.

Input: Brain MRI:There are a few scattered foci of T2 hyperintensity within the periventricular and subcortical 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. A mucous retention cyst with inspissated secretions is present in the left maxillary sinus. Otherwise the paranasal sinuses and mastoid air cells are clear. Cervical and lumbar spine MRI:There is diffuse heterogeneity of the cervical and lumbar spine marrow appearing predominantly more hypointense on T1 than expected for patient age, however without corresponding worrisome lesions with sagittal STIR technique.Cervical spine MRI:Alignment is anatomic. There are no fractures or subluxations. 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. A tracheostomy is in place.C2/3: UnremarkableC3/4: UnremarkableC4/5: Minimal posterior osteophyte disc complex without stenosis.C5/6: Mild posterior osteophyte disc complex and bilateral uncinate hypertrophy without stenosis.C6/7: Minimal posterior osteophyte disc complex without stenosis.C7/T1: UnremarkableLumbar spine MRI:Transitional anatomy is present with partial sacralization of L5 including bilateral pseudoarticulations.Alignment is anatomic. There are no fractures or subluxations. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: UnremarkableL1/2: UnremarkableL2/3: Mild disc bulge without stenosisL3/4: Mild disc bulge without stenosisL4/5: Mild disc bulge without stenosisL5/S1:Mild disc bulge without stenosis

Output: 1.Mild chronic small vessel ischemic disease of the brain.2.There is diffuse heterogeneity of the cervical and lumbar spine marrow appearing predominantly more hypointense on T1 than expected for patient age, however without corresponding worrisome lesions with sagittal STIR technique. This is a nonspecific benign appearance and the differential diagnosis would most likely include anemia of any cause and/or chronic smoking.3.Minimal to mild degenerative changes throughout the cervical and lumbar spine without significant associated stenosis.


Instruction: Generate impression based on findings.

Input: 62-year-old male patient with neck pain and bilateral shoulder pain. Evaluate for cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. There are mild multilevel degenerative changes of the cervical, including a posterior disc-osteophyte complex at C4/C5. There are partially imaged lung masses and a left thyroid nodule, which are better evaluated on prior CT soft tissue neck and chest.

Output: 1. 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. No cord compression is identified.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.2. Mild degenerative changes of the cervical spine.3. Partially imaged lung masses are better evaluated on prior chest CT.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: preop planning for crani for tumorSigns and Symptoms: preop planning There is a mass measuring 19 x 23 mm sagittal dimensions and 17 x 17 mm axial dimensions located along the right occipital pole. It is associated with a vasogenic pattern of edema.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the in the right maxillary sinus into a lesser degree ethmoid air cells. There is some opacification of the left petrous apex. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: A mass in the right occipital lobe is suspicious for metastatic disease.


Instruction: Generate impression based on findings.

Input: Stage III C melanoma status post re-do right radical axillary lymph node dissection with excision of separate subcutaneous nodule of the right proximal upper extremity on 10/26/15 for metastatic melanoma, rule out brain metastasis. There is no evidence of intracranial mass, hemorrhage or acute infarct. There is no abnormal intracranial enhancement. There is patchy and confluent and intracerebral white matter T2 hyperintensity which may be nonspecific, but most compatible with small vessel ischemic changes. There is mild global parenchymal loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening in the bilateral maxillary sinuses. There is trace fluid in the bilateral mastoid air cells. The orbits, skull and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastasis.2. Chronic small vessel ischemic changes, but no evidence of acute infarction.


Instruction: Generate impression based on findings.

Input: 61-year-old male with h/o glioblastoma presents with weakness. Evaluate for intracranial bleed. There is no evidence of intracranial hemorrhage, mass, or edema. Post-surgical changes of a right-sided craniotomy and right temporal resection with encephalomalacia are similar to prior. Extensive confluent hypoattenuation involving primarily the white matter of the right cerebral hemisphere is similar to prior. Based on recent MRI findings, this is compatible with post-radiation changes.Hypoattenuating lesions in the left thalamus is seen on prior MRI and is compatible with lacunar infarct. It demonstrates increased hypodensity, compatible with expected evolutional changes. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial hemorrhage. Evolutionary change of lacunar infarct at left thalamus. Post-surgical and post-treatment changes similar to prior.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, with fatigue, gait disorder, and previous abnormal MRI. Redemonstrated are numerous small foci of T2 hyperintensity and T1 hypointensity, ranging in size from punctate up to about 5 mm, identified within the bilateral deep and subcortical cerebral white matter. There is also a larger curvilinear focus of T2 hyperintensity involving the cortex and subcortical white matter of the right frontal operculum. Of note, no lesions are seen within the corpus callosum and there are no infratentorial lesions. These lesions are unchanged and there are no definite new lesions. Postcontrast images demonstrate no evidence of pathologic parenchymal or extra-axial enhancement. Brain morphology is otherwise unremarkable. No mass-effect or parenchymal edema is detected. No abnormal fluid collections are seen. The ventricles are normal in size and morphology.

Output: Stable appearing scattered small foci of signal abnormality are identified in the bilateral cerebral white matter with one larger lesion also involving the cortex of the right frontal operculum. None of the lesions demonstrates contrast enhancement. The corpus callosum and posterior fossa are spared. There are no definite new lesions.


Instruction: Generate impression based on findings.

Input: Male, 43 years old, history of T4 N0 nasopharyngeal adenoid cystic carcinoma status post chemoradiation. T2 hyperintense, mildly enhancing soft tissue centered along the floor of the left sphenoid sinus has not significant changed from the prior exam (see image 16 series 4). Also stable is mild infiltrative T2 hyperintensity and very subtle ill-defined enhancement involving the left nasopharynx, left parapharyngeal space, questionably the left carotid space, and the left prevertebral soft tissues. No new or growing lesions are seen. No evidence of pathologic adenopathy is detected in the neck by size criteria. The salivary glands and thyroid are unremarkable. Thickening along the left middle nasal turbinate and the overlying left ethmoid air cells is similar to prior. The paranasal sinuses are otherwise unremarkable. The left mastoid air cells remain completely opacified and there is persistent soft tissue thickening and subtle enhancement along the left carotid canal and the expected location of the Eustachian tube. Limited intracranial views demonstrate no significant abnormality.

Output: 1.Stable soft tissue thickening along the floor of the left sphenoid sinus.2.Stable ill-defined signal abnormality and vague enhancement involving the left nasopharyngeal, parapharyngeal and prevertebral spaces which may reflect treated infiltrative tumor.3.Persistent opacification of the left mastoid air cells.4.No pathologic adenopathy is detected in the neck.


Instruction: Generate impression based on findings.

Input: 55 years old, Female, Reason: hyperpara localization History: hyprepara biochemically RIGHT LOBE MEASUREMENTS: 4.9 by 1.7 x 1.4 cmLEFT LOBE MEASUREMENTS: 4.3 by 1.2 x 1.1 cm.ISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: The inferior pole of the right thyroid lobe is a solid appearing nodule with internal vascularity and hypoechoic rim which is isoechoic to normal thyroid tissue measuring 0.8 x 0.4 x 0.5 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No parathyroid adenoma or hyperplasia identified on this exam.LYMPH NODES: Multiple benign appearing lymph nodes are identified bilaterally.OTHER: No significant abnormality noted.

Output: 1.No evidence of parathyroid adenoma or parathyroid hyperplasia.2.Subcentimeter solid right thyroid nodule.


Instruction: Generate impression based on findings.

Input: Intractable seizure. Localization-related focal partial seen in peptic syndrome with complex partial seizures Re-demonstration of the left frontal lobe middle and inferior gyri tissue loss with multiple lobulated cystic lesions which occupying the volume. The cystic lesions appear to be lined with brain tissue likely grey matter. In addition, underlying brain tissues of the cystic lesions show linear high signal intensity indicating gliosis. Therefore, most likely diagnosis of these lesions would be post-ischemic stroke porencephalic cyst. However, the communication of these cystic lesion with subarachnoid space cannot be confirmed with this MR scan.Comparing to prior MR images, the size of cystic lesions do not show any significant interval change since prior exam.Left inferior frontal gyrus and possibly inferior aspect of the left post central gyrus appear are not clearly identified but replaced with CSF spaces. The extent and morphology do not show any significant interval change since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Extensive left inferior frontal gyrus and inferior aspect of the left post central gyrus tissue loss with possible Porencephalic cyst formation with gliotic changes, no interval change since prior scan.2. Otherwise no remarkable finding.


Instruction: Generate impression based on findings.

Input: Cortical/subcortical foci of T2 hyperintensity are present in bilateral cerebral hemispheres, the pons, the right dorsal brainstem, and bilateral cerebellum. There is some associated restricted diffusion within cortical watershed areas, in conjunction with with these aforementioned T2 hyperintense abnormalities.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. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Scattered fluid can be found throughout the paranasal sinuses and mastoid air cells, likely secondary to the patient's intubated status. There is no abnormal enhancement within the brain.

Output: The constellation of MRI abnormalities found within both the supratentorial and infratentorial brain are most consistent with posterior reversible encephalopathy syndrome (PRES). Differential considerations include postictal seizure foci with ischemia considered less likely.


Instruction: Generate impression based on findings.

Input: Dedicated images through the sella demonstrate a nonenhancing teardrop shaped CSF signal intensity lesion within the left aspect of the pituitary gland, with associated osseous remodeling of the sella, corresponding to previous questioned abnormality. There appears be normal enhancing pituitary tissue superior to the margin of the cyst. Overall, size and contour appear similar to prior MRI of the spine from 2011. The cyst does abut the medial margin of the cavernous left internal carotid artery without encasement. The cyst measures 0.9 cm transverse x 1.0 cm AP centimeter AP x 0.9 cm CC.There is no other focal abnormal signal intensity or mass is seen within the enhancing pituitary tissue. The pituitary stalk essentially lies in the midline. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.Remainder of the visualized intracranial structures are grossly unremarkable. There is partial opacification of the left sphenoid sinus, similar to previous MR.

Output: Likely incidental chronic finding of nonenhancing CSF signal intensity intrasellar cyst which involves the left aspect of the sella with associated bony remodeling and abutment of the cavernous left internal carotid artery. This is grossly unchanged since 2011. The pituitary tissue appears to have a claw sign around the cyst, and therefore this may represent a nonneoplastic pituitary cyst, less likely felt to relate to a cystic pituitary microadenoma. Given its location and T2 appearance, pars intermedia cyst is felt to be unlikely. There is no associated soft tissue nodularity to suggest craniopharyngioma.


Instruction: Generate impression based on findings.

Input: Reason: multiple ligament damage History: concern for ACL/MCL/possible PCL on exam MENISCI: The medial and lateral menisci are normal in appearance.ARTICULAR CARTILAGE AND BONE: There is a bone contusion of the lateral tibial plateau. Bone marrow signal intensity is otherwise normal. Reticular cartilage of the knee appears normal.LIGAMENTS: There is a tear of the anterior cruciate ligament. The posterior cruciate ligament appears intact. The medial collateral ligament and lateral collateral ligament complex appear intact.EXTENSOR MECHANISM: The quadriceps tendon and patellar tendon appear intact.ADDITIONAL

Output: 1. ACL tear2. Bone contusion of the lateral tibial plateau


Instruction: Generate impression based on findings.

Input: Female 59 years old Reason: Fall 6 weeks ago, evaluate for rotator cuff tear vs biceps tear History: left shoulder pain. ROTATOR CUFF: There is mild increased signal intensity within the supraspinatus and infraspinatus tendons suggesting mild tendinosis. There is also focal increased signal intensity replacing the bursal surface fibers of the posterior supraspinatus/anterior infraspinatus indicating fraying and/or low-grade bursal surface tearing. We see no full-thickness rotator cuff tear. The supraspinatus and infraspinatus muscles appear normal. The teres minor tendon and muscle appear normal. The subscapularis tendon and muscle appear normal.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint. No frank fluid is seen within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small amount of fluid within the glenohumeral joint, but no large effusion. The glenohumeral joint alignment is within normal limits. Increased signal intensity within the glenoid labrum is suggestive of mild degeneration, but we see no labral detachment or fluid-filled tear. Small cysts are seen in the posterior aspect of the humeral head.BICEPS TENDON: The tendon of long head of the biceps appears intact.

Output: 1.Mild focal bursal surface fraying/low-grade partial thickness tearing of the rotator cuff as described above. We see no full-thickness tear.2.Acromioclavicular joint osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: History of cerebellopontine angle meningioma status post surgical resection and radiotherapy. Follow-up exam. There are postsurgical findings related to right suboccipital craniotomy and resection of the right cerebellopontine angle meningioma. There is unchanged mild dural enhancement along the posterior aspect of the right petrous apex, as well as minimal patchy enhancement in the right cerebellar hemisphere, but no discernible residual mass lesion is identified. There is persistent flattening of the right cerebellar hemisphere. There is mild patchy periventricular and subcortical white matter T2 hyperintensities and a chronic right corona radiata lacunar infarct, but no acute ischemic infarct. There is a left parietal developmental venous anomaly. The ventricles and basal cisterns are stable in size and configuration. There is trace fluid in the mastoid air cells.

Output: Stable postsurgical findings related to prior surgical resection of a right cerebellopontine angle meningioma without gross residual or recurrent tumor.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Relapsed neuroblastoma treated with 4 cycles chemotherapy. Orbits: The lobulated heterogeneous mass arising from the left lateral orbital wall has not significantly changed in size, measuring up to approximately 3.0 cm, previously also approximately 3.0 cm, with slide left lateral extraconal space and bulging into the left masticator space via subperiosteal extension, but no significant mass effect upon the intraorbital contents. The right orbit is unremarkable.Brain: There are postoperative findings related to left pterional craniotomy. There is persistent diffuse enhancement within the left foramen rotundum. There is no discernible tumor within the cavernous sinuses or Meckel caves. Aside from the minimal epidural extension of tumor associated with the left lateral orbital wall tumor, no other intracranial tumors are apparent. There is no evidence of intracranial hemorrhage or acute infarct. There is mild mega cisterna magna. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift. There is diffuse paranasal sinus mucosal thickening and secretions. There is fluid and mucosal enhancement within the bilateral middle ears and mastoid air cells.

Output: 1. No significant interval change in size of tumor arising from the left lateral wall of the orbit.2. Persistent diffuse enhancement within the left foramen rotundum, which may represent the residual of treated perineural tumor.3. Diffuse paranasal sinus mucosal thickening and secretions.4. Persistent fluid within the bilateral middle ears and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Osteomyelitis There is diffuse soft tissue edema and inflammation of the radial portion of the hand and entirety of the thumb. There is T1/high T2 signal of the distal phalanx of the thumb consistent with osteomyelitis. Additional areas of increased T2 signal are noted within the proximal phalanx without corresponding T1 signal and this is likely reactive in nature. Although no discrete fluid collection is identified, there is ill-defined peripheral enhancement on the volar portion of the distal phalanx likely representing phlegmonous change. The distal attachment of the flexor tendon is not well seen which may be the result of partial tearing/rupture. The remaining fingers demonstrate normal marrow signal. A small amount of fluid is noted within the first MCP joint.Diffuse edema affects the thenar musculature. The median nerve is also enlarged.

Output: Osteomyelitis of the distal phalanx of the thumb. Although there is no discrete fluid collection, surrounding phlegmonous change tracks into the thenar eminence.


Instruction: Generate impression based on findings.

Input: Numbness and tingling, subcutaneous amyloidosis The marrow signal intensity of the radius and ulna is normal.There is no abnormal enhancement or evidence of a mass lesion following administration of contrast. The soft tissues of the forearm including the subcutaneous fat and musculature demonstrate no signal abnormalities. The visualized portion of the radial nerve is normal.

Output: Normal MRI examination of the forearm.


Instruction: Generate impression based on findings.

Input: 74-year-old male with bilateral quadriceps weakness. Evaluate for nerve impingement. Metallic susceptibility artifact limits evaluation of the right hip and surrounding musculature/soft tissues.Right hip:Metallic susceptibility artifact from a right total hip arthroplasty device limits evaluation. There is a large lobulated focus of fluid signal intensity along the right hip along the lateral margin of the rectus femoris musculature which is incompletely visualized due to metallic susceptibility artifact from the aforementioned right total hip arthroplasty device as well as incompletely characterized on this noncontrast examination, but measures at least 7.8 cm in the craniocaudal dimension and 4.9 cm in the transverse dimension. There is associated partial thickness tearing of the right rectus femoris muscle at the level of the myotendinous junction. The rectus femoris tendon attachment on the anterior inferior iliac spine appears intact. There is atrophy of the right psoas musculature. There is diffuse fatty atrophy of the musculature of the right hip most pronounced within the right gluteus minimus muscle and adductor musculature. Heterogeneous bone marrow may represent residual islands of red marrow.Left hip:There is fatty atrophy of the musculature of the left hip most pronounced within the gluteal musculature. There is nonspecific increased signal abnormality within the rectus femoris and vastus lateralis muscles. The remainder of the imaged musculature of the left hip is normal in appearance. Heterogeneous bone marrow may represent residual islands of red marrow. There is a 14 mm bladder diverticulum along the left posterosuperior bladder.

Output: 1. Postoperative changes of a right total hip arthroplasty with a lobulated fluid collection along the anterior and lateral aspect of the right rectus femoris muscle which is incompletely visualized/characterized due to extensive metallic susceptibility artifact. These findings appear most consistent with hematoma/seroma formation related to partial tearing of the right rectus femoris at the level of the myotendinous junction. Superimposed infection cannot be excluded by this examination.2. Fatty atrophy of the musculature of the hips bilaterally as described above.3. Nonspecific increased signal abnormality within the left rectus femoris and vastus lateralis muscle bellies can be seen in subacute denervation or myositis.


Instruction: Generate impression based on findings.

Input: 73-year-old male patient with cholangiocarcinoma/HCC mixed status post chemotherapy. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: There is hypertrophy of the caudate and left hepatic lobe with deepening of the fissures, suggestive of chronic liver disease.A lesion within segment 5 which demonstrates enhancement and washout on delayed phases is grossly stable in size measuring 4.5 x 4.2 cm (image 149, series 11), previously 4.5 x 4.6 cm. A segment 4A/8 lesion which demonstrates capsular retraction is similar in size to the prior study measuring 4.7 x 2.8 cm (image 34, series 10). This lesion has an enhancing nodular component which demonstrates washout and more peripheral components that demonstrate progressive enhancement.A previously described hypoenhancing segment 4A lesion is smaller in size now only a small focus of T2 hyperintensity without diffusion abnormality. Numerous additional T2 hyperintense lesions throughout both hepatic lobes are stable in size. No new lesion is identified. 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: An enlarged portocaval lymph node has increased in size measuring 3.7 x 2.0 cm (image 26, series 3), previously 3.0 x 1.6 cm. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Grossly stable size of a segment 4A/8 lesion with capsular retraction with imaging findings compatible with HCC and possibly cholangiohepatoma. 2.Grossly stable size of a segment 5 lesion with imaging characteristics of HCC.3.Decreased size of a segment 4A lesion and stable appearing T2 hyperintense hepatic lesions. 4.Enlarging portocaval lymph node.


Instruction: Generate impression based on findings.

Input: MRI Brain:There are multiple cortical/subcortical T2/FLAIR hyperintense lesions without mass effect in the right greater than left frontal lobes and right paramedian parietal lobe. These are not associated with restricted diffusion or contrast enhancement and there is no evidence of intracranial hemorrhage. 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. Mild left sphenoid sinus mucosal thickening.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRV Brain:The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, and internal cerebral veins are patent. There is no evidence of venous thrombosis.

Output: 1.Several cortical/subcortical foci of T2/FLAIR signal abnormality in the right greater than left frontal lobes as well as right paramedian parietal lobe. Findings most likely represent PRES. Alternative etiologies such as encephalitis can be considered in the appropriate clinical setting but seem less likely.2.No evidence of intracranial arterial or venous abnormality.


Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental status, unspecified Unspecified convulsionsClinical question: seizure etiology The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate enhancing focus present in the right putamen of the basal ganglia which is associated with high signal on FLAIR MRI and a punctate hypointensity on susceptibility imaging.There are several punctate foci of hypointensity on susceptibility imaging present within the pons and basal ganglia.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and left 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 right vertebral artery flow-void is not distinct distally.The visualized portions of the paranasal sinuses demonstrate scattered opacities.. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.

Output: 1.There is a punctate enhancing lesion present within the putamen of the right basal ganglia. It is associated with a microhemorrhage. Most likely this is vascular related; it is, however, nonspecific and could be the result of an entity other than a vascular related insult. A follow-up exam would help assess this further.2.There are several punctate microhemorrhages in the brainstem and basal ganglia. Given their distribution most likely these are related to hypertension.3.The right vertebral artery is not identified distally. This could very well be a result of a hypoplastic right vertebral artery


Instruction: Generate impression based on findings.

Input: 83 year old female with right side neck mass. Again identified is a well-defined, heterogeneous soft tissue mass involving the superficial lobe of the right parotid gland. This lesion measures approximately 1.5 x 1.3 cm (image 43 series 3), unchanged. There is mild enhancement of the soft tissue component anteriorly. No definite additional masses are abnormal enhancement. The left parotid, sublingual, and submandibular glands are unremarkable. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. No abnormal lymphadenopathy is noted. Calcified atherosclerosis affects both carotid arteries at the bifurcation, left greater than right. Small hypodense nodules are present within left thyroid gland. The jugular veins are patent. The osseous structures are unremarkable. The prevertebral and paraspinal soft tissues are unremarkable.  The visualized intracranial structures demonstrate ventriculomegaly, unchanged since prior brain MRI. The intraorbital structures are unremarkable. Degenerative changes affect the cervical spine. No suspicious focal osseous lesions are seen. Limited views of the chest are unremarkable.

Output: Stable partially-enhancing right parotid mass. Benign etiology, such as pleomorphic adenoma, is favored.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1] / Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: nerve root compression, bone metastasis. History: History of lung cancer presenting with left leg weakness, urinary retention Cervical Spine MRI:There is normal cervical lordosis. The cranial-cervical junction is normal. Spinal cord signal intensity is normal.Multilevel disc degenerations with disc desiccation on cervical spine including central disc protrusion at the level of C34 C4-5 and diffuse disc bulging C6-7 minimal to mild right side neural foraminal narrowing at the level of C6-7. However, there is no definitive evidence of spinal canal stenosis.There is about 24.8 mm x 29 mm sized soft tissue lesion likely representing lymph node on the right side of thyroid gland.Thoracic Spine MRI:There is about 23mm sized intramedullary lesion with diffuse enhancement at the level of T7-T8 level. There are evidence of spinal cord edema above and below the lesion with cord expansion.There is no evidence of associated syrinx.There is no evidence of hemorrhagic foci within or peripheral aspect of the lesion.Constellation of these findings suggest possible intramedullary spinal metastasis. Differential diagnosis include primary spinal cord lesion such as ependymoma. There is normal thoracic kyphosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. Lumbar Spine MRI:There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved but there are focal bone marrow edema especially anterior aspect of vertebral body at the level of the L2 and L3 which may suggest focal compression fracture without height reduction.At the level of :45 there is disc dessication, decreased disc height and central focal extrusion of disc which compresses thecal sac. In addition, associated, bilateral ligamentum flavum thickening at the level results moderate to severe spinal canal stenosis.The cord signal is normal. The conus medullaris terminates at the level of T12-L1. Again the bladder distention is shown.There is no evidence of abnormal enhancement except focal enhancement surrounding the extruded disc. No evidence of cord compression or mass.

Output: 1. Intramedullary enhancing mass at the level of T7-T8, likely represents intramedullary metastatic lesion with the differential diagnosis include spinal cord ependymoma. 2. Central disc extrusion at the level of L45 with thecal sac compression.3. No evidence of spinal cord compression.4. Multilevel various degree degenerative disc diseases as described above including cervical spine and lumbar spine level.


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial hemorrhage. Signs and symptoms: Headaches, nausea and vomiting Subtle periventricular and subcortical foci of increased signal intensity in bilateral cerebral hemispheres are noted. These findings are no noticeable than prior CT from 6 -- 30 -- 2007. This discrepancy may be due to technique. Similar findings were noted on prior MRI examinations and were believed to represent press. Cortical sulci, ventricular system and all CSF cisterns are otherwise within normal limits and stable since prior study. No evidence of hemorrhage, mass effect, midline shift or hydrocephalus.

Output: Subtle subcortical areas of low-attenuation as detailed above which may represent sequela of prior press.


Instruction: Generate impression based on findings.

Input: Chiari decompression with thoracic syrinx: surveillance. There are postoperative findings related to Chiari decompression. The inferior cerebellar hemispheres extend to the level of the tip of the dens. There is intact cerebrospinal fluid fluid across the anterior neo-foramen magnum, but flow posteriorly appears to be blunted. There also appear to be fine low signal linear strands that extend from the mildly deformed posteroinferior cerebellar hemispheres to the overlying dura. There is interval decrease in caliber of the thoracic syrinx, which now measures up to 2 mm in width. There is mild retroflexion of the dens. The vertebral column alignment is otherwise 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 no evidence of pseudomeningocele.

Output: 1. Postoperative findings related to Chiari decompression with suggestion of adhesion formation between the cerebellum and overlying dura and mild retroflexion the dens.2. Marked interval decrease in size of the thoracic syrinx.