Instruction: Generate impression based on findings.

Input: Clinical question: Preop planning for tumor resection. Signs and symptoms: Headaches. Pre and postcontrast enhanced Stealth brain MRI:Examination is limited due to extensive motion artifact in particular on post enhanced series.There is a well-demarcated enhancing and minimally necrotic tumor in the inferior-posterior aspect of right cerebellum measuring 17 x 11.5 mm in size.There is a large necrotic mass in the right posterior temporal-occipital region measuring at approximately 40 x 42 mm in transaxial dimensions with diffuse surrounding vasogenic edema and regional mass effect. The mass encases the occipital horn of left lateral ventricle.The ventricular system remains within normal size and with interval resolution of previously noted rightward midline deviation.Note should be made that this examination is performed as a surgical planning study and is not a true diagnostic test.

Output: 1.Suboptimal exam due to motion artifact.2.Tumor measuring at 17 x 11.5 mm in the right cerebellum posteriorly and a larger necrotic mass in the left posterior temporal-occipital region measuring at 40 x 42 mm.3.Stable normal size of ventricular system however with interval resolution of rightward deviation of midline since prior outside institute exam from 6-1-15.


Instruction: Generate impression based on findings.

Input: Evaluate for osteomyelitis Examination of the pelvis was performed before and after the intravenous administration of gadolinium. There is a large ulceration posterior to the distal sacrum and coccyx.. This ulceration abuts the coccyx and therefore osteomyelitis is highly suspected. There is also enhancement of the distal coccyx with the intravenous gadolinium.Note is made of metallic artifact involving the right hip.

Output: Ulceration reaching the coccyx and abnormal enhancement within the distal segments. Consistent with osteomyelitis


Instruction: Generate impression based on findings.

Input: Seizure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal scattered nonspecific cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is deformity of the left inferior orbital wall, which may be due to a prior fracture. The skull, paranasal sinuses, and scalp soft tissues are otherwise grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: Evaluate for ischemia and vessel wall History: L BG infarct on prior MRI, RUE distal weakness There are eccentric intracranial arterial wall thickenings including right distal cervical ICA and petrous ICA junction, right distal ICA, right MCA, left ICA cavernous sinus segment, left MCA proximal M2 segment indicating atherosclerotic changes.These lesions show relatively homogenous enhancement of wall thickening except left ICA cavernous sinus segment lesion. The lesion shows enhancement of intimal and adventitia side but not core of the wall thickening. Thus, this lesion can be regarded as a vulnerable plaque.The leftThe left basal ganglia ischemic lesion shows enhancement indicating luxury perfusion status.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal intracranial arterial eccentric wall thickening involving left ICA cavernous sinus segment, left MCA proximal M2 segment, right distal ICA, right MCA indicating possibility of atherosclerotic changes. 2. Differential diagnosis include vasculitis, vasospasm, or focal dissection with underlying atherosclerosis.


Instruction: Generate impression based on findings.

Input: History of left mastectomy in 1999 now with positive contralateral (right) axillary node and supraclavicular nodes seen on CT. Assess for right breast lesion. There is scattered fibroglandular tissue in the right breast.Moderate parenchymal enhancement is noted in the right breast.There is linear clumped non-mass enhancement in the right upper outer breast. This measures 3.9 x 0.8 x 1.5 cm. Scattered foci are seen elsewhere, especially in the anterior depth, but these do not enhance as early or to the same degree as the non-mass enhancement mentioned above.In the right axilla, the biopsy proven malignant node has associated clip artifact and measures 2.4 x 1.8 cm. Other normal sized axillary nodes are also seen.No abnormal enhancement is seen in left chest wall. No abnormal lymph nodes are identified in the left axillary region.

Output: 1. Linear non-mass enhancement in the right upper outer breast measures up to 3.9 cm. An MRI directed ultrasound is recommended. If no ultrasound correlate is seen, then MRI guided biopsy would be needed for diagnosis.2. Biopsy proven malignant right axillary node measures up to 2.4 cm. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: History of lung cancer with brain metastasis. The multiple supratentorial brain lesions have decreased in size and are now all subcentimeter. For example, a left parietal lobe lesion measures up to 7 mm, previously 9 mm. The T2 hyperintensity surrounding the metastases has also diminished. There is residual susceptibility effect associated with some of the lesions. However, there is new patchy restricted diffusion in the left parietal lobe with high T2 signal. The ventricles and sulci are stable. Otherwise, patchy and confluent periventricular and subcortical white matter T2 hyperintensity is similar to the prior exam. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is fluid signal in the mastoid air cells bilaterally.

Output: 1.The multiple brain metastases have generally decreased in size since June 2015. Comparison with the brain MRI from July 2015 is otherwise limited due to the extensive motion artifact on that scan.2.Recent infarct involving the left parietal lobe superimposed upon a background of chronic small vessel ischemic disease.Findings discussed with Dr. Salgia by phone at 4:30pm on 10/14/2015.


Instruction: Generate impression based on findings.

Input: Male 46 years old s/p meniscal and ACL repairs; new injury with new pain and laxity. MENISCI: There has been repair of the radial tear of the lateral meniscus. Residual tear or repair is seen along the inner margin of the body of the lateral meniscus. Degenerative changes seen at the posterior root of the lateral meniscus, compatible with postsurgical changes.Branching linear signal indicating tearing within the posterior horn and body of the medial meniscus appears new. There is no meniscal extrusion.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits. There are changes from prior ACL reconstruction.There is mild thinning of the articular cartilage along the lateral surface of the patella and a focus of edema signal in the marrow but no evidence of full-thickness cartilage defect. The articular cartilage of the medial and lateral compartments is preserved.LIGAMENTS: There is mild thickening of the ACL graft but the fibers are intact. The PCL, MCL and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.New tear of the posterior horn and body of the medial meniscus.2.Residual tear or retear along the inner margin of the body of the lateral meniscus.3.Intact ACL graft.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: Chronic vertigo History: Above without nystagmus IAC MRIThere is about 4mm x 2mm sized lenticular shaped T1 high signal intensity lesion at the right IAC (series 1401, image 12/20). There is no evidence of mass effects toward adjacent CN 7, 8 or bony IAC. However, the lesion is not seen on any other sequences including post enhancement scans. Therefore, this could represent fat containing non enhancing lesion such as small dermoid or lipoma or dural extension with fatty component. Follow up can be considered if clinically indicated.The brainstem, cerebellum, vermis and tonsils are normal. The inner ear structures, cochlea, vestibule, semicircular labyrinth are normal. The internal auditory canals are normal with delineation of the facial, cochlear and vestibular nerves except above described right IAC lesion. No evidence of signal abnormality, mass or abnormal enhancement is noted. Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Bilateral (left more than right) superior parietal lobule encephalomalacia are seen with gyriform low signal intensities indicating prior hemorrhagic lesion.Scattered periventricular white matter high signal intensity lesions on FLAIR indicate non specific small vessel ischemic disease.The ventricles, cerebral 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 paranasal sinuses and mastoid air cells are clear.

Output: 1. Likely an artifact at the right IAC as described above with the differential diagnosis of dermoid, lipoma or fatty infiltration of dural extension. Follow up can be considered.2. Chronic hemorrhagic lesions on bilateral superior parietal lobules as described above.3. Non specific small vessel ischemic disease.4. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis complex. There is interval decrease in size of the lobulated enhancing mass with areas of susceptibility effect in the left lateral ventricle, which measures up to 32 mm, previously 40 mm. There is persistent mild vasogenic edema in the surrounding brain parenchyma. There is also an enhancing mass within the right lateral ventricle, which measures up to 8 mm, previously 14 mm. There is slightly decrease prominence of the lateral ventricles, which are mildly dilated, and slightly increased diffuse periventricular white matter T2 hyperintensity. There is no significant interval change in numerous foci of subcortical T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. There is a right cerebellar hemisphere developmental venous anomaly. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is persistent mild scattered paranasal sinus mucosal thickening. There is new left tympanomastoid fluid.

Output: 1. Interval decrease in size of bilateral lateral ventricular subependymal giant astrocytomas, left larger than right.2. Other stigmata of tuberous sclerosis are not significantly changed.3. New left tympanomastoid fluid may represent otomastoiditis.


Instruction: Generate impression based on findings.

Input: Increasing dementia in an immunocompromised patient. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate foci of high T2 signal in the cerebral white matter bilaterally. The brainstem and cerebellum appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is mild staphylomatous deformity of the bilateral globes.

Output: a few punctate foci of high T2 signal in the cerebral white matter bilaterally are nonspecific and may represent chronic small vessel ischemic disease or perhaps sequela of infection, but characterization is limited without intravenous contrast. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with weakness and paresthesias. Evaluate for demyelinating disease. Brain:Numerous foci of white matter T2 hyperintensity are seen in the bilateral cerebral hemispheres ranging in size from punctate up to about 7 mm in diameter. A few of these lesions are periventricular in location but most are found in the more peripheral subcortical white matter. The morphology of these lesions is nonspecific. No discrete lesions are seen within the corpus callosum. With the exception of a punctate focus of signal abnormality in the pons, the posterior fossa structures are also spared.No evidence of restricted diffusion, parenchymal edema or mass effect is detected. No abnormal extra-axial fluid collections are seen. There is no evidence to suggest intracranial hemorrhage. The ventricles and sulci may be very slightly prominent for age but this is an equivocal finding.Bone marrow signal characteristics are unremarkable. Extensive paranasal sinus mucosal inflammatory disease is noted.Cervical spine:Evidence of instrumented anterior spinal fusion is seen at C5-6. Laminectomy has also been performed bilaterally from C3 through C7. These surgical findings are unchanged.Also unchanged is a band of T2 hyperintensity within the dorsal spinal cord at the C5-6 level which likely represents myelomalacia as the cord is thinned through this region. There may also be mild linear T2 hyperintensity tracking longitudinally within the cord at the C3 and C4 levels, also unchanged. No evidence of any new spinal cord lesion is seen.Reversal of the normal cervical lordosis is a stable finding. Degenerative endplate signal alteration is seen at C3 and C4, but no worrisome or destructive marrow lesions are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Decompression of the spinal canal. No significant foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation. Decompression of the spinal canal. Mild bilateral foraminal narrowing. C5-6: Disc space is not well visualized due to artifact from orthopedic instrumentation. Decompression of the spinal canal. No significant foraminal narrowing. C6-7: Decompression of the spinal canal. The neural foramen are not well visualized due to motion artifact. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Thoracic spine:Allowing for some image degradation by motion artifact, no spinal cord lesions are seen. The spinal cord demonstrates normal morphology throughout.A very slight scoliotic curvature of the thoracic spine is seen. Sagittal alignment is anatomic. Marrow signal characteristics are somewhat heterogeneous but without any aggressive or worrisome findings.Loss of disc height is seen from T3-4 through T9-10. Disc bulging is also evident at T6-7, T7-8 and T9-10 resulting in at most mild spinal canal narrowing. The T9-10 neural foramina are also likely narrowed to a mild degree. Elsewhere, no significant spinal canal or neuroforaminal stenosis is seen.

Output: 1.Numerous scattered T2 hyperintense lesions are seen within the cerebral white matter. A majority of these lesions are located peripherally in the subcortical white matter and the morphology of the lesions is nonspecific. Of note, the corpus callosum is completely spared. These imaging findings would not be typical for multiple sclerosis, though an atypical demyelinating process should still be considered. Other etiologies, including vasculitic, inflammatory and granulomatous processes, can also be considered.2.Evidence of extensive surgery is seen in the cervical spine including anterior fusion of C5-6 and bilateral laminectomy from C3 through C7. The spinal canal is widely decompressed through the operative region. A focus of encephalomalacia is seen within the spinal cord at the C5-6 level which is unchanged compared to the prior examination. The nature of this lesion is uncertain. Correlation with preoperative imaging would be helpful in this regard. There may be minimal T2 hyperintense signal within the cord above the C5 level, but this is also unchanged. No new cervical cord lesions are seen.3.No evidence of any focal spinal cord lesion is seen in the thoracic spine.4.Degenerative findings are evident in the cervical and thoracic spine with details as indicated above.


Instruction: Generate impression based on findings.

Input: Patient is a 40-year-old female with biopsy proven malignancy in the left breast, approximately 4:00 position, and the indeterminate subcentimeter left retroareolar focus approximately 11:00. Mammogram was requested to evaluated the postbiopsy clip which was placed at outside hospital. DIAGNOSTIC MAMMOGRAM OF LEFT BREAST: Three standard views of left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A focal asymmetry is identified in the lower outer quadrant of left breast, which corresponds to the findings on the prior MRI and the mammogram. An S shaped is present in the slightly medial and inferior aspect of the focal asymmetry.DIAGNOSTIC ULTRASOUND OF THE LEFT BREAST:Left breast ultrasound was performed at the upper in her left breast where the indeterminate subcentimeter enhancement is found on the recent MRI. Ultrasound demonstrates a 4 x 3 x 4 mm hypoechoic mass at 11:00 location, 1.2 cm medial and superior to the known cancer. Incidental note is made of a 3 mm cyst adjacent to this 4 mm mass.

Output: Indeterminate 4 mm hypoechoic mass, 1.2 cm medial to the known cancer in the left breast, for which ultrasound guided biopsy is recommended. Postbiopsy clip in the slightly medial and inferior aspect of known left breast cancer. Results and recommendation were discussed with the patient and Dr. Jaskowiak.BIRADS: 6 - Known cancer.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with encephalopathy. Scattered foci of FLAIR hyperintensity are seen within the bilateral cerebral hemispheres. No edema, mass effect or restricted diffusion is seen. No evidence of acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. Ventricular size and morphology are within normal limits. Postcontrast imaging is degraded by motion which limits sensitivity for subtle findings. Given this caveat, no definite pathologic intracranial enhancement is observed.

Output: 1.Scattered FLAIR hyperintense lesions are seen which statistically most likely represent chronic microvascular ischemia.2.No definite acute intracranial abnormality is seen within the limitations of a motion degraded exam.


Instruction: Generate impression based on findings.

Input: 67 year old man with coronary artery disease s/p 4 vessel CABG and multiple stents. He has recurrence of angina and is referred for location of ischemia.MEDICATIONS: aspirin, clopidogrel, imdur, metoprolol, ramipril, and rosuvastatin First Pass PerfusionDuring hyperemia, there are extensive and severe perfusion defects involving the entire apex, the mid anteroseptal, inferoseptal, and inferior walls, and the entire base except the anterolateral wall.Viability/ Myocardial ScarBased on late gadolinium enhancement imaging, there are 2 distinct myocardial infarctions. The first is a fairly small partially transmural infarction involving the basal inferior and inferoseptal walls. The second is small transmural infarction involving the apical lateral wall. These segments are not likely to be viable; however, the remainder of the myocardium is likely to be viable, including much of the above described ischemic territories and below described wall motion abnormalities. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 42%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 197 ml (normal range 142+/-34), the LV end systolic volume index is 59 ml/m2 (normal range 25+/-9), the LVESV is 113 ml (normal range 47+/-19), the LV mass index is 59 g/m2, and the LV mass is 112 g. There is hypokinesis of th basal to mid inferoseptal, inferior, and inferolateral walls. There is hypokinesis of the mid to apical anterior and anterolateral walls.Left AtriumThe left atrium is normal in sizeRight VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 156 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in sizeAortic 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 mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is mild to moderate atherosclerosis of the brachiocephalic vessels.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 FindingsSternal wires are noted. 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. There is extensive ischemia in the usual distribution of the mid LAD and the RCA territories. The ischemic segments are associated with resting wall motion abnormalities and a significant amount of viability.2. There are 2 distinct, small, transmural myocardial infarctions. The first involves the basal inferior and inferoseptal walls. The second involves the apical lateral wall. 3. Normal LV size with mildly reduced systolic function (LVEF 42%) with the above described regional wall motion abnormalities.4. Normal RV size and systolic function (RVEF 53%).


Instruction: Generate impression based on findings.

Input: A9 year old female with history of multiple myeloma. Presenting with two months history of bilateral neck pain. No vertebral tendinous or neurological findings. Exaggerated lordosis of cervical spine is noted. Extensive lytic lesions of the skull base in particular the clivus is noted. These changes are consistent with patient's diagnosis of multiple myeloma.Multiple lytic lesions involving the entire vertebral body of C2 including the dens, C3, C4 is also noted. There is no evidence of collapse of any of the vertebral bodies and no evidence of malalignment is detected. No definitive evidence of abnormality of the posterior elements is detected. Reformatted images with wide window settings demonstrates no definitive evidence of a soft tissue abnormality within the spinal canal. The caliber of the cord appears unremarkable and subarachnoid space is visualized. If clinical concern persists further evaluation with an MRI would be most helpful. No definitive evidence of bony neural frontal compromise or central spinal stenosis is present.

Output: Extensive lytic changes of skull base and upper cervical spine consistent with multiple myeloma as detailed above.


Instruction: Generate impression based on findings.

Input: History of renal cell carcinoma status post resection, evaluate for recurrence. 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: Status post right nephrectomy. There is a stable small soft tissue nodule in the right nephrectomy bed (series 4, image 16) measuring up to 12 mm, unchanged from 5/5/2015 CT likely representing postoperative change. No suspicious left renal lesions. RETROPERITONEUM, LYMPH NODES: Reference aortocaval lymph node near the aortic bifurcation (series 8, image 35) measures approximately 4 x 6 mm previously 7 x 10 mm on 5/5/2015 CT. Previously described gastrohepatic lymph node is not well-visualized.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fat-containing umbilical hernia.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. No adnexal masses. Previously seen right adnexal lesion has resolved.BLADDER: No significant abnormality noted.LYMPH NODES: The previously described multiple cystic foci in the distribution of the obturator chains which are thought to represent lymph nodes have decreased in size from prior previously measuring up to 1.5 cm now measuring up to 0.7 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable soft tissue nodule in the right nephrectomy bed, likely postsurgical. Previously described abdominal and pelvic lymph nodes have decreased in size.


Instruction: Generate impression based on findings.

Input: Left orbital rhabdomyosarcoma. Partially resected in March 2014. Treated with chemotherapy and proton beam therapy. In remission. The infiltrative signal abnormality involving the left lacrimal fossa and the superior and lateral extraconal aspects of the left orbit has minimally diminished since the previous examination. The associated contrast enhancement is also slightly decreased. There is no evidence of a discrete tumor, however. The minimal thickening and bone marrow T1 hyperintensity in the region of the sphenoid triangle is unchanged, probably reactive. The rest of the left orbit is unremarkable. Focal T2 hyperintensity in the left lateral, inferior aspect of sphenoid body is unchanged and may represent variant pneumatization or other benign entity. The right orbit is normal. The included portions of the brain appear unremarkable. Mucosal thickening in the sphenoid and maxillary sinuses has increased since the previous examination. In addition, mucosal thickening in the mastoid air cells has increased and is worse on the left.

Output: 1. Post-treatment findings in the left orbit without evidence of locally recurrent tumor.2. Increased diffuse paranasal sinus inflammation.3. Nonspecific inflammatory changes in the bilateral mastoid air cells may represent mastoiditis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of fevers. Prior imaging with concern for discitis. Evaluate for osteomyelitis discitis Lumbar Spine:Redemonstrated postoperative changes from L4-5 posterior spinal fusion. Susceptibility artifact related to the hardware limits evaluation of this region. The vertebral body heights are preserved. Alignment is anatomic. Again seen is mildly increased STIR signal and mild enhancement within the T12 vertebral body. There are small Schmorl's nodes and degenerative endplate irregularity at T11-12, but there is no frank osseous destruction identified. The T11-12 disc shows nonspecific increased T2 signal but no pathologic enhancement. Marrow signal within the T11 vertebral body is normal. No epidural collections are identified at this level.Multiple small renal cysts are seen bilaterally.Additional level by level findings are as follows:T11-12: No disc bulge. Moderate facet hypertrophy creates mild right neural foraminal stenosis. No significant spinal canal stenosis or left neural foraminal stenosis. T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: Marked degeneration of the right facet joint. Mild asymmetric thickening of the right dorsal epidural tissues with mild enhancement with no obvious fluid collections. No significant spinal canal or neural foraminal stenosis.L2-L3: Bilateral facet arthropathy, hypertrophy of the ligamentum flavum and mild disc bulge create mild spinal canal and mild left neural foraminal narrowing. No significant right neural foraminal narrowing. Mild thickening and enhancement of the dorsal epidural tissues is also seen without evidence of a fluid collection.L3-L4: Facet arthropathy and hypertrophy of ligamentum flavum without significant spinal canal or neural foraminal stenosis. L4-L5: There are degenerative fatty endplate changes and marked disc degeneration. Diffuse disc bulge/osteophytic spurring and bilateral facet arthropathy. Severe right and moderate left neural foraminal narrowing. No significant spinal canal stenosis. There is a 12 mm fluid collection in the right paraspinal soft tissues adjacent to the spinous process of uncertain clinical significance. No adjacent soft tissue inflammation.L5-S1: Bilateral facet arthropathy and hypertrophy of the ligamentum flavum. Severe bilateral neural foraminal stenosis.

Output: 1. Abnormal marrow signal and subtle enhancement within the T12 vertebral body and abnormal T2 signal (without enhancement) of the adjacent T11-12 disc without without frank osseous destruction, or significant adjacent soft tissue inflammation, or epidural collection. Findings are nonspecific and could represent early infection versus inflammatory (either degenerative or traumatic) etiologies.2. Previously questioned ventral epidural fluid collection at the L1-2 level is not clearly identified on this dedicated exam. Instead there is mild dorsal epidural soft tissue thickening at L1-2 and L2-3 with mild enhancement. This may represent mild inflammation adjacent degenerated facets, less likely a manifestation of infection.3. Nonspecific 12 mm fluid collection in the right paraspinal soft tissues at the L4-5 level of uncertain significance.4. Multilevel degenerative changes with associated neural foraminal narrowing at L4-5 and L5-S1.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is a large soft tissue mass involving the posterior elements of L1 through L4 effacing the thecal sac with compression of the cauda equina at L3/4. It also extends into adjacent neural foramina. There is no cord or conus compression, acute or chronic.

Output: 1.There is a large soft tissue mass involving the posterior elements of L1 through L4 effacing the thecal sac with compression of the cauda equina at L3/4.2.There is no cord or conus compression.3.These results were transmitted to the emergency department via STAT Consult 27 minutes prior to exam completion by the technologist.


Instruction: Generate impression based on findings.

Input: 86-year-old female with weakness. This exam is extremely limited secondary to motion. There is reversal of cervical lordosis. Craniovertebral junction appears intact. Vertebral bodies are normal in height. There are numerous disc bulges evident, most significantly at C3-C4. There is significant spinal stenosis most notably at the C3-C4 and C4-C5 level. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord is difficult to assess on this examination.Degenerative changes are seen in the cervical spine as described below:C2-3: There is a disc osteophyte complex and ligamentum flavum hypertrophy causing mild spinal stenosis without neural foraminal stenosis.C3-4: There is a broad disc osteophyte complex with substantial ligamentum flavum hypertrophy causing severe spinal stenosis with cord impingement and questionable left neural foraminal stenosis. The cord signal is difficult to ascertain due to artifact.C4-5: There is a disc osteophyte complex and ligamentum flavum hypertrophy causing mild-moderate spinal canal stenosis. There is mild right and moderate left neural foraminal stenosis.C5-6: There is a small disc osteophyte complex and right facet degeneration. There is anterior effacement of the thecal sac with moderate right and mild left neural foraminal stenoses.C6-7: There is a small disc osteophyte complex with a small amount of ligamentum flavum hypertrophy causing anterior effacement of the thecal sac. There is mild right neural foraminal stenosis.C7-T1: Mild disc osteophyte complex.The upper thoracic spine demonstrates multiple disc bulges.

Output: Multilevel degenerative changes including disc bulges, ligamentum flavum hypertrophy, and neural foraminal stenoses. These are most apparent at C3-C4 and C4-C5 where there is spinal stenosis and cord impingement.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for altered mental status in patient with metastatic lung adenocarcinoma. Signs and symptoms: 76-year-old male with newly diagnosed stage IV lung cancer. Enhanced head CT:60 cc of Omnipaque 350 is administered for this study.There is a focus of subtle increased density in the inferior aspect of the vermis measuring approximately 14 times 10-mm in size (axial image 7). There is no distinct mass effect or any detectable surrounding vasogenic edema. Possibility of artifact cannot be entirely ruled out considering patient's history. Recommend further follow-up with enhanced brain MRI. The fourth ventricle is normal in size. Images through the supratentorial space demonstrate no findings to suggest metastatic lesion. There are however subtle subcortical and periventricular low-attenuation of white matter in bilateral cerebral hemisphere concerning for moderate degree of small vessel ischemic stroke of indeterminate age. The cortical sulci, ventricular system and all CSF cisterns remain within normal.Limited images through the orbits are unremarkable.Calvarium is intact.

Output: 1.One subtle focus of increased density/enhancement in inferior aspect of vermis with no associated surrounding vasogenic edema or any detectable mass effect. To exclude possibility of metastatic lesion recommend follow-up with an MRI exam.2.Small vessel ischemic strokes of indeterminate age.3.Calvarium is intact.


Instruction: Generate impression based on findings.

Input: Female, 33 years old, with Hashimoto encephalitis and seizure. Some sequences are degraded by motion artifact which slightly limits the evaluation.The previously seen T2 hyperintense signal involving the right parietal, occipital and temporal lobes is largely stable. Extensive bilateral progression of signal abnormality is seen, however, throughout the remaining cerebral hemispheres. There are now patchy areas of new cortical and subcortical T2 hyperintensity with a predominance of findings in the inferior frontal, parietal, occipital and temporal lobes. The basal ganglia are spared, but some involvement of the thalami is seen. Lesions in the midbrain and left cerebellar hemispheres were present previously and have not progressed. Patchy areas of mild cortical restricted diffusion are seen matching the distribution of new disease, though the size of the T2/FLAIR lesions is larger than that of the diffusion lesions.No significant generalized mass effect is seen. No large intracranial hemorrhage or abnormal fluid collection is evident. The ventricular system is stable in size and morphology.

Output: Interval progression of disease is seen with numerous new cortical and subcortical lesions involving both cerebral hemispheres. Mild new cortical restricted diffusion is also seen matching the pattern of new disease but of a lesser magnitude, indicating a minor component of cytotoxic edema.MRA images are motion degraded, but no significant proximal vascular stenosis or occlusion is seen.The constellation of findings would be compatible with progression of an autoimmune encephalitis, as indicated by history, as well as vasculitis.


Instruction: Generate impression based on findings.

Input: Seizures, assess for focal lesion causing epilepsy. There are multiple nodules that are isointense to gray matter on both T1 and T2 along the undersurface of the trigone and occipital horn of the left lateral ventricle, compatible with temporal and occipital subependymal heterotopia. Similar abnormality is present along the superior aspect of the posterior body of the left lateral ventricle (parietal). There is no associated susceptibility.There is mild asymmetric expansion of the temporal horn of the left lateral ventricle. High resolution coronal T2 and T2 FLAIR imaging of the hippocampi is notable for mildly increased T2 FLAIR signal in the left hippocampal head (images #15 and 16 of series #1001), which is associated with asymmetric volume loss. The remainder of the brain shows no abnormality. The ventricles and other CSF-containing spaces are normal in size. There is no midline shift or brain herniation. The flow voids of the major intracranial vessels are preserved, reflecting gross patency.There is no gross orbital abnormality. The mastoid air cells are clear. There is no destructive skull lesion.

Output: 1.Multiple nodules along the left lateral ventricle as described above are consistent with nodular subependymal heterotopia.2.Findings suggestive of left mesial temporal sclerosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 47 years old, with right-sided hyperreflexia and weakness. Assess for cord compression versus nerve root compression. Brain:Diffusion-weighted images are within normal limits. A small linear focus of T2 hyperintensity is evident within the brainstem at the pontomedullary junction, actually best appreciated on sagittal spine views. No evidence of edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.C-spine:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen.The visualized spinal cord shows normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Facet arthropathy is evident on the right. A small expansile cystic lesion noted on prior CT within the C4 superior articulating process is T2 hyperintense. Minimal posterior disc-osteophyte complex formation is seen. No significant spinal canal stenosis. Severe right foraminal narrowing with possible nerve root impingement. C4-5: Posterior disc-osteophyte complex formation asymmetric to the right paracentral zone which impinges upon and mildly deforms the spinal cord. No cord signal abnormality. Mild left foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation with central focality which mildly impinges upon the spinal cord. No cord signal abnormality. Mild left foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: Facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1.No acute lesions are evident in the brain. Note is made of a small T2 hyperintense focus within the brainstem at the pontomedullary junction for which there is no correlation on prior CTA. This finding is nonspecific and could reflect a small chronic ischemic lesion or gliosis from prior inflammation or injury.2.Multilevel cervical spondylosis is demonstrated in the cervical spine. This is most notable at C4-5 and C5-6 where disc osteophyte complexes also impinge upon the spinal cord. At C3-4, significant facet arthropathy is evident on the right with probable degenerative cyst formation. This results in a severe stenosis of the neural foramen and possible nerve root impingement.


Instruction: Generate impression based on findings.

Input: Possible schwannoma: neck pain and abnormal brain MRI. There is an extra-axial, lobulated, heterogeneously enhancing right suprasellar mass with extension into the right prepontine cistern that measures up to 23 mm. There is mild mass-effect upon the surrounding neurovascular structures, including the pons and optic apparatus, but no significant narrowing of the arterial flow voids. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchymal signal and pituitary gland appear unremarkable. The ventricles are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: An extra-axial, lobulated, heterogeneously enhancing right suprasellar mass with extension into the right prepontine cistern measures up to 23 mm. Differential considerations include craniopharyngioma and meningioma, for example.


Instruction: Generate impression based on findings.

Input: History of recurrent astrocytoma treated with chemotherapy and radiation therapy, current off therapy for 15 1/2 years. There are postoperative findings related to suboccipital craniectomy and upper cervical laminectomies. There is unchanged non-enhancing, diffuse, patchy, infiltrative T2 hyperintense signal that extends from the lower medulla to the C5 level with associated expansion of the spinal cord, particularly at the upper to mid C2 levels. There are also unchanged subcentimeter cystic cavities within the mass at the C1 and C2 levels. The vertebral column alignment is unchanged. The upper cervical vertebral bodies remain relatively small in size and there is persistent T1 hyperintense signal in the bone marrow of C2 and C3, which is likely related to radiation therapy. There is an unchanged focus od low T2 and T1 signal in the C5 vertebral body. There is no significant central spinal stenosis or neural foraminal narrowing. There is an unchanged nonspecific prominent left supraclavicular lymph node.

Output: No evidence of cervicomedullary astrocytoma progression and stable associated treatment effects.


Instruction: Generate impression based on findings.

Input: 62 years, Female, Reason: f/u HCC s/p TACE/RFA on 1/7/2015. History: HCC. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Liver morphology shows an enlarged caudate lobe and widening of the intrahepatic fissure is with a slightly nodular contour suggestive of cirrhosis.There are posttreatment changes of interval TACE/RFA with a cavity in segment 5 at the site of prior lesion measuring 2.6 x 1.5 cm (9/246). There is blood within the cavity and peripheral enhancement. Inferior to this cavity within segment 5, there is persistent enhancement measuring 1.7 x 0.9 cm (9/59) which likely represents residual tumor.Subtle focus of enhancement in segment 7 may represent fibrosis.Gallbladder is not visualized.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postsurgical findings of TACE/RFA with enhancement inferior to the ablation cavity which likely represents residual tumor.2.Cirrhotic liver morphology.


Instruction: Generate impression based on findings.

Input: 41-year-old female with generalized abdominal pain. History of scleroderma. Rule out obstruction. ABDOMEN:LUNG BASES: Moderate cardiomegaly. Moderate pericardial effusion. Interstitial lung disease at both lung bases may be due to scleroderma. Diffuse esophageal wall thickening and dilatation.LIVER, BILIARY TRACT: Diffuse infiltrative changes in the liver, especially the right hepatic lobe, narrows the hepatic veins near the intrahepatic IVC. This may be due to fatty infiltration or other etiology. Dedicated hepatic CT or MRI examination may be helpful for further evaluation, if indicated.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: A mesenteric lymphadenopathy is present, most prominently at the mesenteric root. For reference, a mesenteric node measures 1.3 x 2.4 cm axial image 71/144 of series 3.BOWEL, MESENTERY: Diffuse small bowel wall thickening. No definite evidence of bowel ischemia. Normal appendix in the right lower quadrant. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites is present.PELVIS:UTERUS, ADNEXA: Uterus is atrophic or absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: No significant abnormality noted

Output: Cardiomegaly with moderate pericardial effusion. Ascites. Infiltrative changes in the right hepatic lobe, see above. Chronic changes in lung and bowel from scleroderma. Mesenteric lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female, 12 years old, with altered mental status and history of sickle cell disease. Evaluate for infection or stroke. Numerous foci of restricted diffusion are seen ranging in size from punctate up to about 5 mm and distributed predominantly within the watershed zones of the bilateral cerebral hemispheres.These lesions are associated with minimal corresponding T2 hyperintensity, but no significant edema or mass effect is seen. No intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricular system is normal in size and morphology.On postcontrast images, there is prominent sulcal enhancement with subtle corresponding FLAIR hyperintensity which may reflect stagnant flow, vascular collateralization or leptomeningeal inflammation.MRA images demonstrate attenuation of flow related signal within the ICAs bilaterally, both at the level of the anterior genu and at the A1/M1 junctions. Distally, the visualized intracranial vessels demonstrate normal caliber. No specific abnormalities are detected within the posterior circulation.

Output: 1. Numerous small scattered acute strokes are seen within the watershed zones of the cerebral hemispheres. These result in no significant parenchymal edema or mass effect.2. Diffuse cerebral sulcal enhancement is seen, a nonspecific finding which, given the above findings, may reflect slow flow or vascular collateralization. However, this could also reflect leptomeningeal inflammation or infection in the appropriate clinical context.3. MRA imaging of the intracranial vessels demonstrates apparent attenuation of flow related signal within the distal ICAs. Such findings can sometimes arise as a result of an imaging artifact. However, given the presence of ischemic lesions, the possibility of true vascular narrowing, as in an early moyamoya phenomenon, should also be considered.


Instruction: Generate impression based on findings.

Input: Episodic tension-type headache, intractable [G44.211], Reason for Study: ^Reason: r/o structural lesion History: HA associated with right side weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of abnormal enhancement.Multiple small high signal intensities on subcortical white matter and periventricular white matter are non specific likely represent non specific small vessel ischemic disease.There are however multiple small susceptibility lesions at the right anterior temporal lobe and right posterior inferior temporal lobe without associated with surrounding edema. In particular, the left cerebellar hemisphere lesion is associated with developmental venous anomaly. A small susceptibility lesion just mesial to the DVA is likely to be adjacent venous structure instead of parenchymal lesion. Constellation of these findings suggest differential diagnosis of possibility of cavernous malformation, chronic petechial hemorrhages and calcifications. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Retention cyst on the left side of sphenoid sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate subtle luminal irregularities of intracranial arterial system without evidence of significant (more than 50%) luminal stenosis. Note is made that distal basilar artery shows about 20-30% luminal narrowing in conjunction with luminal irregularities of bilateral PCAs indicating atherosclerotic changes. No aneurysm is seen. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left vertebral artery originates from the aortic arch directly. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. 2-3 susceptibility lesions on the right temporal lobe with DVA on the left cerebellar hemisphere. Differential diagnosis include cavernous malformation, chronic petechial hemorrhage and calcifications.3. Atherosclerotic changes of intracranial arterial system without evidence of significant luminal narrowings. No aneurysm.4. Normal Neck MRA.


Instruction: Generate impression based on findings.

Input: Female, 61 years old. Pain. MENISCI: There is abnormal signal intensity throughout the expected location of the anterior horn of the lateral meniscus as well as the anterior half of the body of the lateral meniscus indicating extensive tearing. Furthermore, there is slight lateral extrusion of the body of the lateral meniscus with deformity suggesting the possibility of a displaced meniscal fragment along the mid body. The posterior horn of the lateral meniscus appears relatively intact. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the lateral tibiofemoral compartment with areas along the weightbearing surface of the lateral femoral condyle and lateral tibial plateau essentially devoid of cartilage. As seen on recent radiographs, there is a focal depression of the surface of the lateral femoral condyle above the torn anterior horn of the lateral meniscus with what appears to be disruption of the subchondral bone plate posteriorly. There are parallel curvilinear bands of high and low signal intensity deep to the depression as well as extensive edema throughout the lateral femoral condyle and extending into the distal femoral metaphysis. These findings suggest osteonecrosis with subchondral collapse perhaps in association with a prior subchondral stress fracture. There are also subchondral cysts and mild edema type signal within the lateral tibial plateau, likely degenerative in etiology. The articular cartilage of the medial and patellofemoral compartments is relatively spared.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Severe cartilage degeneration and meniscal tearing affecting the lateral compartment with focal depression of the articular surface of the lateral femoral condyle suggesting osteonecrosis with extensive adjacent marrow edema.2.Joint effusion and Baker's cyst.


Instruction: Generate impression based on findings.

Input: History of cirrhosis. Presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour, fissural prominence and morphology compatible with cirrhosis.Bandlike reticular increased T2 signal especially near the porta hepatis is compatible with superimposed fibrosis. Stable subcentimeter right hepatic lobe cyst.No discrete suspicious lesion is evident.Mildly prominent common bile duct tapers smoothly at the level of the ampulla without a discrete mass or stone. This is unchanged.The portal vein, hepatic veins and hepatic artery are patent.SPLEEN: Splenomegaly measuring 19 cm in craniocaudal dimension. Trace perisplenic fluid.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing subcentimeter renal lesions, likely cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Recanalized umbilical vein. Small retroperitoneal, periportal and peripancreatic lymph nodes are likely reactive and are unchanged.BONES, SOFT TISSUES: Body wall collateral vessels are noted.OTHER: No significant abnormality noted.

Output: Cirrhosis and stigmata of portal hypertension including splenomegaly without a suspicious liver lesion. Minimal perisplenic fluid, decreased from the prior study. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dorsalgia, unspecified. Other chronic painClinical question: rule out abscess, osteoSigns and Symptoms: pain, imaging findings of osteo Five lumbar type vertebral bodies are presumed to be present. The patient is status post posterior fusion at L3-4, L4-5 and L5-S1 associated with bilateral pedicle screws at L3, L4, L5 and S1. Patient is status post laminectomies at L4 and L5. There is anterior wedging of the L3 vertebral body. 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 loss of disc space height and a diffuse disc bulge at this level. There is partial effacement of the fat surrounding the exiting nerve roots within the neural foramina at this level. These findings are stable compared to the August exam.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and a diffuse disc bulge at this level associated with effacement of the fat surrounding the exiting nerve roots within the neural foramina. The endplates are irregular at this level and there is mild anterior subluxation of L4 and L5. There are endplate reactive changes present which are bright on T1. These findings are stable compared to the August 2015 exam.At L3-4 there is no significant compromise to spinal canal or neural foramina.There is mild anterior subluxation of L3 and L4. There is ligamentum flavum hypertrophy present at this level as well as facet hypertrophy. At L2-3 there is a large left lateral recess disc extrusion present with disc material extending behind the L2 and L3 vertebral bodies and compressing the thecal sac and effacing spinal fluid surrounding the nerve roots of the cauda equina at this level. On sagittal imaging the disc extrusion measures approximately 26 x 11 mm sagittal dimensions. There is also a left far lateral disc protrusion at this level which displaces the left-sided exiting nerve root after it exits the neural foramen. These findings are stable compared to the August exam. Since the prior exam, however, the adjacent vertebral arteries have the lower T1 signal and the endplates are not readily visualized. Additionally, there is signal hyperintensity within the L2-3 disc space and which is new since the prior exam.At L1-2 there is no significant compromise to spinal canal or neural foramina.Examination is degraded by patient motion which may obscure more subtle abnormalities.There is atrophy of the left psoas muscle.A well-circumscribed T1 hyperintense 6 mm lesion is present in the right psoas muscle at the L2-3 disc space level. It is unclear whether this was previously present on the prior exam because the prior exam is degraded by patient motion.

Output: 1.There are inflammatory changes present at the L2-3 disc space level which were not as present on the prior exam from August 2015. The possibility of discitis and osteomyelitis should be considered.2.There is a large disc extrusion at L2-3 which creates significant spinal stenosis. These findings were also present on the August exam 2015.3.A 6 mm collection the right psoas muscle is of unknown significance.4.The patient is status post lower lumbar spine surgery as described above with posterior fusion and laminectomies.


Instruction: Generate impression based on findings.

Input: Hemiplegia, unspecified, affecting unspecified side [342.90], Reason for Study: ^Reason: r/o stroke History: right-sided weakness and dysarthria No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 55-year-old male with rectal cancer PELVIS:PROSTATE/SEMINAL VESICLES: Indeterminate subcentimeter T2 hypointense lesion in the medial right peripheral zone - incompletely characterized on this study. BLADDER: No significant abnormality noted.LYMPH NODES: Lymph nodes in the perirectal space, confined by the mesorectal fascia: bilateral lymph nodes with the largest measuring 11 x 13 mm on the right. Lymph nodes outside the mesorectal fascia: none. BOWEL, MESENTERY: There is a mildly enhancing mass in the anterior wall of the rectum that measures 2.8 x 2.0 x 5.7 cm (TR x AP x CC). Tumor appears to involve the muscularis propria although does not definitively extend beyond. Rectal Tumor:Size: 4.4 x 1.8 x 2.9 cm (image 8/series 32)Tumor appearance on T2-weighted images: iso to hyperintense. Tumor location: anterior wall of the lower rectum(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 2.3 cmCircumference of the rectum involved: Nearly 360 degree involvement of the rectal wall at the inferior aspect of the tumor. Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): Uninvolved and separated by fat planes. MRI T-stage: T1-T2 - Tumor invades submucosal and/or tumor invades muscularis propriaTumor Distance to Mesorectal Fascia: Anterior tumor without significant mesorectal fat in between tumor rectal wall and pelvic floor muscles (image 4/series 33).BONES, SOFT TISSUES: Probable bone island in the right posterior acetabulum.OTHER: No significant abnormality noted.

Output: 1.Lower rectal wall tumor as described above. Enlarged right mesorectal lymph node and additional lymph nodes as above. 2.Indeterminate subcentimeter T2 hypointense lesion in the medial right peripheral zone of the prostate gland. Correlation with PSA is recommended.


Instruction: Generate impression based on findings.

Input: Reason: Med Men Tear History: Pain MENISCI: There is globular increased signal abnormality within the anterior horn of the lateral meniscus indicating intrasubstance degeneration. Some of the signal extends to the femoral articular surface indicating superficial fraying/degenerative tearing. The posterior horn appears intact. There is globular increased signal abnormality within the posterior horn of the medial meniscus indicating intrasubstance degeneration. There is blunting of the body of the medial meniscus indicating degenerative tearing. No fluid-filled tear is evident.ARTICULAR CARTILAGE AND BONE: The medial compartment articular cartilage appears intact. There is full-thickness articular cartilage degeneration along the lateral femoral condyle anterior to the anterior horn of the meniscus. There is full-thickness articular cartilage degeneration affecting the patellofemoral joint particularly along the lateral facet of the patella which is nearly completely devoid of articular cartilage. There is focal full-thickness articular cartilage degeneration along the lateral facet of the femoral trochlea, inferiorly, with underlying subchondral cyst formation and degenerative signal abnormality. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is increased signal abnormality and thickening of the proximal fibers of the lateral collateral ligament proper which may reflect prior injury or sprain. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Intrasubstance degeneration and superficial fraying/degenerative tearing of the menisci without evidence of an unstable fluid-filled tear.2. Osteoarthritis of the knee including full-thickness articular cartilage degeneration most pronounced along the patellofemoral articulation as described above.3. Increased signal abnormality within the lateral collateral ligament proper may reflect a mild sprain in the correct clinical setting.


Instruction: Generate impression based on findings.

Input: Ewing sarcoma, restaging Note that the evaluation of the femur is severely limited secondary to the presence of a femoral endoprosthesis and hip arthroplasty.Again noted are surgical changes in the lateral soft tissues of the right upper thigh with a linear tract extending from the skin to the the vastus lateral and intermedius. There is persistent low signal intensity on T1 and bright signal on T2 although the extent of T2 hyperintensity within the musculature appears slightly improved from the prior exam (series 13 image 7/44 compared to series of 11 image 35/52 on the prior). There is persistent heterogeneous enhancement of the left thigh without discrete mass. There is fullness of the lateral thigh (image 13/44 of series 21) which appears to be related to muscular outpouching, conceivably related to scarring, however continued attention in this area is recommended on future exams. There is generalized mild fatty atrophy of the thigh musculature which is similar to the prior exam.

Output: Significantly limited examination secondary to susceptibility artifact. Within the limits of the exam, there is no discrete mass identified. There is persistent heterogeneous enhancement of the lateral thigh musculature with an area of fullness in the lateral thigh which may be related to scarring and tethering of the musculature however attention to this area on follow-up exams is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: History of CVA. Signs and symptoms: Weakness. Non-enhanced head CT:Examination demonstrate an area of low-attenuation involving the inferior aspect of the left cerebellum highly concerning for an acute/early subacute nonhemorrhagic left pica territory stroke. This lesion measures approximately 20.5 x 20-mm in size. No evidence of hemorrhagic component is detected. This finding is best appreciated on axial image number 8. There is also an additional similar area of low-attenuation involving the tip of a right occipital lobe representing an additional focus of non-hemorrhagic acute/early subacute cortical stroke. Few additional very small patchy areas of low attenuation are also noted in the superior aspect of left cerebellum which are also concerning for additional areas of cortical stroke of indeterminate age (due to very small size).Additional foci of low-attenuation involving high convexity left frontal lobe cortex which is concerning for additional foci of a stroke. None of this finding is associated with a hemorrhagic component.Focal area of high density within the upper pons with extension into the left cerebellar peduncle is present. This finding measures approximately 10 x 7-mm in size. The finding could represent a small area of hemorrhage other possibility of mild calcification from a cavernous malformation cannot be entirely ruled out. There are no prior exams for comparison. This lesion can be further evaluated with a dedicated MRI of the brain.There is a small vessel ischemic disease. No evidence of midline shift or hydrocephalus.Above described findings were discussed with the referring clinical physician Dr. Eaton Kelly pager number 3051 at the time of interpretation. If

Output: 1.Multiple foci of acute/early subacute nonhemorrhagic vertebral basilar system strokes in the left pica territory, right occipital lobe and left superior cerebellar artery.2.High convexity left frontal stroke likely subacute.3.Small vessel disease of indeterminate age.4.Small foci of increased density in the pons and the base of the left cerebellar peduncle which could represent small area of hemorrhage or a cavernoma. Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Male 14 years old Reason: Eval for signs of disease (pt has chronic non-infectious osteomyelitis) History: pain, elevated inflammatory markers TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: There is a near contiguous intermediate T1 and high T2 signal intensity material, when compared to the paraspinal musculature, which diffusely and avidly enhances within the anterior epidural space, the neural foramina, and prevertebral spaces extending from the inferior aspect of C4 to the T6/T7 level. Along the upper spine, this appears to be centered at the C7 level where there is mild lordosis of the cervicothoracic junction and edema type signal within the posterior elements of C7, as well as scattered elsewhere throughout the cervical and thoracic vertebrae.This process effaces/invades the bilateral neural foramina from C4 to C7, the right neural foramina from T1-T7/T9, the left neural foramina from T1 to T10/11. There is moderate spinal canal stenosis at the cervicothoracic junction and scattered mild stenosis of the upper to mid thoracic spinal canal. There are more focal regions of heterogeneity within this material at C7/T1 extending into the right T1/T2 neural foramina and within the epidural space of T5 extending into the left neural foramina of T5/T6, without defined collections measurable. There is no abnormal signal abnormality within the cord. Furthermore, the right cervical vessels are displaced anteriorly from mass effect. The vertebral arteries, right greater than left, are also encased, however, flow voids appear preserved. There is a near continuous peripherally enhancing, central low intensity collection in the prevertebral soft tissues extending from the level of T1 to T11/T12 with loculated/complex components in areas. The collection at its maximal thickness measures 10 mm along the right anterior aspect of the T6/T7 vertebral bodies. There is low T1 signal intensity within the C4-T1 vertebral bodies and posterior elements of C7 with associated abnormal T2 signal and enhancement which is more prominent within the vertebral bodies of C4 and C5 and the spinous process of C7. There is additional patchy low T1 signal, high T2 signal, and enhancement within the posterior aspect of the T2-T7 vertebral bodies and throughout the T8-T11 vertebral bodies. There is no significant signal abnormality within the interposed disc spaces of the cervical or thoracic spine. There is irregular opacity within the posterior right upper lobe as well as focal pleural thickening and enhancement medially, adjacent to the paraspinal inflammatory change. Fluid is noted within the esophagus.

Output: 1. Extensive enhancing paravertebral and epidural material extending from the C4 to T6/T7 which appears to be centered at the level of C7 along the upper spine, with isolated signal abnormality within the posterior elements at this level and a loculated prevertebral peripherally enhancing collection extending from T1 to T12. Epidural material nearly completes effaces the neural foramina of the mid cervical spine to the lower thoracic spine and there is scattered up to moderate central spinal canal stenosis without intrinsic cord signal abnormality. There is also bone marrow signal abnormality within the mid cervical to lower thoracic vertebral bodies without evidence of disk abnormality. Given the patient's history, the differential diagnosis primarily includes TB spondylitis with abscess formation, although atypical infectious or fungal etiologies are possible. Lymphoma or metastatic disease are also a consideration.2. Posterior right upper lobe nonspecific irregular opacity with adjacent pleural thickening, incompletely evaluated; dedicated chest radiograph is recommended for further evaluation, especially with the consideration for possible TB involvement. Findings communicated via telephone to Nathan Frogge at 1117 hrs on 1/27/2016.


Instruction: Generate impression based on findings.

Input: Male, 2 years old, with seizures. Evaluate for focal abnormality. Brain parenchymal morphology is within normal limits. No structural abnormality, dysplasia or migrational anomaly is suspected. No evidence of any focal signal abnormality, edema or mass effect is seen. The mesial temporal lobe structures are symmetric in size and signal characteristics.No pathologic parenchymal or extra-axial enhancement is observed. There are no findings to suggest intracranial hemorrhage. The ventricles are normal in size and morphology. A mega cisterna magna is demonstrated.The pituitary region is unremarkable. The corpus callosum is fully formed and intact. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed and intact. The pattern of white matter myelination is appropriate for age.

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


Instruction: Generate impression based on findings.

Input: 81-year-old female with a nonhealing ulcer and elevated CRP greater than 200. Evaluate for osteomyelitis of the left third toe stump. Note is made of increased signal abnormality on fluid sensitive sequences within the proximal phalanx of the third toe of the left foot with associated decreased signal abnormality on T1-weighted images and enhancement on postcontrast sequences. These findings are consistent with osteomyelitis. No additional bone marrow signal abnormality is identified. There is nonspecific subcutaneous edema along the midfoot and forefoot most pronounced along the dorsal aspect of the metatarsals. Superimposed infection cannot be excluded and clinical correlation is indicated. No focal fluid collection is identified to suggest abscess formation. There is nonspecific increased signal abnormality within the imaged flexor and extensor musculature of the midfoot/forefoot.

Output: Findings consistent with osteomyelitis of the remnant of the third toe as described above.


Instruction: Generate impression based on findings.

Input: 61-year-old woman with aphasia. Please evaluate progression of hematoma. The left temporoparietal junction parenchymal hemorrhage now measures 3.7 x 3.3 cm in the axial plane (series 2 image 13). Accounting for differences in patient positioning, this appears increased in size compared to previous scan on which it measured 3.4 x 3.0 cm. A rim of edema surrounds the hemorrhage. There is no appreciable midline shift. No new areas of hemorrhage are seen.There is mild mass effect upon the left lateral ventricle but no appreciable midline shift. The 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. Extensive soft tissue abnormality is present in the occipital region. This may represent sequela of prior soft tissue hemorrhage as seen on the MRI dated 1/17/2007.

Output: Interval enlargement of left parietal parenchymal hemorrhage as detailed above.


Instruction: Generate impression based on findings.

Input: Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.Limited acquisitions through the brain parenchyma demonstrate T2 hyperintensities within the white matter, primarily periventricular, without associated mass effect. There is also mild diffuse volume loss.

Output: 1.Negative MRI of the internal auditory canals including gadolinium enhancement.2.Limited acquisitions of the brain parenchyma demonstrate small vessel ischemic disease as well as mild diffuse volume loss.


Instruction: Generate impression based on findings.

Input: Female 44 years old Reason: Treatment planning for brachytherapy History: Treatment planning for brachytherapy PELVIS:UTERUS, ADNEXA: Further interval decreased size of necrotic cervical mass, which is now ill-defined and difficult to accurately delineate. Correlating with the location of the mass on prior exams, it appears to measure up to approximately 2.6 x 2 cm on T2-weighted images (series 401/36), previously 3.3 x 4.4 cm. BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral ureteral stents, partially visualized.

Output: Further interval decrease size of cervical mass, which is now ill-defined and difficult to accurately delineate. No new sites of disease.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is moderate to severe thinning of the articular cartilage of the lateral patellar facet with superficial delamination superiorly and near full-thickness cartilage loss more inferiorly. Foci of marrow signal abnormality in the underlying patella may be degenerative in nature or reflect sites of prior microfracture surgery. The articular cartilage of the medial facet is relatively preserved. A low signal intensity cleft of the articular cartilage of the femoral trochlea centrally likely represents a focus of full-thickness degeneration with mild degenerative signal abnormality in the underlying bone. The articular cartilage of the medial and lateral compartments is relatively preserved.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Patellofemoral cartilage degeneration and other findings as described above.


Instruction: Generate impression based on findings.

Input: Metastatic NSCLC to brain status post SRS. Since May 2015, the left parietal lobe lesion has decreased in size, measuring up to 4 mm in diameter, and the enhancement associated with the tiny right parieto-occipital region lesion is no longer discernible, with only a residual punctate focus of susceptibility effect. There are scattered nonspecific punctate foci of susceptibility effect in the bilateral cerebral hemispheres. There is also nonspecific scattered T2 hyperintensity in the cerebral white matter. 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: Since May 2015, the left parietal lobe lesion has decreased in size, measuring up to 4 mm in diameter, and the enhancement associated with the tiny right parieto-occipital region lesion is no longer discernible, with only a residual punctate focus of susceptibility effect.


Instruction: Generate impression based on findings.

Input: Reason: Osteomyelitis of the tibia? History: Erythema and purulence from anterior tibial lesion. Outside bone scan suggestive of osteomyelitis There is a small focus of abnormal signal intensity and enhancement within the skin and subcutaneous fat anterior to the tibial tubercle that presumably represents the site of prior intervention/lancing. There is thickening and mild enhancement of the adjacent skin as well as mild enhancement of the subcutaneous fat perhaps representing a cellulitis which extends laterally along the anterior and lateral compartment musculature. We see no inter or intramuscular fluid collection or enhancement. There is minimal increased signal intensity on fluid sensitive sequences and enhancement of the tibial tubercle with relative preservation of bone marrow signal intensity on T1-weighted images and no frank cortical destruction. These findings likely represent reactive osteitis rather than osteomyelitis. There is a small amount of fluid within the knee joint but no large effusion is evident. There are small cysts seen within the intercondylar eminence of the proximal tibia of doubtful current clinical significance.

Output: Superficial soft tissue inflammation as described above with findings suggestive of mild reactive osteitis rather than osteomyelitis of the tibial tubercle


Instruction: Generate impression based on findings.

Input: Follow-up prostate cancer on focal ablation trial PELVIS:PROSTATE:Prostate Size: 4.1 x 5.2 x 4.8 cm (AP x TR x CC).Peripheral Zone: Ablation zone in the left paramedian mid gland / base with surrounding T1 hyperintensity is unchanged. There is T2 and ADC signal heterogeneity in the peripheral zone, however, no dominant lesion is evident.Central Gland: Benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: Suprapubic catheter. There is soft tissue to the right of catheter in the bladder that is suboptimally evaluatedLYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Post ablation changes.2.Bladder outlet obstruction secondary to BPH with suprapubic catheter. Soft tissue like material or debris within the bladder either from the prostate or the bladder wall.


Instruction: Generate impression based on findings.

Input: Cavernous malformations. 6 month follow-up. The cavernous malformation involving the periphery of the right pons at and just medial to the entry zone for the trigeminal nerve is slightly smaller given regression of the central T1/T2-hyperintense focus. In the axial plane, it now measures 14 mm x 10 mm compared to 17 mm x 10 mm previously. The lesion shows prominent peripheral hemosiderin staining as before. There is no surrounding edema or other findings to suggest acute hemorrhage. Postcontrast images are significantly limited by patient motion. The serpentine vessels medial to the cavernous malformation on the prior examination cannot be assessed due to current artifact.There is no remote focus of susceptibility effect. There is no acute infarct. Few scattered punctate T2-hyperintense lesions in the cerebral white-matter are nonspecific and have not significantly changed. The ventricles, sulci and basal cisterns remain unchanged. There is no mass-effect, midline shift or brain herniation. The major intracranial vascular flow voids are preserved accounting for small/hypoplastic right vertebral artery.

Output: The single cavernous malformation in the right lateral pons is slightly smaller compared to the December 2015 examination, reflecting expected evolution from the prior examination. No other remote lesion identified.


Instruction: Generate impression based on findings.

Input: 26 year old female with symptoms of shortness of breath, prior imaging with EF 51%, mitral valve prolapse and mitral valve regurgitation. Looking for assessment of EF, chamber quantification Left VentricleThe left ventricle is normal in size with low normal ejection fraction. The overall LV ejection fraction is 51%. The LVEDV is 194 ml (normal range 109+/-23), LV end diastolic volume index is 99 ml/m2 (normal range: 65+/-11), LVESV is 100 ml (normal range 31+/-10), and LV end systolic volume index is 51 ml/m2 (normal range 18+/-5). The LV mass is 140 g (normal range 114+/-24) and the LV mass index is 72 g/m2 (normal range 67+/-11). 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.The native T1 myocardial relaxation time is [1036]ms. These values are [normal], suggestive of [no]underlying diffuse fibrosis or infiltration. Left AtriumThe left atrium is normal.Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 162 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 72 ml (normal range 35+/-13). Right AtriumThe right atrium is normal sized. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is mild prolapse of the mitral valve leaflets and mild 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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is normal in size with low normal ejection fraction. The overall LV ejection fraction is 51%2. Right ventricle is normal in size and function. The overall RV ejection fraction is 55%.3. There is mild prolapse of the mitral valve leaflets with mild mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for etiology of breakthrough seizure. Signs and symptoms: Breakthrough seizures, patient has known metastatic esophageal cancer with left brain met. Pre-and post-enhanced brain MRI:Examination demonstrates no evidence of an acute intracranial hemorrhage, midline shift or hydrocephalus.A necrotic rim enhancing tumor in the left post central gyrus is again identified. It measures at 13.8 x 14.4 x 16.7-mm and demonstrates very subtle interval increased size since prior study measurement of 13 x 14.8 X 15.6-mm. Large focus of surrounding vasogenic edema demonstrates no significant change since prior exam and results in regional mass-effect without mass effect on the lateral ventricle or midline shift.There is no detectable additional foci of parenchymal or leptomeningeal enhancement.Finding suggestive of mild chronic non-hemorrhagic small vessel ischemic strokes are again noted and diffusion-weighted images are negative.Calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Unremarkable images through the orbits and included axial fat sat post enhanced series. Excellent all paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.No detectable acute intracranial process. 2.Left post central gyrus rim enhancing metastatic lesion demonstrates subtle interval increased size (likely as result of treatment) however with stable surrounding vasogenic edema with resultant regional mass-effect and no midline shift.3.Negative diffusion weighted images and finding suggestive of mild chronic small vessel ischemic strokes


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with low back pain. A grade 1 anterolisthesis of L3 relative to L4, and L4 relative to L5 is seen. Vertebral body heights are preserved. Marrow signal characteristics are within normal limits.The visualized distal spinal cord and conus are within normal limits. The cauda equina is unremarkable except as discussed below. No epidural abnormalities are suspected.L1-2: Facet arthropathy and ligamentum flavum thickening. Minimal disc bulging. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Minimal disc bulging. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. L3-4: Advanced facet arthropathy and ligamentum flavum thickening. Disc bulging and disc uncovering. Severe spinal canal stenosis with crowding of the cauda equina. Mild bilateral foraminal narrowing. L4-5: Advanced facet arthropathy and ligamentum flavum thickening. Disc bulging and disc uncovering. Severe spinal canal stenosis with crowding of the cauda equina. Moderate left and mild right foraminal narrowing. L5-S1: Advanced facet arthropathy. Minimal disc bulging. No spinal canal or foraminal stenosis.

Output: Multilevel disc and posterior element degeneration is seen. At L3-4 and L4-5, these findings result in severe spinal canal stenosis with crowding of the cauda equina.


Instruction: Generate impression based on findings.

Input: 89-year-old female with history of hip fracture, status post right hip replacement, now with left hip pain, inability to ambulate. Evaluate for fracture.IMAGE ACQUISITIONS: Routine high-resolution CT of the left hip was performed without intravenous contrast. There is a nondisplaced fracture the left femoral neck with minimal impaction, which is likely subacute, given lack of effusion or associated soft tissue abnormality. MRI could be considered for further evaluation. Corticated linear lucency through the inferior acetabulum (coronal image 47/93), is consistent with prior fracture. Additional cleft in the articular surface of the superior acetabulum (coronal image 39/93), may also represent prior fracture deformity.Bones are diffusely demineralized. Moderate degenerative changes affect the left hip.Arterial atherosclerotic calcifications are present. Small paraumbilical fat containing hernia is seen.

Output: Left femoral neck fracture is likely subacute. Additional prior acetabular fractures, as described above.


Instruction: Generate impression based on findings.

Input: Reason: L proximal arm mass, evaluate for hematoma vs malignancy History: expanding L proximal arm mass ROTATOR CUFF: There is thickening and intermediate signal intensity of the supraspinatus indicating moderate tendinosis. There is a partial thickness tear of the anterior fibers of the infraspinatus at the level of its insertion on the greater tuberosity measuring 4 mm in the AP dimension. There is interstitial tearing of the infraspinatus more proximally. There is thickening and intermediate signal intensity affecting the infraspinatus indicating moderate tendinosis. There is partial thickness articular surface tearing of the subscapularis at the level of its insertion on the lesser tuberosity. There is no significant retraction. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Mild osteoarthritis affects the glenohumeral joint. There is a small amount of fluid within the joint without evidence of a large effusion. The glenoid labrum appears intact within the limitations of a non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Tendinosis and partial thickness tearing of the infraspinatus without significant retraction as described above. 2. Osteoarthritis of the left shoulder. 3. Lobulated collection along the anterior aspect of the mid humeral diaphysis which is incompletely imaged/characterized on this examination. Please refer to the dedicated MRI humerus report for additional details.


Instruction: Generate impression based on findings.

Input: 66-year-old female patient with small cell lung cancer with brain metastases. Evaluate for progression. Redemonstration of numerous supratentorial and infratentorial enhancing lesions seen on a pretreatment scan from 12/25/2014 which remain decreased in size and similar to the most recent study on 6/22/2015 except for a right periventricular lesion along the right lateral ventricle (image 59, series 12). This lesion is more prominent on this examination and measures approximately 8 mm in the longest dimension, previously 6 mm. Many of these lesions are hemosiderin stained, appearing similar to the prior study. A formerly large extra-axial lesion along the right frontal lobe, now a hemosiderin stained cystic space, continues to decrease in size.Multiple enhancing lesions which were new on the prior examination compared to the pretreatment study have continued to increase in size. A lesion along the right superior frontal gyrus measures approximately 7 mm, previously 4 mm. A lesion along the orbital gyrus of the right inferior frontal lobe measures approximately 7 mm, previously 6 mm. A lesion along the left frontal operculum measures approximately 6 mm, previously 4 mm. A lesion on the left precuneus measures approximately 7 mm, previously 5 mm. An additional lesion along the lateral left post-central gyrus is also larger in size (image 38, series 12). None of lesions are associated with significant parenchymal edema or mass effect. Abnormal periventricular T2 signal, particularly adjacent to the right frontal horn, is not significantly changed from prior study. The ventricles are stable size

Output: 1. Redemonstration of numerous formerly large enhancing lesions on the pretreatment study which remain decreased in size compared to the most recent study except for increased prominence of a right periventricular lesion.2. Interval continued increase in size of at least 5 enhancing lesions which were new on the most recent study on 6/22/2015 and not evident on the pretreatment study consistent with progressive metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: T12 compression fracture with neurologic changes. Signs and symptoms: Neurologic changes. Nonenhanced thoracic MRI:Examination demonstrates more than 50% compression fracture of T12 vertebrae with extensive T2/T2 hyperintensity of bone marrow consistent with edema and representing acute fracture. There is posterior expansion of compressed vertebrae into the spinal canal with resultant mass effect, flattening and posterior displacement of the cord and resultant moderate central spinal stenosis without neural foraminal compromise. There is also evidence of circumferential epidural hemorrhage (more along the dorsal aspect of the spinal canal) which extends superiorly to at least T3 level. Epidural hemorrhage is larger at T11 and T12 levels and measuring approximately 5.5 mm in thickness posterior. Epidural hemorrhage at L1 level with mass effect on the conus and the proximal cauda equina measures approximately 6.2 mm thickness. There is increased T2 signal intensity of the cord highly suspicious for edema without convincing evidence of hemorrhage and extending from T10-T11 disc level to the conus.Unremarkable nonenhanced MRI of thoracic spine and without evidence of spinal stenosis or significant neural foraminal compromise at any level.Nonenhanced lumbar MRI:Examination demonstrates dorsal epidural hemorrhage from acute T12 lumbar fracture with mass effect and forward displacement of conus and proximal cauda equina. There is increased T2 signal intensity extending from L1-L2 disc level inferiorly to S2 level with mass effect and forward displacement of cauda equina which is also suspected for hemorrhage within the spinal canal/subarachnoid space. This finding measures approximately at 9.5 mm at L3 level and 8mm at L5 level. This finding appears as a low signal intensity on T1-weighted images. There is no evidence of fracture or malalignment of the lumbosacral spine.T2 hypointense kidneys are noted. To exclude possibility of underlying pathology recommend follow-up with ultrasound studies.

Output: 1.Acute larger than 50% compression fracture of T12 vertebral body, retropulsion into the spinal canal, mass effect and posterior displacement of the cord with resultant moderate central spinal stenosis without neural foraminal compromise. There is evidence of cord edema extending from T10-T11 disc level to the conus.2.Circumferential epidural hemorrhage extending from the fracture site superiorly to at least T3 and inferiorly to approximately L1-L2 disc level with associated mass effect as detailed/measured above.3.Hemorrhage within the spinal canal extending from approximately the L1 level to S2 and with resultant mass effect and forward displacement of cauda equina along its entire course.


Instruction: Generate impression based on findings.

Input: Reason: seizure protocol 2 History: epilepsy since age 17 after a head trauma The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma (i.e prior axonal injury), vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: 30 year old woman with cardiomyopathy referred to evaluated etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 22%, the LV end diastolic volume index is 190 ml/m2 (normal range: 65+/-11), the LVEDV is 398 ml (normal range 109+/-23), the LV end systolic volume index is 148 ml/m2 (normal range 18+/-5), the LVESV is 310 ml (normal range 31+/-10), the LV mass index is 63 g/m2 (normal range 67+/-11), and the LV mass is 132 g (normal range 114+/-24). There is global hypokinesis. There is late gadolinium enhancement noted in the pattern of the septal mid-wall stripe. This pattern is associated with myocardial fibrosis and well described in dilated cardiomyopathy and old myocarditis. It does not consistent with old myocardial infarction. Based on T2-imaging there is no evidence of acute inflammation.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 104 ml/m2 (normal range 69+/-14), the RVEDV is 217 ml (normal range 110+/-24), the RV end systolic volume index is 86 ml/m2 (normal range 22+/-8), and the RVESV is 180 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate to severe mitral regurgitation with bileaflet tethering.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 a small pericardial effusion.Extracardiac FindingsThere is atelectasis or infiltrate in the right lower lung. Small lymph nodes noted in bilateral axilla. 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. Severe LV dilation with severely reduced systolic function (LVEF 22%). On late gadolinium enhancement images, a mid-wall septal stripe is noted. This pattern is not consistent with myocardial infarction and suggests the presence of underlying myocardial fibrosis. The pattern has been commonly described in dilated cardiomyopathy and also in old myocarditis. There is no evidence of active inflammation based on T2-imaging. No evidence of myocardial iron overload. 2. Normal RV size with severely reduced systolic function (RVEF 17%). 3. Severe left atrial dilation.4. Moderate to severe mitral regurgitation with bileaflet tethering. 5. Small pericardial effusion.6. See extra-cardiac findings.