Instruction: Generate impression based on findings.

Input: Status post Chiari decompression on 3/10. Postop follow-up. There are postoperative changes of suboccipital craniectomy and C1 laminectomy with interval increase in CSF spaces in the posterior fossa. Posterior fossa is well decompressed. There is good biphasic CSF flow ventrally and dorsally at the foramen magnum.The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign with T1 hyperintense lesion involving the left aspect of the C7 vertebral body compatible with a small hemangioma. Examination is motion degraded, however, no obvious cord signal abnormality or evidence of syrinx is appreciated. There is T2 hyperintensity in the pons which was present on prior brain MRI and may be related to small vessel ischemic disease.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: Left paracentral disc extrusion with mild craniocaudal extension and associated mild stenosis involving the left aspect of the spinal canal. There is also mild left neural foraminal stenosis. Right neural foramen is patent. Prior imaging demonstrates minimal disc bulge at this level.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Expected postoperative changes of Chiari decompression. Posterior fossa structures are well decompressed with good biphasic CSF flow ventrally and dorsally at the foramen magnum. No appreciable cord signal abnormality or syrinx within the limits of a motion degraded study.2. Mild degenerative changes in the cervical spine including left paracentral disc extrusion at C6-C7 which is new since prior study from 9/29/2015.


Instruction: Generate impression based on findings.

Input: T4aN0 nasal cavity cancer s/p debulking 11/2014. Please eval extent of residual disease in comparison to MRI 1/2015. There are postoperative findings related to interval resection of a sinonasal mass with an subcentimeter enhnacing lesion in the region of the olfactory recesses. There is also persistent slight epidural enhancement in the left olfactory groove. There are residual scattered secretions and mucosal thickening within the paranasal sinuses. There is a dural based lesion along the posterior falx cerebri that measures up to 3 mm in width, which is unchanged. There is diffuse cerebral volume loss. There are bilateral lens implants and staphylomatous deformity of the globes. There is no evidence of tumor extension into the orbits.

Output: 1. Postoperative findings related to resection of a sinonasal mass with an unchanged subcentimeter lesion in the region of the olfactory recesses that appears to have slight epidural extension along the floor of the anterior cranial fossa, which may represent residual tumor.2. A dural based lesion along the posterior falx cerebri that measures up to 3 mm in width is unchanged and may represent a meningioma.


Instruction: Generate impression based on findings.

Input: Myelofibrosis. Enrolled in clinical trial. ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense subcentimeter lesions, compatible with cysts. Atrophy of the right hepatic lobe. Status post cholecystectomy. No biliary ductal dilatation. Chronic portal vein thrombosis with cavernous transformation.SPLEEN: Unchanged marked splenomegaly measuring 25 cm in the craniocaudal dimension. Multiple splenorenal shunts. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys with small cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unchanged splenomegaly.2.Chronic portal vein thrombosis.


Instruction: Generate impression based on findings.

Input: 60 year old female with seizure. Diffuse white matter hypodensity in the left parietal lobe consistent with persistent vasogenic edema that appears increased compared to prior. Mass-effect compresses the posterior horn of the left lateral ventricle and effaces the sulci on the left side. There is a question of a mass within the region of the edema. For further evaluation consider MRI or CT with contrast. Postsurgical changes are noted in the left parietal calvarium.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Increased vasogenic edema in the left parietal lobe. No acute hemorrhage. Postsurgical changes are again noted. Question mass within the edema region. For further evaluation consider MRI or CT with contrast.


Instruction: Generate impression based on findings.

Input: 37-year-old woman with history of Crohn's proctitis and flex sigmoidoscopy showing left colonic inflammation, now with worsening diarrhea. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of small bowel inflammation. Specifically, the terminal ileum appears normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: There is a simple 4.2 cm right ovarian cyst, physiologic in a patient of this age. IUD is noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is circumferential wall thickening involving a length of distal descending colon and sigmoid colon over a length of approximately 30 cm. This segment demonstrates loss of normal haustration, diffusion restriction, and mild enhancement (501/26-61). Of note, the rectal wall appears relatively normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Active inflammation in the distal descending colon and sigmoid with loss of haustration suggestive of prior inflammation. This is nonspecific but could represent inflammatory bowel disease or infectious colitis.2.Rectum relatively spared of inflammatory change.3.Terminal ileum normal in appearance.


Instruction: Generate impression based on findings.

Input: 31-year-old female. Difficulty with penetration, husband only able to enter 1 to 2 inches and then something blocks the way, transverse vaginal septum. Evaluate for pelvic organ anomaly. Evaluate urinary tract for anomaly. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cyst. Kidneys are normal in morphology and symmetric in size and enhancement. No renal anomalies are evident. The ureters are not well-opacified on post-contrast sequences and therefore not visualized; however, given lack of a renal anomaly, the likelihood of a ureteral anomaly is low.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.PELVIS:UTERUS, ADNEXA: Retroverted uterus. No uterine masses. No uterine anomaly is identified. Small follicles in the ovaries, which are normal in size and appearance. The vagina is collapsed. No vaginal dilatation to suggest a completely obstructing septum. Small 5 mm cyst at the midline posterior aspect of the upper vagina. BLADDER: No significant abnormality noted.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.Retroverted uterus. No uterine anomaly is evident.2.No vaginal dilatation to suggest a completely obstructing septum. Collapsed state of vagina makes it difficult to evaluate for a partial septum.3.No renal anomalies. Ureters are not well-visualized; however, given the lack of renal anomaly, the likelihood of a ureteral anomaly is low.


Instruction: Generate impression based on findings.

Input: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The left A1 segment is hypoplastic with bilateral A2 segments being supplied by the right A1; this finding is a normal variant. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. Anterior communicating artery is patent. Right posterior communicating artery is patent. Left posterior communicating artery is not definitively seen.MRV HEAD

Output: There is no significant stenosis in the intracranial vasculature. Neck MRA and brain MRV are suboptimal without contrast; there is however no evidence of venous sinus thrombosis or stenosis in the vasculature in the neck.


Instruction: Generate impression based on findings.

Input: 25 years Male (DOB:4/14/1991)Reason: low back pain History: low back pain leg painPROVIDER/ATTENDING NAME: JAVAD HEKMATPANAH HILLARY M HECKTMAN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is minimal disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

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


Instruction: Generate impression based on findings.

Input: 19 year-old male with headache, sudden onset. Evaluate for intracranial hemorrhage. Electronic medical records provided history of sickle cell disease. There is no evidence of intracranial hemorrhage, mass or edema. A single focus of low attenuation is present along the anterior aspect of the left frontal horn which represents a focus of encephalomalacia. This is present on prior CT and MRI examinations compatible with a focus of encephalomalacia most likely secondary to sequela of sickle cell disease and appears unchanged. No new foci are appreciated.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 abnormalities.


Instruction: Generate impression based on findings.

Input: 74-year-old male with HCC. ABDOMEN:LIVER, BILIARY TRACT: Cluster of T2 hyperintense foci surrounding the left portal vein (coronal series 5 image 15, axial series 8 image 60) are unchanged and suggestive of peribiliary cysts. Nonenhancing posttreatment effect of the right hepatic lobe and left lateral segment (series 12 image 292) ablation cavities are unchanged. Precontrast T1 hyperintense signal of both ablation cavities (series 1100 image 81) could represent residual blood products. Perfusional changes surrounding both cavities are noted only on the arterial phase. No suspicious lesions showing arterial hyperenhancement or washout are identified to suggest residual or recurrent tumor. SPLEEN: No significant abnormality noted.PANCREAS: Normal bright T1 signal intensity of the pancreatic parenchyma. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable simple cyst of the right lower renal pole. Additional bilateral subcentimeter T2 hyperintensities are too small to characterize, favor cystic.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Sternotomy wires are partially visualized.

Output: 1.Ablation cavities of the hepatic dome and left lateral hepatic segment. No evidence of residual or recurrent tumor.2.Small T2 hyperintense foci surrounding the left portal vein are suggestive of peribiliary cysts.


Instruction: Generate impression based on findings.

Input: 31 year old female with known multiple fibroadenomata presents for silicone implant evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.Retropectoral silicone implant is present in both breast. No implant rupture or herniation is seen.No abnormal silicone signal is present in either breast.There are multiple circumscribed, slowly enhancing oval masses in both breasts, consistent with fibroadenomata (more left than in right).No suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy or implant rupture. Multiple fibroadenomata. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Spinal metastatic disease. EMG with diffuse muscle denervation consistent with spinal disease. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is in the lumbar spine is benign without abnormal enhancement or suspicious lesions to suggest metastatic disease in the lumbar spine. No evidence of epidural tumor or abnormal leptomeningeal enhancement along the cauda equina. The conus medullaris is normal in position.Multilevel degenerative changes are again seen as seen on recent study from 9/29/2015 including moderate disc height loss at L5-S1. Individual levels as below:L1-2: No significant spinal canal or neuroforaminal stenosis. L2-3: Minimal bilateral foraminal disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Minimal bilateral foraminal disc bulge. No significant spinal canal stenosis. Mild to moderate right and mild left foraminal narrowing. L4-5: Severe right and moderate left facet hypertrophy. Mild ligamentum flavum thickening. Bulging disc with small superimposed left paracentral and right foraminal protrusions. Mild spinal canal narrowing involving the lateral aspects of the thecal sac. Moderate right foraminal narrowing. Minimal left neural foraminal narrowing.L5-S1: Moderate bilateral facet hypertrophy. Mild bulging disc. No significant spinal canal stenosis. Severe bilateral foraminal narrowing worse on the left and the right.Mild enhancement is seen in the posterior paraspinous soft tissues at the L3-L4 level which may be related to recent lumbar puncture. Known pelvic tumor recurrence better seen on recent CT.

Output: 1. No evidence of metastatic disease in the lumbar spine.2. Degenerative changes in the lumbar spine as above including severe bilateral L5-S1 neural foraminal stenosis and lesser degree of neural foraminal stenoses at right L3-L4 and L4-L5 levels. No high-grade spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of cerebral meningesClinical question: h/o right atypical meningoma s/p resection; now with recurrenceSigns and Symptoms: preop planning There is a large extra-axial mass which extends from the right cerebellar medullary angle cistern, the right cerebellopontine angle cistern over the right petrous bone into the right cavernous sinus and into the right half of the suprasellar cistern, the right sella into the sphenoid sinus through the right foramen rotundum and right foramen ovale into the infratemporal fossa. In the posterior fossa it extends into the right internal auditory canal and through the right hypoglossal canal and surrounds the right carotid artery at the C1 and C2 levels. It appears to also extend into the petrous portion of the right carotid canal. It displaces the right cerebellar hemisphere posteriorly and displaces the brainstem towards the left and distorts it. It compresses the right temporal lobe infiltrates the entire right cavernous sinus and pituitary fossa and encases the right internal carotid artery. It displaces the right optic nerve superiorly and medially and displaces the optic tract and partially surrounds the right optic nerve along its cisternal portion and enters into the right orbital apex. It also insinuates itself into the right sylvian fissure. It surrounds some of the right middle cerebral artery vasculature. It extends into the right ambient cistern suspected to be encasing the nerves and vasculature in that location. It is associated with midline shift shift of the third ventricle approximately 8 mm to the left of midlineThere is associated signal change in the right temporal lobe and the right cerebellar hemisphere.The flow-void of the right jugular vein is not identified.There is opacification of the right mastoid air cells.

Output: 1.There is a large extra-axial mass which surrounds the right temporal bone fills much of the right middle cranial fossa and extends through the neural foramina and the posterior fossa on the right side as well as the right skull base, extends into the cavernous sinus and surrounds the right internal carotid artery along its distal cervical, petrous segment and cavernous and supraclinoid segments. It also extends into the right orbital apex and displaces and partially surrounds the right optic nerve. It is also insinuates itself into the right sylvian fissure and surrounds some of the middle cerebral artery branches. It compresses the right temporal lobe and compresses the insula and deep gray nuclei and is associated with midline shift. It also occupies the pituitary fossa some of the foramina that are involved include the right jugular foramen, right hypoglossal canal, right internal auditory canal, right foramen rotundum, right foramen ovale, right carotid canal, right orbital apex. Extracranially extends into the right infratemporal fossa and the right carotid space as well as the right orbit and the sphenoid sinus. It also peeled 6 to infiltrate the right skull base and the right temporal bone. The right jugular vein may be occluded2.This is a limited exam for stereotactic guidance


Instruction: Generate impression based on findings.

Input: Reason: eval for changes in hemorrhagic enhancing lesions of uncertain etiology. Prior LP was negative. Pt w/ NSCLC. History: abnml brain MRI.. Multiple enhancing supratentorial and infratentorial metastases, some with increased intrinsic T1 signal, have overall progressed. Lesion in the right paracentral lobule measures 1.0 cm (1101/22), previously 0.9 cm. Lesion in the right inferior frontal gyrus measures 0.8 cm, unchanged. Lesion in the right periatrial white matter measures 0.9 x 0.7 cm, previously 0.7 x 0.6 cm. Multiple additional lesions, including lesions in the right frontal lobe and left occipital lobe are slightly increased in size. Gyriform enhancement along the right temporal lobe is also increased and likely reflects leptomeningeal disease. Scattered foci of susceptibility corresponding to lesions are compatible with blood products, some of which are slightly increased. No significant mass effect or edema from these lesions.A few scattered punctate periventricular and subcortical T2 hyperintensities are unchanged. 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: Mild enlargement of multiple small supra- and infratentorial hemorrhagic enhancing lesions consistent with metastases. Evidence of leptomeningeal disease again noted. No significant edema, mass effect, or herniation.


Instruction: Generate impression based on findings.

Input: 66 year old man with history of hypertension, diabetes and recently diagnosed non-ischemic cardiomyopathy, referred for cardiac MRI for evaluation of possible etiologies. Left VentricleThe left ventricle is severely dilated with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 148 ml/m2 (normal range: 74+/-15), the LVEDV is 256 ml (normal range 142+/-34), the LV end systolic volume index is 68 ml/m2 (normal range 25+/-9), the LVESV is 117 ml (normal range 47+/-19), the LV mass index is 121 g/m2 (normal range 85+/-15), and the LV mass is 210 g (normal range 164+/-36). There is moderate concentric left ventricular hypertrophy (septal wall thickness = 14mm). There is global hypokinesis. There is mild patchy late gadolinium enhancement in the basal inferior and basal lateral wall, which is atypical for myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 relaxation time is moderately elevated (1130-1160ms) in the basal and mid ventricular segments, which can be seen in early infiltrative or diffuse fibrotic states, such as cardiac amyloidosis. Although the gadolinium kinetics and pattern of late gadolinium enhancement are not classic for cardiac amyloidosis, the diagnosis should none-the-less be considered (in addition to other infiltrative processes) given the associated hypertrophy. There is no evidence for myocardial iron overload.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderately dilated with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 132 ml/m2 (normal range 82+/-16), the RVEDV is 228 ml (normal range 142+/-31), the RV end systolic volume index is 71 ml/m2 (normal range 31+/-9), and the RVESV is 124 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a right axillary lymph node which is borderline enlarged (9 x 10mm). This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severely dilated left ventricle with mildly reduced systolic function (LVEF 54%).2. There is mild patchy late gadolinium enhancement in the basal inferior and basal lateral wall, which is atypical for myocardial infarction and suggests the presence of a focal underlying fibrosing, infiltrative, or inflammatory process. Although the gadolinium kinetics and pattern of late gadolinium enhancement are not classic for cardiac amyloidosis, the diagnosis should none-the-less be considered (in addition to other infiltrative processes) given the associated moderate concentric hypertrophy. The diagnosis of myocardial iron overload and Fabry's is unlikely given the moderately elevated native myocardial T1 times.3. Moderately dilated right ventricle with mildly reduced systolic function (RVEF 46%).4. Biatrial dilatation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Altered mental status [780.97], Reason for Study: ^Reason: subacute stroke vs malignancy History: subacute stroke vs malignancy Motion artifact degraded image quality.New low attenuation area (right inferior parietal lobule) found on prior CT scan does not show evidence of restricted diffusion. In addition, those areas show high signal intensity on T2-weighted images. Therefore, this lesion is more likely to be subacute or chronic ischemic stroke with the T2 shine through effect. The possibility of metastatic lesion with surrounding edema cannot be completely excluded due to lack of postcontrast enhancement scan. Since post Gad enhanced scans were not obtained, these scans should be repeated without additional charge to exclude any possibility of underlying abnormal enhancing lesion.Redemonstration of right occipital lobe encephalomalacia likely due to prior right PCA territorial infarct.There is no evidence of new ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable except extraocular changes of right lateral ventricle occipital horn. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal irregularity of intracranial arterial systems including bilateral MCAs as well as bilateral cavernous sinus segment of ICAs without evidence of significant (more than 50%) luminal stenosis. Distal right vertebral artery is not seen. No definitive intracranial arterial aneurysm is seen. For more precise vascular evaluation, CT angiography can be considered for further imaging study if clinically indicated.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuosity and irregularity were seen on bilateral carotid bifurcation area. Otherwise, bilateral common carotid arteries and left vertebral arteries were demonstrated without significant luminal stenosis.

Output: 1. Chronic ischemic infarction with right PCA territorial ischemic infarction2. Right inferior parietal lobe high signal intensity on T2 and FLAIR images without evidence of restricted diffusion, thus unlikely to be an acute ischemic infarction. No hemorrhagic transformation was seen.3. Atherosclerotic changes on both extracranial and intracranial arterial system. No definitive evidence of intracranial aneurysm. No evidence of significant (more than 50%) luminal stenosis.4. If indicated CTA of head can be considered for more precise vascular evaluation. 5. Since post Gad enhanced scans were not obtained, these scans should be repeated without additional charge to exclude any possibility of underlying abnormal enhancing lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: 21-year-old male with metastatic testicular tumor, evaluate spine for metastases versus leptomeningeal enhancement. Signs and symptoms: N/V, metastatic disease, rule out leptomeningeal disease. Pre and postcontrast enhanced total spine MRI:Cervical spine demonstrate normal signal intensity and alignment of vertebral column. Normal signal intensity and caliber of the cervical cord.No evidence of enhancing metastatic lesion of the vertebral column, cord or the meninges.No appreciable degenerative disease, no central spinal stenosis or neural foraminal compromise.Thoracic spine MRI demonstrate normal anatomical morphology, signal intensity and alignment of vertebral column without detectable metastatic lesions.Normal signal intensity, caliber and morphology of thoracic cord without detectable abnormal enhancement of the cord or the leptomeninges to suggest metastatic disease.Incidental note is made of partially visualized pulmonary nodules/masses as well as reported on prior chest x-ray.Lumbosacral spine MRI demonstrate a single focus of T1 hypointense, T2/T2 STIR hyperintense and enhancing lesion in the vertebral body of L4 measuring at 6 x 8.5 mm on sagittal post enhanced fat-sat series 3201 image 11. The lesion is most demarcated and demonstrate no surrounding marrow edema and is a nonspecific finding. However considering history of testicular cancer possibility of a single osseous metastatic lesion cannot be entirely excluded. The signal intensity of the vertebral column is otherwise within normal on all MRI sequences and without detectable abnormal enhancement. The signal intensity and morphology of the conus and the cauda equina is within normal and without detectable abnormal enhancement.No appreciable degenerative disease of the lumbosacral spine and no detectable neural foraminal or spinal compromise/stenosis.

Output: 1.Examination demonstrate a single 6 x 8.5 mm focus of marrow signal change with enhancement in the vertebral body of L4. The finding is nonspecific but likely a benign lesion, however considering patient's history of metastatic testicular cancer less likely possibility of a single osseous metastatic lesion cannot be entirely ruled out.2.Unremarkable pre and enhancement total spine MRI otherwise.3.No appreciable degenerative disease, no spinal stenosis or neural foraminal compromise at any level.4.Incidental note is made of partially visualized pulmonary nodules/masses as was reported on prior chest x-ray.


Instruction: Generate impression based on findings.

Input: SLE and back injury with compression fractures: back pain and numbness in right foot. There is concavity of the superior endplate of the T6 vertebral body, with up to 25% loss of height centrally, but no evidence of bone marrow edema or retropulsion. There is a compression fracture of the T11 vertebral body with up to nearly 50% loss of height and a T2 hyperintense fracture cleft, as well as 5 mm of retropulsion of bone from the posterior superior endplate, without spinal cord compression. There is anterior wedge deformity of the L3 vertebral body with approximately up to 10% loss of height and underlying bone marrow T2 hyperintensity, but no retropulsion. There is associated mild kyphotic deformity at the T11 level, but the alignment of the rest of the vertebral column is essentially intact. There is mild degenerative spondylosis in portions of the cervical, thoracic, and lumbar spine, but no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There are a few scattered subcentimeter vertebral body high T1 and T2 signal foci, some of which may represent hemangiomas. There is a nonspecific subcentimeter high T2 and low T1 signal splenic lesion.

Output: 1. Concavity of the superior endplate of the T6 vertebral body, with up to 25% loss of height centrally, but no evidence of bone marrow edema or retropulsion.2. Compression fracture of the T11 vertebral body with up to nearly 50% loss of height and a T2 hyperintense fracture cleft, as well as 5 mm of retropulsion of bone from the posterior superior endplate, without spinal cord compression. 3. Anterior wedge deformity of the L3 vertebral body with approximately up to 10% loss of height and underlying bone marrow T2 hyperintensity, but no retropulsion.4. Mild degenerative spondylosis in portions of the cervical, thoracic, and lumbar spine, but no associated significant spinal canal stenosis. 5. Nonspecific subcentimeter high T2 and low T1 signal splenic lesion. An abdomen ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 17-year-old male with bilateral tinnitus. Evaluate for vestibular schwannoma and inner ear abnormalities. MRI Brain:The brain parenchyma and pituitary gland appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Specifically no signal abnormality involving the brainstem is appreciated. Postcontrast sequences are motion degraded but grossly 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. There is minimal ethmoid and maxillary sinus mucosal thickening. The remainder of the orbits, skull, and scalp soft tissues are grossly unremarkable. Mastoid air cells are clear.MRI IACs:The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are normal, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle cisterns bilaterally or within the internal auditory canals.

Output: 1.Brain parenchyma appears within normal limits. Specifically no signal abnormality involving the brainstem.2.No evidence of vestibular schwannoma or other inner ear abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: 54 y/o with follicular lymphoma with several mos L arm heaviness, please eval for etiology History: see above Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk dessication present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor/mild disk bulge and posterior ligamentous hypertrophy at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.To the extent of visualization, there is no compromise to cervical spine or thoracic spine.2.No cervical or thoracic cord lesions are appreciated to explain the patient's left arm weakness.3.Please note that the patient refused contrast administration and did not complete axial imaging of the thoracic spine. As a result this exam is limited.


Instruction: Generate impression based on findings.

Input: 64-year-old female with chronic cervical radiculopathy. There is patchy T2 hyperintensity visualized within the pons.Focal T2/STIR hyperintensity is noted in the right paramedian dorsal location at the C1-C2 level. Punctate abnormal signal is suggested in the left side of the spinal cord at the upper C4 level. There is no associated volume loss at these levels to suggest myelomalacia. Further, there is no anatomic narrowing of the spinal canal at these levels.Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is trace grade 1 retrolisthesis of C5 on C6. There is diffuse disc desiccation. There is a small disc bulge at C5-C6 and resultant mild right as well as moderate left foraminal stenosis at this level. Bone marrow signal is within normal limits. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Focal areas of abnormal signal in the cord at the right paramedian dorsal C1-C2 level and left upper C4 level. Please correlate clinically for possible demyelinating disease, especially as patchy signal is also noted in the visualized pons although this could represent age-indeterminate small vessel ischemic changes. No definite volume loss to suggest myelomalacia. Differential would also include sequelae of previous ischemia or infection. Dedicated contrast enhanced brain MRI is recommended, and if clinically warranted a thoracic spine MRI could also be obtained.2. Trace retrolisthesis of C5 on C6 with a disc bulge at that level causing mild right and moderate left neural foraminal stenoses.


Instruction: Generate impression based on findings.

Input: daily headache No evidence of acute ischemic or hemorrhagic lesion on this scan.A couple of high signal intensity lesions on the left superior frontal gyrus white matter which are likely to be non specific.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. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Right maxillary sinus shows mucosal thickening.

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


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with lower back pain. Assess for compression fracture or lytic lesions. For numbering purposes, the T12 vertebral body bears rudimentary ribs, while the L5 vertebral body shows a transitional morphology.A large region of marrow replacement is evident within the left aspect of the T12 vertebral body with a smaller region of marrow replacement in the right aspect of the L1 vertebral body. The pattern of this disease appears similar to that seen on a prior CT scan from March 2015. There may be some erosion of the superior endplate of L1, but no significant vertebral body compression is seen.Smaller marrow replacing lesions are evident on the left within the L4 vertebral body and L5 vertebral body. Again, these lesions appear similar to those seen on the prior CT, and no significant vertebral body compression is detected.Sagittal alignment of the spine is anatomic. The remaining vertebral bodies demonstrate normal morphology and signal characteristics.The spinal canal is patent throughout with no evidence of any significant epidural disease. The spinal cord, conus and cauda equina are unremarkable.At T12-L1, the right-sided L1 lesion results in very minimal bony expansion with slight effacement of the right ventral thecal sac. No significant spinal canal or neuroforaminal stenosis is detected.The remaining vertebral body levels are likewise free of significant spinal canal and neuroforaminal stenosis. No significant disc disease is evident.A marrow replacing lesion is partially visualized within the left iliac bone, also similar to that seen on prior CT.

Output: 1. Metastatic lesions are revisualized within the T12, L1, L4 and L5 vertebral bodies, as well as the left iliac bone. The size and morphology of these lesions appear similar to that noted on a prior CT exam from March 2015. No evidence of compression deformity or significant epidural disease extension is seen.2. The spinal canal remains patent throughout. At most, the lesion at L1 causes slight bony expansion which minimally effaces the right ventral thecal sac.3. No evidence to suggest any new vertebral body lesions is seen.


Instruction: Generate impression based on findings.

Input: 76 yo F w/ back pain; prior XR shows degeneration vs discitisSigns and Symptoms: back pain Five lumbar type vertebral bodies are presumed to be present. The conus medullaris on sagittal imaging is grossly intact. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disk space height at this level associated with endplate reactive change (bright on T1) and a mild disk bulge.At L4-5 there is a diffuse disk bulge present associated with bilateral facet and ligamentum flavum hypertrophy. There is effacement of fat at the lateral recess bilaterally at this level. Overall there is moderate spinal stenosis at this level. The exiting nerve roots are surrounded by fat within the neural foramina.At L3-4 there is loss of disk space height and end plate reactive change with high T1 signal . There is a diffuse disk bulge present associated with bilateral facet and ligamentum flavum hypertrophy. There is effacement of fat at the lateral recess bilaterally at this level. Overall there is moderate spinal stenosis at this level. There is mild encroachment of the exiting nerve roots at this level. There is T2 signal hyperintensity within the disk at this level.At L2-3 there is loss of disk space height and end plate reactive change with low T1 and low T2 signal and irregular endplates. There is a diffuse disk bulge present associated with bilateral facet and ligamentum flavum hypertrophy. There is effacement of fat at the lateral recess bilaterally at this level. Overall there is moderate to severe spinal stenosis at this level. There is encroachment of the exiting nerve roots at this level. There is T2 signal hyperintensity within the disk at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes present in the lumbar spine with moderate spinal stenosis at L4-5 and L3-4 and moderate to severe spinal stenosis at L2-3. There is also bilateral encroachment of exiting nerve roots at L2-3 and to a lesser degree L3-4.2.There are inflammatory changes at L2-3 with suggested endplate sclerotic change. This could represent old diskitis possibly with some superimposed acute inflammation. Alternatively it could represent marked degenerative change. Comparison to any prior exams or a contrast enhanced follow-up exam may be helpful to further evaluate this.


Instruction: Generate impression based on findings.

Input: 55 year-old female with left-sided numbness. There is no evidence of intracranial hemorrhage, mass or edema. Multiple patchy areas of hypoattenuation consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. 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: Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 70 year old female with history of right-sided weakness and hyperacusis in right ear. History of TIA, DM and HTN. Evaluate. Low attenuation within the right posterior parietal lobe with loss of gray-white differentiation. Likely subacute infarct; recommend MRI for further evaluation.Periventricular low attenuation compatible with small vessel disease of indeterminate age.Atrophy of the right caudate head with ex-vacuo dilatation of the frontal horn of the right lateral ventricle.There is no evidence of intracranial hemorrhage, mass or edema. 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.Ectasia of the basilar artery is noted.

Output: Low attenuation within the right posterior parietal lobe with loss of gray-white differentiation. Likely subacute infarct; recommend MRI for further evaluation.


Instruction: Generate impression based on findings.

Input: Brain metastases. There are multiple, greater than 10, supratentorial and infratentorial lesions with mild surrounding vasogenic edema. The largest of these lesions measures up to 10 mm in the left frontal lobe. Some of the lesions contain susceptibility effect, which may represent hemorrhage or calcification. Overall, the lesions appear to have increased slightly in size since December 2014. There is no evidence of acute infarct. The ventricles are unchanged 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. There are bilateral lens implants.

Output: Multiple supratentorial and infratentorial lesions with mild vasogenic edema are compatible with metastases. The largest of these lesions measures up to 10 mm in the left frontal lobe. Overall, the lesions appear to have increased slightly in size since December 2014.


Instruction: Generate impression based on findings.

Input: Metastatic renal cell carcinoma, status post laser ablation of a right parietal lobe lesion. There are interval postoperative findings related to right parietal lobe lesion laser ablation with presumed peripheral enhancement surrounding the ablation zone, which measures up to 22 mm, with surrounding edema. There are findings related to prior right parietal craniotomy with low signal in the treatment bed related to chronic blood products, as well as what may represent a punctate focus of enhancement or intrinsic high T1 signal in the medial portion of the treatment bed. There is also a punctate presumably enhancing lesion in the right superior frontal gyrus. The ventricles are unchanged in size.

Output: 1. Interval postoperative findings related to right parietal lobe lesion laser ablation with presumed nonspecific peripheral enhancement.2. Findings related to prior right parietal craniotomy with low signal in the treatment bed related to chronic blood products, as well as what may represent a punctate focus of enhancement or intrinsic high T1 signal in the medial portion of the treatment bed, which may represent treatment effects or tumor, but is otherwise incompletely characterized. Follow up via a complete brain MRI my be useful for further evaluation.3. A punctate presumably enhancing lesion in the right superior frontal gyrus may represent metastatic disease.


Instruction: Generate impression based on findings.

Input: There is an irregular rim enhancing lesion in the left occipital/posterior parietal lobe which measures 21 x 17 mm (series 13, image 17). Retrospective comparable measurements indicate this lesion has increased in size compared to the prior exam. Additionally there is increasing surrounding vasogenic edema predominantly anteriorly abutting the occipital horn of the left lateral ventricle. There is a new rim enhancing lesion posteriorly involving the epidural space and extending into the calvarium which measures 8 x 15 mm (series 13, image 14). A small rim enhancing lesion in the right cerebellar hemisphere measures 5 x 7 mm (series 13, image 25) without surrounding edema, unchanged. There are no additional new foci of abnormal enhancement. There is no midline shift. There is no restricted diffusion to suggest acute ischemia or infarct. Prominence of the ventricles and sulci is compatible with parenchymal volume loss. The basal cisterns remain patent. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.Increasing left occipital/posterior parietal lobe metastatic lesion. Adjacent focus of enhancement involves the epidural space and extends into the calvarium, which may represent infection although tumor is not excluded. 2.Stable right cerebellar metastatic lesion.


Instruction: Generate impression based on findings.

Input: Male, 26 years old. Fall at work on March 1 2016 and injured his right leg. Unable to bear weight for any length of time-- knee is unstable. MENISCI: The menisci appear normal.ARTICULAR CARTILAGE AND BONE: There is heterogeneous signal intensity within the articular cartilage of the medial facet of the patella, likely representing full-thickness degeneration with underlying subchondral cyst formation. The remainder of the articular cartilage appears normal. The remaining bone marrow signal is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is a small amount of fluid in the joint, but no large effusion.

Output: Degeneration of the articular cartilage of the medial facet of the patella, but otherwise no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain and spinal cord [198.3], Reason for Study: ^Reason: eval post surgical resection History: brain lesion There is evidence of right fronto-parietal craniotomy with biopsy of the right frontal pre central gyrus lesion.In fact, the size of the lesion appears to be slightly smaller and shows central unenhancing portion with peripheral enhancement.There are multiple enhancing lesions which are similar to prior scan performed on Sep 14 2015. However, there are new enhancing and/or more conspicuous lesions on Gad enhanced images including left middle frontal gyrus (series 501, image 145), left inferior frontal gyrus (series 501, image 126), and right cingulate gyrus (series 501, image 113).Other scattered lesions including right posterior temporal lobe, right cerebellar hemisphere and left cerebellar small hemorrhagic lesion appear to be stable.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The mild mucosal thickening of bilateral maxillary sinus and opacification of the mastoid air cell (right greater than left) do not show any significant interval change.

Output: 1. Post surgical resection status of the right pre central gyrus lesion.2. There are lesions which are either new or more conspicuous on today's scan than prior exam as described above.3. Most of other scattered enhancing lesions including right posterior temporal and right cerebellar hemisphere appear to be stable.


Instruction: Generate impression based on findings.

Input: Male 61 years old with elevated PSA and 2 prior negative biopsies. PELVIS:PROSTATE:Prostate Size: 4.9 x 6.0 x 6.0 cmPeripheral Zone: There is a 9 x 6 mm lesion (series 301, image 64) in the left base and a 5 x 4 mm lesion (series 301, image 66) in the right base. These lesions are dark on T2 and ADC and demonstrate early contrast enhancement and are suspicious for prostate carcinoma.Central Gland: Multiple large BPH nodules are noted.Seminal Vesicles: The left seminal vesicle is collapsed. The right seminal vesicle is unremarkable.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Diffuse diverticulosis and wall thickening of the the sigmoid colon.

Output: Small peripheral zone lesions in the prostate base bilaterally are suspicious for prostate carcinoma.


Instruction: Generate impression based on findings.

Input: 41-year-old female recalled for abnormality on high-risk screening MRI. History of BRCA2 mutation and family history of ovarian cancer. A targeted left ultrasound was performed for the MRI detected area of concern at 12:00 in the left breast. There is no solid or cystic mass identified. Normal glandular tissue is identified present.

Output: No sonographic evidence for malignancy at the site of MRI detected abnormality. Surgical consultation was arranged. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on findings.

Input: 66 year-old female with left foot ulcer concerning for osteomyelitis TENDONS: The extensor and flexor tendons are intact.LIGAMENTS: The lateral collateral ligaments and deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is chronic appearing periosteal reaction about the distal fibula without marrow changes or edema to indicate acute osteomyelitis. There are subchondral cysts, osteophytes and extensive edema involving the midfoot articulations consistent with osteoarthritis and changes likely related to the patient's diabetes.ADDITIONAL

Output: Soft tissue thickening and chronic periosteal reaction about the distal fibula without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Reason: pt with severe endometriosis s/p TAH, LSO. Now with severe pelvic pain, constipation History: abdominal pain, constipation PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Small right ovarian follicle.There is spiculated enhancing tissue in the pelvis, the region of the rectosigmoid, measuring approximately 4.5 x 2.6 cm (903/67), likely representing endometriosis. This tissue surrounds the rectosigmoid, extending along left lateral pelvic sidewall, and causes obstruction of the left distal ureter (7/30).BLADDER: Dilated left ureter.LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: There is bowel wall thickening involving the rectum and distal sigmoidBONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis.

Output: 1.Soft tissue within the pelvis, surrounding the rectosigmoid, is suspicious for endometriosis.2.Bowel wall thickening of the adjacent rectosigmoid may suggest an associated colitis.


Instruction: Generate impression based on findings.

Input: Grade 2 oligoastrocytoma. There are postoperative findings related to right frontal lobe tumor resection. There is confluent high T2 signal surrounding a 35 mm diameter surgical cavity, which appears to be unchanged, but no mass-like abnormal enhancement. There is no evidence of acute infarct. There is ex vacuo dilatation of the right lateral ventricle. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of tumor progression in the treated right frontal lobe region.


Instruction: Generate impression based on findings.

Input: 64-year-old male with prostate cancer. Right mid lateral Gleason 6. PELVIS:PROSTATE:Prostate Size: 6.0 x 3.6 x 4.3 cm.Peripheral Zone: There is a focus of rapid early arterial enhancement in the right mid gland peripheral zone measuring 11 x 7 mm (series 1201, image 1375). This corresponds with subtle T2 hypointensity. There is an additional focus T2 hypointensity measuring 4 x 3 mm in the lateral right mid gland peripheral zone with corresponding restricted diffusion (series 301, image 11).Central Gland: Severe degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No capsular extension is present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Focus of rapid early arterial enhancement in the right mid gland peripheral zone suspicious for malignancy.2.Smaller focus of T2 hypointensity with corresponding restricted diffusion in the lateral right mid gland peripheral zone.


Instruction: Generate impression based on findings.

Input: Altered mental status, evaluation for cerebrovascular accident. Multifocal scattered high signal intensities on FLAIR images especially on deep white matter and periventricular white matter indicate nonspecific small vessel ischemic disease.There is a focal tissue loss with a high signal intensity on FLAIR imaging on the right basal ganglia and bilateral external capsule indicate chronic ischemic lacunar infarcts.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.There is a well-circumscribed mass lesion on right side anterior to masseter space within subcutaneous fat tissue. The lesion demonstrated restricted diffusion but shows high signal intensity on both T1 and T2 weighted images and the signal intensity is very similar to that of subcutaneous fat. The differential diagnosis include epidermoid, epidermal inclusion cyst or other cystic lesion with high protein content.

Output: 1. Non specific small vessel ischemic disease and multifocal chronic lacunar infarctions as described above.2. Well circumscribed cystic lesion (22.9mm x 38mm) with restricted diffusion within the right subcutaneous tissue, differential diagnosis include epidermoid, epidermal inclusion cyst, or other cystic lesion with high protein content.


Instruction: Generate impression based on findings.

Input: S/p craniotomy for resection of a right frontal cystic mass. Examination demonstrates postoperative changes of the right frontal craniotomy. There are a surgical cavity containing fluid/blood in the right frontal lobe, where the cystic mass located previously shown on MRI. Anteriorly, there is right frontal extra-axial fluid/hemorrhage/air extending across the interhemispheric falx. The surgical cavity appears in communication with the frontal fluid collection at its lower portion. In addition, there are areas of hypoattenuation anteriorly adjacent to the surgical cavity. These likely represent either vasogenic edema or ischemia. In comparison with prior MRI, there is less midline shift and less mass effect on the lateral ventricles. The left lateral ventricle appears slightly enlarged. Bifrontal subgaleal focal emphysema is present. The brain is otherwise appears normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Postoperative changes the right frontal craniotomy for resection of a right frontal cystic mass, including fluid/hemorrhage collection in the right frontal surgical cavity and bifrontal extraaxial spaces as well as bifrontal pneumocephalus. 2. Interval reduction of the midline shift and mass effect on the lateral ventricles. 3. Right frontal hypoattenuation anteriorly adjacent to the surgical cavity likely represents either vasogenic edema or ischemia.


Instruction: Generate impression based on findings.

Input: Cervical thoracic syrinx that has been managed conservatively. There is no significant interval change in the extent or caliber of the cervicothoracic syrinx, which measures up to 7 mm in width. There is straightening of the cervical and thoracic vertebral column alignment in the sagittal plane and mild rotatory thoracic scoliosis. The cerebellar tonsils are not low-lying. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No significant interval change in the extent or caliber of the cervicothoracic syrinx, which measures up to 7 mm in width.


Instruction: Generate impression based on findings.

Input: Anterolateral ankle pain and possible impingement TENDONS: The tendons are normal.LIGAMENTS: The lateral collateral ligament complex is intact. The distal tibiofibular syndesmotic complex is intact. There is loss of the normal fatty striation of the deep fibers of the deltoid ligament which may reflect prior sprain; the ligamentous complex of the medial ankle is otherwise intact. The spring ligament is normal.ARTICULAR SURFACES AND BONE: The bones marrow signal is normal. A small lobulated foci of fluid signal intensity is noted adjacent to the base of the fourth metatarsal which may represent a small ganglion. There is normal fat signal within the sinus tarsus.ADDITIONAL

Output: Possible small ganglion adjacent to the base of the fourth metatarsal but otherwise there are no specific findings to account for the patient's pain and no findings to suggest anterolateral impingement.


Instruction: Generate impression based on findings.

Input: Reason: eval lucency seen on plain film History: new left hip pain The proximal femoral lucency seen on recent radiographs likely corresponds to a focus of cortical thinning along the posterior aspect of the femur at and below the level of the lesser trochanter. This appears benign and we see no focal lesion within the medullary bone. There is patchy intermediate bone marrow signal intensity on T1-weighted images likely representing residual red marrow. Mild osteoarthritis affects the hip with cartilage degeneration. There is mild subchondral edema within the femoral head and acetabulum. Although this examination was not protocoled for detailed evaluation of the acetabular labrum, there is intermediate signal intensity within the superior labrum likely representing degeneration/degenerative tearing. There is a small lobulated collection of fluid signal intensity along the anterior superior aspect of the hip joint which may represent a paralabral cyst. Additional fluid signal intensity along the posterior aspect of the femoral neck may represent a small amount of fluid within the joint perhaps associated with a mild synovitis. On the large field-of-view images, mild osteoarthritis affects the right hip and degenerative disc disease affects the lower lumbar spine.

Output: 1. Osteoarthritis of the left hip and other findings as described above.2. The lucency within the proximal femur likely corresponds to an area of benign cortical thinning. We see no underlying medullary lesion.


Instruction: Generate impression based on findings.

Input: Scaphoid fracture LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: There is no evidence of scaphoid fracture or nonunion. Mild cystic changes are noted in the proximal pole which are chronic in nature. There is mild apparent negative ulnar variance however this can be better evaluated with dedicated radiographs of the wrist.ADDITIONAL

Output: No evidence of scaphoid fracture or nonunion. There are mild cystic changes of the proximal pole which appears chronic in nature. The previously described edema signal within the scaphoid has resolved.


Instruction: Generate impression based on findings.

Input: 29-year-old female with Crohn's disease in the ileum and right colon, evaluate extent of disease; abdominal pain, nausea ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.CALCIFICATIONS IN ABDOMINAL AORTA AND ITS BRANCHES: None.BOWEL, MESENTERY: Wall thickening and enhancement involving the distal 6 cm of terminal ileum consistent with active inflammatory bowel disease. The remaining small bowel and colon are unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Wall thickening and enhancement of the terminal ileum as described above consistent with active inflammatory bowel disease.2. No other sites of disease.


Instruction: Generate impression based on findings.

Input: H/o porencephalic cyst . S/p Ommaya shunt. Evaluate for interval change. Examination demonstrates further enlargement of the right porencephalic cyst and the supratentorial ventricular system. There have been large areas of encephalomalacia in the bilateral cerebral hemispheres since prior exams. There has been an interval placement of a right frontal catheter, and the tip appears to be approximately within the confluence of the sinus. No hemorrhage is identified. The cerebellar hemispheres remain unchanged from prior exam.

Output: 1. Diffuse cerebral encephalomalacia which has further evolved since prior exam. Findings are compatible with ischemic injury. 2. Further enlargement of the right porencephalic cyst and the supratentorial ventricular system, which is secondary to underlying brain volume loss related to diffuse encephalomalacia versus increased intraventricular pressure.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is mild deformity of the free edge of the medial meniscus involving the posterior horn and body that could reflect prior surgical intervention in the correct clinical context. Additionally, there is poorly defined increased signal within the posterior horn and body representing degeneration however a more discrete linear component extends to the undersurface of the meniscus, consistent with a tear. This was not well seen on the prior exam. Furthermore, there is a defect along the undersurface of the meniscus which is also more prominent on the current exam and is suspicious for a displaced horizontal flap tear. The anterior horn is intact.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is tricompartmental degeneration and thinning of the articular cartilage particularly of the medial and patellofemoral compartments. Overall this appears similar to the prior exam. Subchondral edema within the medial tibial plateau appears similar as well; however the edema within the femoral condyle appears improved. LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: The extensor mechanism is unremarkable.ADDITIONAL

Output: 1. Tricompartmental osteoarthritis of the knee, similar to the prior exam.2. Abnormal appearance of the medial meniscus, which may in part be the result of prior surgical intervention; however there is a new suspected tear of the medial meniscus with a probable horizontal undersurface flap present.


Instruction: Generate impression based on findings.

Input: Female 54 years old Reason: twisting injury History: possible ACL vs PCL tear MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow is normal. No significant bone marrow edema. Bone island is present in the medial femoral condyle. No focal articular cartilage defect. Mild articular cartilage fraying and thinning of the lateral patellar facet.LIGAMENTS: The ACL, PCL, MCL, and lateral collateral complex is intact. No significant edema in the posterior lateral corner.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.No ligamentous injury. 2.Mild articular cartilage fraying and thinning of the lateral patellar facet.


Instruction: Generate impression based on findings.

Input: 30 year old male patient with seizures. Limited sequences obtained for treatment planning and intraoperative evaluation. Laser fiber is seen extending from a left occipital burr hole to the medial left temporal lobe in the region of the hippocampus. Within the region of the left hippocampus and portions of the left amygdala, there is a 2.2 x 1.2 cm peripherally enhancing ablation zone (image 71, series 1201). Additional left sided burr holes are also noted. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The orbits and paranasal sinuses are grossly unremarkable.

Output: Expected post-surgical changes of repeat laser ablation of the left hippocampus and portion of the amygdala.


Instruction: Generate impression based on findings.

Input: Ovarian cyst. PELVIS:UTERUS, ADNEXA: Slightly anteverted and retroflexed uterus displaced towards the left due to a large right adnexal lesion. The endometrial 11 mm, within normal limits. Myometrium/trunk was also measures 7 mm, within normal limits without any cystic changes. The remainder of the myometrium is normal in appearance without a discrete lesion.The cervix is normal in appearance.The left ovary measures approximately 2.8 x 2.7 cm (series 601/30) with numerous physiologic follicles. In the right adnexa there is a large multiseptate cystic lesion measuring approximately 12.3 x 9.8 x 10.9 cm. Several of the larger components demonstrate low T1 weighted signal and fluid bright T2-weighted signal intensity, compatible with hemorrhagic/proteinaceous contents. Centrally the mass contains smaller multilobulated multicystic variable homogeneous density signal with very low signal foci compatible with blood product. This does not appear to enhance on postcontrast imaging. No normal right ovarian tissue is definitively identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Free fluid in the pelvis, within physiologic limits. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large cystic and multiseptated right adnexal lesion without definite identification of the normal right ovarian tissue or enhancing components. Differential considerations include a cystadenoma or cystadenocarcinoma.


Instruction: Generate impression based on findings.

Input: Female, 75 years old, with history of right nasopharyngeal carcinoma status post chemotherapy and radiation. Globular, nonenhancing soft tissue is redemonstrated in the right nasopharynx. Since the prior examination, areas of frank tissue loss have progressed. No masslike lesions are seen to suggest recurrent tumor.Ill-defined edema and hyperenhancement persist within the right parotid gland and masticator space. The salivary glands are otherwise unremarkable. No pathologic adenopathy is observed. The right mastoid air cells are largely opacified with mild partial opacification on the left. Mucous retention cysts are seen in both maxillary sinuses and there is progressive mucosal thickening on the left. Marrow signal abnormality persists within the clivus, anterior C1 arch, and odontoid process. The adjacent ligamentous structures are thickened. Multilevel cervical spondylosis is again seen.

Output: 1.Progressive necrosis and tissue loss along the right nasopharyngeal mucosal space is seen. No findings are evident to suggest recurrent tumor.2.No pathologic adenopathy is detected within the field-of-view of the examination.3.Treatment related findings involving the soft tissues of the right masticator space and parotid gland are unchanged. Likewise, marrow signal abnormality and thickening along the and C1-2 articulation are unchanged and likely treatment related.4.Progressive mucosal thickening is seen in the left maxillary sinus. Opacification of the mastoid air cells suggests Eustachian tube dysfunction.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of urethra and mental status changes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged scattered foci of T2 hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged 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: 1. No evidence of intracranial metastases, although the images are degraded by patient motion. 2. Unchanged scattered foci of T2 hyperintensity in the cerebral white matter, which are nonspecific, but likely represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 65 years Female (DOB:2/8/1951)Reason: low back pain with radiculopathy History: low back pain with radiculopathyPROVIDER/ATTENDING NAME: DALIA H. ELMOFTY DALIA H. ELMOFTY Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with some ligamentum flavum hypertrophy. There are some mild narrowing of the spinal canal at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation and a mild disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are some mild degenerative changes present in the lumbar spine without significant compromise to spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 51-year-old male with posterior medial joint line pain and popping. MENISCI: There is deformity and linear branching increased signal abnormality within the posterior horn of the medial meniscus extending to the femoral articular surface consistent with a complex tear of the meniscus. There is mild increased signal abnormality in the distal femur in the overlying area, consistent with mild bone marrow edema. ARTICULAR CARTILAGE AND BONE: There is mild fraying of the articular cartilage along the lateral facet of the patella. There is mild articular cartilage degeneration affecting the medial facet of the patella. No full-thickness or near full-thickness articular cartilage defects are identified. Incidental note is made of an subcentimeter focus of T1 shortening in the medial condyle of the femur consistent with an interosseous lipoma. Otherwise no bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Complex tear of the posterior horn of the medial meniscus and other findings, as described above.


Instruction: Generate impression based on findings.

Input: 57 year old female with a family history of breast cancer in 3 sisters and paternal grandmother. History of melanoma diagnosed 13 years ago. Patient is on tamoxifen. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.There are multiple small cysts in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 14 years Female (DOB:1/9/2002)Reason: r/o signs of vasculitis, i.e. SLE History: autoimmune hepatitis with withdrawn, depressed affectPROVIDER/ATTENDING NAME: RUBA K. AZZAM RUBA K. AZZAM MRI of the brainThere is diffusion restriction present along the subcortical white matter of the frontal and parietal lobes and temporal lobes as well as within the corpus callosum and tectal plate. The pattern is very symmetric.There is T1 hyperintense signal present along the basal ganglia bilaterally.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are opacified. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. In the peripheral vasculature, there is an appearance of smooth narrowing of some of the peripheral vasculature.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the posterior cerebral arteries bilaterally. The left P1 segment is slightly smaller than the posterior communicating artery whereas the right P1 segment is much smaller. The vertebral arteries are similar in size.

Output: 1.Foci of confluent diffusion restriction are present in the subcortical white matter of the frontal, parietal and temporal lobes and corpus callosum as well as the tectal plate and posterior brainstem. This a fairly symmetric pattern which would be more consistent with toxic/metabolic cause such as neurotoxicity from pharmacologic agents, leukoencephalopathy and possibly hepatic encephalopathy (given the clinical history). Vasculitis, although conceivable as a cause of this pattern, tends to be associated with asymmetric lesions.2.Lesions within the globus pallidus bilaterally suggestive of chronic liver failure.3.The possibility of vasculitis cannot be excluded.4.Mastoid air cell and middle ear opacification is a nonspecific finding which could relate to retained secretions.


Instruction: Generate impression based on findings.

Input: New diagnosis of cholangioadenocarcinoma and gallbladder carcinoma, abdominal pain and elevated LFTs Suboptimal exam due to extensive patient motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Improved biliary duct dilatation, likely related to placement of biliary stent. Thick walled gallbladder, likely combination of inflammation from adjacent ascites and reported gallbladder carcinoma, small sludge/hemorrhagic or proteinaceous material and cholelithiasis in gallbladder, nonspecific rounded restricted diffusion seen in the gallbladder lumen, may also reflect reported gallbladder malignancy. Nodular liver contour. New from prior study are multiple hepatic lesions (examples include located in hepatic dome and hepatic segment 8/5 and hepatic segment 6, see images 524, 396 and 300 series 607) demonstrating mildly increased T2 signal and restricted diffusion, with ill-defined borders and minimal to no internal enhancement seen, appearance suspicious for hypoenhancing metastatic disease. Lesion near gallbladder fossa may reflect metastatic disease or direct tumor invasion. Submitted for reference is a hepatic segment 5 lesion measuring 1.3 x 1.2 cm, image 372 series 1502. Left portal vein and splenic vein not well seen, suspicious for occlusion, heterogeneous left lateral hepatic parenchymal enhancement.SPLEEN: No significant abnormality noted.PANCREAS: Nonspecific peripancreatic soft tissue attenuation and stranding.ADRENAL GLANDS: Diffusely enlarged adrenal glands.KIDNEYS, URETERS: Bilateral renal cortical thinning.RETROPERITONEUM, LYMPH NODES: Again visualized retroperitoneal soft tissue thickening, with associated flattened configuration of the IVC, assessment including patency suboptimal secondary to extensive patient motion artifact. Small inguinal lymph nodes.BOWEL, MESENTERY: Wall thickening, likely reactive in setting of ascites.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right greater than left small pleural effusions and moderate to large ascites visualized.

Output: 1. Suboptimal exam due to extensive patient motion artifact and presence of ascites, contrast-enhanced CT abdomen and pelvic imaging for improved assessment should be considered.2. Hepatic metastatic disease, new. Left portal vein and splenic vein not well seen, suspicious for occlusion, heterogeneous left lateral hepatic parenchymal enhancement.3. Improved biliary duct dilatation, likely related to placement of biliary stent. Thick walled gallbladder, likely combination of inflammation from adjacent ascites and reported gallbladder carcinoma, small sludge/hemorrhagic or proteinaceous material and cholelithiasis in gallbladder, nonspecific rounded restricted diffusion seen in the gallbladder lumen, may also reflect reported gallbladder malignancy. 4. Nonspecific peripancreatic soft tissue attenuation and stranding. Again visualized retroperitoneal soft tissue thickening,5. Right greater than left small pleural effusions and moderate to large ascites visualized.


Instruction: Generate impression based on findings.

Input: Reason: lateral meniscus tear History: left knee pain and swelling MENISCI: There is a small linear cleft within the posterior horn of the lateral meniscus, reflecting either the site of prior repair or a re-tear. The medial meniscus appears intact. ARTICULAR CARTILAGE AND BONE: Orthopedic changes in the lateral femoral condyle and medial aspect of the tibial plateau reflect prior ACL reconstruction. There is bone marrow edema in the posterolateral tibial plateau and lateral femoral condyle from a contusion injury. There is less pronounced marrow edema within the medial femoral condyle. Articular cartilage of the knee appears unremarkable.LIGAMENTS: There is indistinctness and intermediate signal within the ACL allograft near its tibial attachment. The posterior cruciate ligament appears intact. The medial collateral ligament and lateral collateral ligament complex appear normal. EXTENSOR MECHANISM: The quadriceps and patellar tendons are normal in appearance.ADDITIONAL

Output: 1.Findings suspicious for recurrent tearing of the ACL allograft near its tibial attachment, where the bulk of the fibers are indistinct. Findings consistent with hemarthrosis. 2.There is a small linear cleft within the posterior horn of the lateral meniscus, reflecting either the site of prior repair or a re-tear.


Instruction: Generate impression based on findings.

Input: 17-year-old male with right shoulder instability, evaluate for intra-articular pathology ROTATOR CUFF: The rotator cuff appears normal.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal. We see no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is a linear band of increased signal intensity between the anterior inferior labrum and underlying glenoid suggesting a tear. There is a bandlike low signal intensity extending from the anterior inferior labrum to the medial aspect of the glenoid that may represent thickened periosteum. These findings are suggestive of a Perthes lesion. The anterior superior labrum also appears detached from the underlying glenoid but this may simply represent a normal variant sublabral foramen. There is gadolinium between the superior labrum and underlying glenoid which may also represent a normal variant sublabral sulcus. The posterior labrum is intact. BICEPS TENDON: The tendon of the long head of the biceps muscle appears normal.ADDITIONAL

Output: Findings compatible with a Perthes lesion of the anterior inferior labrum.


Instruction: Generate impression based on findings.

Input: Reason: smoldering myeloma new diagnosis, baseline MRI r/o lesions History: none Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. Overall the marrow signal is somewhat mottledNo abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level.At C5-6 there is no significant compromise to the spinal canal. There is a disk bulge present at this level. There is some associated narrowing of the right neural foramen at this level due to disk materialAt C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is diffuse marrow replacement present.No abnormal enhancing lesions are appreciated in the throacic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is diffuse marrow replacement present.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is diffuse disk bulge present associated bilateral facet ligamentum flavum hypertrophy and effacement of the fat of the lateral recesses bilaterally. Overall there is a mild to moderate degree of spinal stenosis at this level. There is mild narrowing of the neural foramina at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Overall the marrow signal is diffusely low . This is a nonspecific finding can but can be seen with myeloproliferative disorders as per the patient's clinical history.2.There are degenerative changes present in the cervical spine worse at C5-6 where there is some encroachment of the right-sided exiting nerve roots due to disk material3.There are degenerative changes present in the lumbar spine worse at L4-5 where there is a mild to moderate degree of spinal stenosis


Instruction: Generate impression based on findings.

Input: Again seen are postoperative findings related to a right posterior parietal craniotomy. The resection cavity is unchanged with mild T2/FLAIR signal surrounding the CSF-filled cavity remaining unchanged across multiple prior studies. There are no areas of pathologic enhancement. Curvilinear susceptibility abnormality along the lateral aspect of the right frontal lobe and within the central sulcus/post central gyrus, likely reflects chronic blood products and is unchanged. Incidentally seen is a small arachnoid cyst without mass effect along the left frontotemporal operculum and also remains unchanged. The ventricles are within normal limits and the basal cisterns remain patent. No areas of diffusion restriction are present to suggest an acute ischemic event. No extra-axial fluid collection is identified. The cerebellar tonsils are in normal position. Pituitary gland is unremarkable for age. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Left maxillary sinus mucous retention cyst. The orbits are unremarkable.

Output: Posttreatment changes in the right parietal lobe. No evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Dyslexia and alexia [R48.0], Reason for Study: ^Reason: rule out posterior circ stroke History: alexia, agraphia Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.On the gradient echo images, there are scattered susceptibility lesions bilateral hemispheres indicating either calcification or chronic hemorrhage.Patchy bihemispheric periventricular white matter FLAIR/T2 high signal intensity lesions are seen which indicate mild to moderate degree nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. 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. Left PCA is fetal origin.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: 45-year-old male. Shoulder pain months with clicking overhead sports. Evaluate for labeled tear or loose body. ROTATOR CUFF: Full thickness tear of the central fibers of the supraspinatus tendon at their insertion, measuring approximately 9 mm in AP dimension. There is associated fluid in the subdeltoid and subacromial bursa. No significant retraction of the supraspinatus muscle, which demonstrates normal signal. Mild tendinosis of the infraspinatus and subscapularis tendons without evidence of a discrete tear.SUPRASPINATUS OUTLET: Widening of the acromioclavicular joint, which could be posttraumatic or from prior surgery, unchanged. Spurring of the distal clavicle.GLENOHUMERAL JOINT AND GLENOID LABRUM: Gadolinium extends into a linear tear within the substance of the superior labrum from the 2 o'clock to 10 o'clock position consistent with a SLAP tear. The anterior and posterior inferior labrum is frayed and irregular in shape likely due chronic degenerative tearing.BICEPS TENDON: The long head of the biceps tendon is intact. ADDITIONAL

Output: Full-thickness non-retracted supraspinatus tear and SLAP tear, as described above.


Instruction: Generate impression based on findings.

Input: 57-year-old female with left knee pain. Evaluate for left knee lateral meniscus re-tear. MENISCI: There is deformity and blunting of the body and posterior horn of the lateral meniscus. Additionally there is increased signal abnormality which extends to the femoral articular surface which presumably represents the sequela of a prior tearing and postsurgical changes from prior partial meniscectomy. No fluid-filled defects are identified to suggest an unstable tear/re-tear of the meniscus. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness articular cartilage degeneration along the posterior aspect of the lateral femoral condyle and posterior aspect of the lateral tibial plateau with associated underlying subchondral signal abnormality. There is thinning of the articular cartilage of the medial compartment. There is focal near full-thickness articular cartilage degeneration along the weightbearing portion of the medial femoral condyle overlying the anterior horn of the meniscus. There is focal near full thickness articular cartilage degeneration along the lateral facet of the patella. There is perhaps mild dysplasia of the medial facet of the trochlea.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Findings consistent with prior tearing and post surgical changes of the lateral meniscus without fluid filled defects to confirm a re-tear as clinically questioned.


Instruction: Generate impression based on findings.

Input: 69 year-old female with a history of breast cancer, poor visualized RV on TTE presents for further evaluation. Left VentricleThe left ventricle is normal in size and has normal systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 83 ml/m2 (normal range: 65+/-11), the LVEDV is 144 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 44 ml (normal range 31+/-10), the LV mass index is 39 g/m2 (normal range 67+/-11), and the LV mass is 67 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Native T1 pre-contrast time: 1037 msLeft AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is upper limits of normal in size and has normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 97 ml/m2 (normal range 69+/-14), the RVEDV is 169 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (25.9 mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a round, circular hyperattenuated lesion noted in the liver. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and has normal systolic function (LVEF 69%)2. The right ventricle is mildly dilated and has normal systolic function (RVEF 55%)3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.4. There is a round, circular hyperattenuated lesion noted in the liver. If clinically indicated, a separate dedicated evaluation should be considered.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: New seizure workup: extremity shaking at night. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appears unremarkable. There is no evidence of heterotopia. The ventricles and basal cisterns are normal in size and configuration. There is mild prominence of the bilateral frontal convexity subarachnoid 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: No evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness and incontinence MRI brain with contrast: Examination is mildly motion degraded. Postcontrast images of the brain demonstrate no abnormal enhancement associated with the extensive T2/FLAIR signal abnormality in the periventricular and subcortical white matter related to known demyelinating disease. Advanced brain parenchymal volume loss is again noted.MRI cervical spine with contrast: Examination is mildly motion degraded. Postcontrast images demonstrate no abnormal enhancement in the cervical cord to suggest active demyelination. There is patchy T2 signal abnormality in the cervical cord such as at the ventral C3-C4 level but difficult to assess due to motion degradation. Diffuse development narrowing of the cervical spinal canal is again noted with moderate spinal canal stenosis more focally at the C5-C6 and C6-C7 levels related to superimposed central disc protrusions.MRI thoracic spine without and with contrast: Examination is motion degraded however there are no abnormal enhancing lesions or clear evidence of edema in the cord to suggest active demyelinating disease. Areas of patchy T2 signal abnormality are questioned on the axial sequences which are severely limited due to artifact. No definite thoracic lesion on the sagittal sequences is appreciated. Cord parenchymal volume is maintained. Vertebral body heights and alignment of the thoracic spine are maintained. No spinal canal or neural foraminal stenosis is seen.

Output: 1. Post contrasted images of the brain demonstrate no abnormal enhancement associated with the extensive white matter signal abnormality related to known demyelinating disease. Advanced brain parenchymal volume loss is again noted.2. Postcontrast images of the cervical and thoracic spine also demonstrate no abnormal enhancement to suggest active demyelination. There is patchy cord signal abnormality particularly in the cervical cord at the ventral C3-C4 level which is suspected to represent a demyelinating plaque.3. Diffuse developmental narrowing of the cervical spinal canal is again seen with up to moderate spinal canal stenosis at the C5-C6 and C6-C7 levels related to superimposed disc protrusions.


Instruction: Generate impression based on findings.

Input: Gait disorder with spasticity and a vibration level in mid thorax. Known lesion in cervical cord. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild periventricular and scattered bilateral cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. There may also be a few foci of T2 hyperintensity in the pons. There is cavum septum pellucidum and vergae. 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: Mild intracranial white matter abnormality is nonspecific and may represent chronic small vessel ischemic disease or demyelinating lesions, for example. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.