Instruction: Generate impression based on findings.

Input: History of mycosis fungoides with CNS involvement treated with 2 cycles of Cytarabine/Etoposide in need of reimaging. Brain: There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle. There is no evidence of acute infarct. There is persistent diffuse enhancement of the cisternal segments of the bilateral trigeminal nerves and oculomotor nerves, left more than right. There also appears mild diffuse enhancement involving the bilateral facial nerves. There are mild nonspecific patchy areas of high T2 signal in the cerebral white matter bilaterally. The rest of the brain parenchyma appears to be unremarkable. 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.Orbits: There is persistent, albeit slightly reduced, high T2 signal and mild hyperenhancement of the left inferior, medial, and superior oblique muscles. The high T2 signal in the right inferior recuts muscle is less conspicuous. The bilateral globes, lacrimal glands, and optic nerves are otherwise unremarkable.

Output: 1. Persistent enhancement of multiple cranial nerves related to lymphoma.2. Residual mild denervation edema in the extraocular muscles supplied by the left oculomotor nerve and to a lesser extent perhaps the right ocular motor nerve.


Instruction: Generate impression based on findings.

Input: Clinical question: Brain metastases. Signs and symptoms: Breast cancer. Pre-and post enhanced CT of brain:100 cc of Omnipaque 350 was administered.Examination demonstrates diffuse subcortical and periventricular areas of low-attenuation which considering patient's age are suspected for advanced small vessel disease of indeterminate age. There is subtle ex vacuo dilatation of the lateral ventricles. There is no evidence of intracranial hemorrhage, edema or mass effect, midline shift or hydrocephalus.There is no evidence of any abnormal enhancement of renal parenchyma or the leptomeninges on post infused images to suggest for metastatic lesions.The calvarium is intact.Limited views of the orbits are unremarkable.Visualized portions of paranasal sinuses and mastoid air cells are unremarkable.Enhanced CT of cervical spine:Examination of the lower cervical spine is severely limited due to excessive artifact from patient's shoulders.Examination demonstrates extensive destructive changes involving vertebral body and the posterior elements of C7 vertebrae as was noted on prior MRI examination. Sagittal reformatted images demonstrate more than 50% compression deformity of C7 vertebrae and antral listhesis of C6 on C1. The destructive bony lesion involves the bodies, pedicles, right facets and lamina and the spinous processes of C7. Assessment for spinal canal stenosis cannot be made due to excessive artifact. Compared to prior MRI examination or were no gross interval change in the degree of subluxation is seen.Osteolytic changes of vertebral body of C6 is also suspected.Due to suboptimal quality of images possibility of additional metastatic lesions cannot be ruled out.Please refer to MRI examination of cervical spine from 12 -- 29 -- 2010 for further information. Follow up with a repeat MRI exam is recommended if surgical intervention is contemplated.Extensive degenerative changes of the cervical spine with resultant multilevel significant neural foramina compromise at C3 -- C4, C4 -- C5 and C5 -- C6 level are noted.

Output: 1.Pre-and post enhanced head CT demonstrates no evidence of metastatic disease. Advanced small vessel disease of indeterminate age is noted.2.Suboptimal enhanced CT of cervical spine due to extensive streak artifact from patient's shoulders. Three visualization of the destructive metastatic lesion involving the body and the posterior elements of C7 and body of C6 vertebrae as described above. Recommend further follow-up with an MRI examination for assessment of any interval change since prior MRI examination of 12 -- 29 -- 10.


Instruction: Generate impression based on findings.

Input: 47-year-old female with left upper extremity pain and numbness.Additional EMR Data: two month history of left-sided arm numbness that is constant as well as intermittent shoulder numbness. Normal recent EMG of the left extremity. Motion limited exam. The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies are appropriate in height. There is loss of disc height involving the C5-6 level. There is a likely hemangioma in the T2 vertebral body. The bone marrow signal is otherwise within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Degenerative changes are seen in the cervical spine as described below:C2-3 through C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Tiny left paracentral disc-osteophyte complex with mild left neuroforaminal narrowing but no spinal canal stenosis. C5-6: There is a diffuse disc osteophyte complex with minimal paracentral prominence along with some left facet arthropathy which contribute to moderate to severe left neuroforaminal narrowing. There is mild right neuroforaminal narrowing but no spinal canal stenosis. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: Trace disc-osteophyte complex without neuroforaminal narrowing or spinal canal stenosis.

Output: Spondylotic changes of the cervical spine most prominent at the C5-6 level where there is moderate to severe left neuroforaminal stenosis. Correlate clinically for a left C5-6 radiculopathy.


Instruction: Generate impression based on findings.

Input: 67-year-old male with plasma cell dyscrasia. Evaluate for lytic lesions of multiple myeloma. Cervical spine:The cervical vertebrae demonstrate diffusely low marrow signal without evidence of edema or pathologic enhancement. The vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is a mild diffuse disk bulge, left greater than right, and moderate facet hypertrophy resulting in minimal central canal stenosis and mild left neuroforaminal stenosis.At C3-4 there is a mild diffuse disk bulge and moderate facet hypertrophy, resulting in mild central canal stenosis and mild left neuroforaminal stenosis.At C4-5 there is moderate facet hypertrophy with no significant central canal stenosis and mild right neuroforaminal stenosis.At C5-6 there is moderate diffuse disk bulge and facet hypertrophy resulting in moderate central canal stenosis and no significant neuroforaminal compromise.At C6-7 there is moderate facet hypertrophy without significant central canal stenosis or neuroforaminal compromise.At C7-T1 there is no significant compromise to spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:As above, the thoracic vertebrae demonstrate diffusely low marrow signal. The vertebral bodies are appropriate in the overall alignment and height. Few fat containing lesions may represent hemangiomas. The thoracic spinal cord has normal signal characteristics and overall morphology. Mild multilevel degenerative changes are present with scattered disk protrusions; most conspicuously a left paracentral T11-T12 protrusion and disk bulge results in mild central canal stenosis. Bilateral cystic renal lesions are partially imaged though on the right appear mildly complex and larger as compared to previous CT abdomen from 2007.Lumbar spine:The lumbar vertebrae also demonstrate diffusely low marrow signal. Five lumbar type vertebral bodies are present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L1-2 there is mild diffuse disk bulge, ligamentum flavum hypertrophy and facet hypertrophy, resulting in mild central canal stenosis and mild bilateral neuroforaminal narrowing.At L2-3 there is disk disease with loss of disk height, diffuse disk bulge and facet hypertrophy, resulting in mild central canal stenosis as well as moderate bilateral neuroforaminal compromise.At L3-4 there is diffuse disk bulge, facet hypertrophy, and mild ligamentum flavum hypertrophy resulting in mild central canal stenosis and no significant neuroforaminal compromise.At L4-5 there is a grade 1 anterolisthesis of L4 on L5, degenerative disk disease with loss of disk height, severe facet hypertrophy, and mild ligamentum flavum thickening, resulting in mild central canal stenosis and moderate to severe bilateral neuroforaminal stenosis.At L5-S1 degenerative disk disease with loss of disk height and facet hypertrophy, without significant neuroforaminal or central canal compromise.

Output: 1.Diffuse low marrow signal throughout the spine is suggestive of red marrow reconversion, which may be seen in patients with anemia or on marrow stimulation therapy.2.No specific evidence of myelomatous lesions.3.Degenerative changes, as above.4.Right renal cystic lesions are partially imaged and incompletely evaluated, though appear larger than seen previously and are mildly complex. Dedicated renal imaging is recommended.


Instruction: Generate impression based on findings.

Input: There is moderate narrowing of the cavernous internal carotid arteries bilaterally. The intracranial internal carotid arteries are otherwise normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber with a fetal origin on the left. There is no evidence of flow-limiting stenosis or aneurysm.

Output: No evidence of aneurysm or significant steno-occlusive lesion.


Instruction: Generate impression based on findings.

Input: 19-year-old female with medial foot pain that is not responsive to conservative treatment. Evaluate for muscle strain or tendon sprain. Along the anteromedial aspect of the tarsal neck, there is bone marrow edema with adjacent soft tissue edema and synovitis. There is thickening of the anterior tibiofibular ligament likely representing chronic injury. Posterior tibiofibular ligament is intact. Plantar fascia ligament is intact. Fat within the sinus tarsi is preserved. The deltoid and spring ligaments are intact.Mild tendinosis of the posterior tibial tendon is present. The flexor digitorum longus and flexor hallucis longus tendons are within normal limits.

Output: 1. Along the anteromedial aspect of the talar neck, there is bone marrow edema possibly secondary to previous direct contusion.2. Thickening of the anterior tibiofibular ligament likely representing a chronic injury.


Instruction: Generate impression based on findings.

Input: 65-year-old male patient with history of HCC status post intraop RFA. Assess liver lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology.Post-ablation cavity in segment 6 measuring approximately 3.9 x 1.7 cm (22, series 1002). There is interval enlargement and heterogeneity of an arterially enhancing, diffusion restricting nodular marginal lesion along the medial aspect of the ablation cavity now measuring 2.6 x 2.5 cm (image 27, series 1001), previously 1.5 x 1.4 cm. An anterior component of this lesion washes out on delayed imaging; this is consistent with residual and/or recurrent hepatocellular carcinoma.Post-ablation cavity in segment 5 measuring approximately 3.6 x 2.2 cm (image 30, series 1002). There is interval enlargement of a marginal nodular area of arterial enhancement with restricted diffusion along the anterior aspect of the ablation cavity measuring approximately 2.5 x 1.5 cm (image 33, series 1001). This lesion washes out on delayed imaging and is consistent with residual and/or recurrent hepatocellular carcinoma.Post-ablation cavity in segment 3 measuring approximately 2.1 x 0.8 cm (image 33, series 1002) without evidence of marginal recurrent/residual disease. A subcentimeter arterially enhancing focus in segment 9 is again noted and does not wash out on delayed imaging; this may be perfusional in etiology (image 23, series 1001). Additional, scattered T2 hyperintense foci are compatible with cysts. There is new vague T2 hyperintensity within the inferior right hepatic lobe with corresponding new restricted diffusion. Within this region, there is also geographic non-enhancement of the liver parenchyma measuring up to 8.5 x 6.7 cm. Furthermore, the posterior branch of the right portal vein is no longer visualized and likely thrombosed secondary to the adjacent hepatic 6 lesion. The hepatic veins are patent. The left and main portal veins are patent otherwise. SPLEEN: Splenomegaly with the spleen measuring 20 cm in the craniocaudal dimension with scattered presumed siderotic nodules. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Splenorenal shunt.RETROPERITONEUM, LYMPH NODES: Periportal lymph nodes are again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable vertebral body enhancing focus (image 41, series 1003).OTHER: No significant abnormality noted.

Output: 1.Two enlarging areas of marginal nodular enhancement about the hepatic segment 5 and 7/6 ablation cavities is consistent with residual and/or recurrent tumor foci. 2.Interval occlusion of the posterior branch of the right portal vein, likely secondary to adjacent hepatic segment 7/6 lesion, with a geographic area of non-enhancement within the inferior right hepatic lobe favored to represent related vascular insult.


Instruction: Generate impression based on findings.

Input: The signal intensity of the vertebral column demonstrates extensive changes related to degenerative changes and is unremarkable otherwise. Alignment is anatomic. The conus is normal in signal and morphology and terminates at an appropriate level.T12/L1 is unremarkable and unchanged.L1/2 is unremarkable and unchanged.L2/3 demonstrates mild degenerative changes. No central spinal stenosis. Mild bilateral neural foraminal compromise is unchanged.L3/4 demonstrates mild degenerative changes. There is mild bilateral facet and ligamentum flavum hypertrophic changes. No central spinal stenosis. There is mild left and moderate right neural foraminal stenosis, unchanged.L4/5 demonstrates mild to moderate disk desiccation without significant loss of disk height, mild left facet and ligamentum flavum hypertrophy. Minimal facet degenerative changes on the right. No evidence of central spinal stenosis. There is mild bilateral neural foraminal stenosis. In the left lateral ventral spinal canal at this level there remains a focus of ferromagnetic metallic artifact. Redemonstrated is a small annular fissure.L5/S1 demonstrates degenerative disk disease, loss of intervertebral disk height and extensive adjacent Modic signal changes of the endplates. There is no central spinal stenosis. Moderate right and mild left neural foraminal compromise is unchanged.

Output: 1.L2/3: Mild bilateral neural foraminal, unchanged.2.L3/4: Mild left and moderate right neural foraminal stenosis, unchanged.3.L4/5: Mild bilateral neural foraminal stenosis. In the left lateral ventral spinal canal at this level there remains a focus of ferromagnetic metallic artifact. Redemonstrated is a small annular fissure.4.L5/S1: Moderate right and mild left neural foraminal compromise is unchanged.


Instruction: Generate impression based on findings.

Input: 31-year-old BRCA positive woman with strong family history of breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Abdominal pain and CBD dilatation on outside study. History of liver transplant for PBC. ABDOMEN:LIVER, BILIARY TRACT: The patient is status post liver transplant. The liver is normal in morphology, size and signal intensity.The CBD-CBD anastomosis appears patent with dilated donor and native cystic duct remnants present.There is intra and extrahepatic biliary ductal dilatation with the common bile duct measuring up to 8 mm. There are low signal intensity filling defects in the distal CBD compatible with stones/debris. Additionally there is smooth tapering of the distal CBD measuring approximately 2.2 cm in length without a discrete mass lesion, favoring a benign stricture. Small porta hepatis lymph nodes are noted.SPLEEN: The spleen is normal in size and morphology without a focal lesion.PANCREAS: The main pancreatic duct is dilated up to 6 mm with moderate smooth narrowing proximal to the ampulla measuring 1.3 cm in length. In the proximal pancreatic tail there is a cystic 7.0 mm lesion, decreased from the prior study where it measured 1.4 cm.In the pancreatic tail there is a 3.6 x 2.6 cm multiloculated cystic lesion, unchanged. It contains a central scar which demonstrates delayed enhancement.ADRENAL GLANDS: Subcentimeter nodularity of the right adrenal gland. The left adrenal gland is unremarkable.KIDNEYS, URETERS: Bilateral simple appearing cysts and too small to characterize hyperintensities. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple presumed injection granulomata in the anterior abdominal wall soft tissues.OTHER: No significant abnormality noted.

Output: 1.New intrahepatic and extrahepatic biliary dilatation to the level of the pancreatic head without a mass lesion with a benign-appearing stricture. Upstream there is debris/stones in the CBD. Similarly the main pancreatic duct is also dilated up to 7 mm with a benign-appearing 1.3 cm stricture at the level of the pancreatic head.2.Stable lobular pancreatic tail mass - prior pathology reported as a serous cystadenoma.3.Decreasing size of the pancreatic body/tail cystic focus now measuring 7 mm.


Instruction: Generate impression based on findings.

Input: There is a small 4 x 7 mm lesion (as measured on axial T2) within the frontal lobe just above the right lateral ventricle with mixed T1 and T2 signal intensity, although primarily hypointense. It demonstrates susceptibility blooming, however has no perilesional edema or associated developmental venous anomaly. There are no other similar appearing lesions.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 4 x 7 mm cavernous malformation just above the right lateral ventricle without perilesional edema or associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: 37 years Male (DOB:10/13/1978)Reason: Source for recurrent intracranial blood? History: siderosis, hearing loww, ataxiaPROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is siderosis present along the surface of the cervical spinal cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Incidental note is made of an arachnoid cyst within the fourth ventricle measuring 26 x 19 mm in sagittal dimensions and this appears to displace the quadrigeminal plate superiorly. The aqueduct of Sylvius is not well visualized.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is siderosis present along the surface of the thoracic spinal cord.

Output: 1.Siderosis along the spinal cord.2.There appears be large arachnoid cyst within the superior portion of the fourth ventricle which expands the fourth ventricle. The aqueduct of Sylvius is not readily visualized on this exam raising the question of stenosis of the aqueduct of Sylvius. Please note that this is often associated with noncommunicating hydrocephalus. Please correlate with patient's clinical history.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for cervical radiculopathy, status post previous perineural cyst. Signs and symptoms: Weakness this right hand. Pre-and post-enhanced cervical MRI:There is normal anatomical alignment of vertebral column however with mild exaggeration of the lordosis.There is normal signal intensity and caliber of cervical and uppermost visualized thoracic cord.There is no areas of spinal canal compromise or stenosis at any level.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 is unremarkable.C4 -- C5 demonstrate mild disk desiccation and loss of disk height and unremarkable otherwise.C5 -- C6 demonstrate moderate disk disease and loss of disk height and mild degenerative changes of posterior elements. Shallow broad base bulge of the disk is present. Mild neural foraminal compromise is suspected.C6 -- C7 demonstrate moderate disk disease and loss of disk height, mild facet and ligamentum flavum degenerative changes. No neural foraminal compromise.C7 -- T1 is unremarkable. There is revisualization of bilateral tiny Tarlov or perineural cysts (right larger than left) without definitive evidence of interval change in size or morphology.Post-enhanced images demonstrate no abnormal enhancement the vertebral column, cord or leptomeninges or the above-mentioned Tarlov cysts.

Output: 1.Mild interval progression of moderate degenerative disk disease since prior exam.2.No evidence of spinal compromise or stenosis at any level.3.Mild bilateral neural foraminal compromise is suspected only at C5 -- C6 and unremarkable at all other levels.4.Stable small bilateral Tarlov cysts (right greater than left at C7 -- T1.5.No detectable abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 45-year-old male, history of altered mental status, evaluate for PTLD or CLL. Patchy increased T2 signal in the subcortical and periventricular white matter is nonspecific but likely related to treatment effect or and/or small vessel ischemic disease. There are no abnormal foci of enhancement, and there is no intracranial mass or mass effect. The ventricles are within normal limits in size and configuration. No evidence of acute ischemia or hemorrhage.Major flow-voids are present. The sella and orbits are grossly normal. Paranasal sinuses and mastoid cells are clear. Mild enhancement of the nasopharyngeal mucosa is noted and likely a sequela of treatment or mucositis. There is mild, diffuse enhancement of the calvarial marrow without a discrete focal lesion, which may be related to CLL.Prominent bilateral parotid lymph nodes are again noted with mild diffusion restriction. Additionally, there is a peripherally enhancing, 1 cm lesion which appears centrally cystic in the posterior left occipital soft tissues immediately posterior to the mastoid air cells (series 1101, image 42). This is favored to represent a necrotic lymph node. Infection remains a possibility but is less likely given lack of secondary associated findings including surrounding inflammation.

Output: 1.No intracranial mass, mass effect, or abnormal enhancement to suggest leukemia or PTLD in the brain.2.Nonspecific symmetrical cerebral white matter abnormality favored to be related to treatment effect or perhaps small vessel ischemic disease.3.Enlarged bilateral cervical and parotid lymph nodes. Additional 1 cm posterior left occipital soft tissue lesion likely represents a peripherally enhancing necrotic lymph node.


Instruction: Generate impression based on findings.

Input: Mr. Snyder is a 56Yrs male with a past medical history of presyncope, ?ARVC, ventricular tachycardia, ventricular fibrillation and has ICD in place. Left Ventricle: not well seen due to artifact from the ICD and lead. Left AtriumThe left atrium is not well seen due to artifact from the ICD and lead. . Right VentricleImage quality is limited by ICD artifact; however, with following observations are made within the limits of the images available: the right ventricle has systolic crinkling of the free wall and the RVOT appears to have a dyskinetic segment. The RV is moderately dilated with mildly reduced systolic function (RVEF 48%). The overall RV ejection fraction is 48%, the RV end diastolic volume index is 132 ml/m2 (normal range 82+/-16), the RVEDV is 241 ml (normal range 142+/-31), the RV end systolic volume index is 69 ml/m2 (normal range 31+/-9), and the RVESV is 127 ml (normal range 54+/-17).Right AtriumThe right atrium is grossly normal..Extracardiac FindingsLarge artifact from ICD is 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 probably RV free wall systolic crinkling and a dyskinetic segment in the RVOT associated with moderate RV dilation. These findings provide 1 major criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy; however, given the presence of significant artifact impact image interpretation, the findings should be interpreted with caution. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left lower extremity weakness. There is linear restricted diffusion and T2 hyperintensity in the right thalamocapsular junction/posterior limb of the internal capsule, as well as what appear to be punctate foci of restricted diffusion and T2 hyperintensity in the left posterior periventricular white matter and right parietal lobe subcortical white matter. There are also mild No change from CT ANG HEAD AND NECK WWO with report dated 6/29/2015 7:52 AM.scattered areas of T2 hyperintensity in the cerebral and pontine white matter, including what appears to be a punctate chronic infarct in the right aspect of the corpus callosum. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. A 3 mm right paraophthalmic aneurysm is better depicted on the recent CTA. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is minimal fluid signal in the right mastoid air cells.

Output: 1. Acute infarction involving the right thalamocapsular junction/posterior limb of the internal capsule and left posterior periventricular white matter, as well as probable punctate acute infarcts involving the right parietal lobe subcortical white matter without evidence of hemorrhagic transformation, superimposed upon a background of chronic probable small vessel ischemic disease and chronic right corpus callosum infarct.2. A 3 mm right paraophthalmic aneurysm is better depicted on the recent CTA.Discussed with Dr. Javed at 10:30 AM on 6/29/15.


Instruction: Generate impression based on findings.

Input: Reason: NASH cirrhosis, CT in May 2016 showed ill-defined arterial enhancement in the right hepatic lobe, please evaluate further - needs MAC due to severe claustrophobia History: NASH cirrhosis ABDOMEN:LIVER, BILIARY TRACT: There is mild diffuse loss of signal on out of phase images suggestive of hepatic steatosis.No suspicious focal hepatic lesions are identified. Specifically, in the area of increased enhancement in the hepatic dome (segments 4A and 8) described on comparison CT, there is no corresponding T1, T2, or DWI signal abnormality. There is perhaps minimally increased ill-defined enhancement on more delayed images in this area, but this is equivocal.The hepatic vasculature appears patent.Status post cholecystectomy. Mild intra and extrahepatic biliary ductal prominence appearing similar to comparison CT. The common bile duct measures up to 9 mm without evidence of obstructing stricture or stone.SPLEEN: The spleen is upper normal in size without focal lesions. Normal variant splenule.PANCREAS: The pancreas demonstrates normal parenchymal signal intensity and enhancement. The pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Few nonspecific mildly prominent upper abdominal lymph nodes. For example, right pericaval lymph node measures 1.2 x 1.5 cm. Mildly prominent cardiophrenic lymph node has a normal fatty hilum and appears similar to recent CT.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hepatic steatosis.2.No suspicious focal hepatic lesions identified.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with multiple myeloma and new acute pain. New T1 hypointense and T2 hyperintense signal abnormality is seen within along the posterior right aspects of the T12-L1 endplates. There also appears to be a new right paracentral and foraminal disc protrusion at this level.No other areas of new marrow signal abnormality are seen. A moderate compression deformity of the T12 vertebral body is unchanged. Likewise, mild endplate cavity affecting the mid thoracic vertebral bodies, and t the L1-L5 vertebral bodies, is unchanged. Mild degenerative disc findings in the lumbar spine are unchanged. No significant spinal canal stenosis is seen. Mild left foraminal narrowing at L3-4 and L4-5 is unchanged. Facet arthropathy at lower lumbar levels is unchanged.The spinal cord itself demonstrates normal signal intensity and morphology. The conus cauda equina are within normal limits. No epidural abnormalities are suspected.

Output: 1.New signal abnormal is seen along the right posterior T12-L1 endplates. Given that this occurs in combination with possible new disc protrusion in the same location, the findings are favored to be degenerative in nature.2.No other definite new lesions are seen to suggest progressive myelomatous disease. No evidence of significant spinal canal stenosis is observed.3.Multiple compression deformities involving the T12-L5 vertebral bodies are unchanged. No new compressions are seen.


Instruction: Generate impression based on findings.

Input: 71-year-old female with biopsy proven right breast DCIS (2 sites) presents for staging MRI. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.In the right breast, there are post-biopsy changes at middle 8:30 position, measuring 28 x 43 x 16 mm (AP x LR x CC). This area of enhancement likely contains the enhancement from residual DCIS; however, it is difficult to separate enhancement of DCIS from post biopsy changes. No other abnormal enhancement is seen in the right breast.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Post-biopsy changes in the right breast at middle 8:30 position, with probable DCIS enhancement. As the area of enhancement corresponds with the mammographic findings, bracketed needle localization under mammographic guidance can be performed.2. No MRI evidence for malignancy in the left breast or either axillaBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: History of prostate cancer diagnosed in 2009. PSA of 4.64. 2009 biopsy showed 3+3 disease involving 1 of 5 cores on the right, 5% of tissue. PELVIS:PROSTATE:Prostate Size: 5.4 x 2.2 x 4.5 cm.Peripheral Zone: The peripheral zone is relatively homogeneously T2 hyperintense. There are a couple punctate T2 hypointense foci with low ADC signal such as in the left medial mid gland measuring 2 to 3 mm (series 601/16 and series 704/264). This focus also has increased signal on high 1550 b value images (710:280)Central Gland: Mild changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No dominant lesion is evident. A few tiny foci in the left mid gland are nonspecific, but one of which is suspicious as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 73-year-old male with right arm stiffness, concern for cord compression. Limited exam redemonstrates diffuse bone marrow signal abnormality throughout the cervical spine, consistent with extensive osseous metastatic disease. In particular, a lesion in the C6 vertebral body demonstrates retropulsion and mass effect upon the spinal cord and bilateral neural foraminal stenosis. However, there is no definite evidence of spinal cord signal abnormality. There are also foci of ligamentum flavum calcification with associated mild spinal canal stenosis at C7 and T2. The vertebral alignment and vertebral body heights are grossly preserved.

Output: 1. Extremely limited exam redemonstrates diffuse osseous metastatic disease with compression of the spinal cord at C6, which is otherwise incompletely characterized. 2. Foci of ligamentum flavum calcification with associated mild spinal canal stenosis at C7 and T2.


Instruction: Generate impression based on findings.

Input: Female 32 years old Reason: lumbar pain and family history of ankylosing spondylitis. We have 6 views of the lumbar spine. Vertebral body heights and intervertebral disk spaces are preserved. There is no evidence of degenerative disk disease.We have 3 views of the sacroiliac joints. The sacroiliac joints appear unremarkable without specific radiographic evidence of inflammatory arthritis.

Output: Normal appearing lumbar spine and sacroiliac joints as described above.


Instruction: Generate impression based on findings.

Input: Multiple Sclerosis on Tysabri for 15 months. Several sequences are motion degraded.BRAIN: There are multiple T2 hyperintense lesions in the periventricular and subcortical white matter, which have not significantly changed in number or size. Many of the lesions demonstrate T1 hypointensity. There are no enhancing lesions. There is no evidence of intracranial mass or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. CERVICAL SPINE: There are multiple stable small demyelinating plaques primarily in the upper cervical spine without abnormal enhancement or interval progression since the prior study. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.THORACIC SPINE: There are several T2 hyperintense lesions in the thoracic cord from T8 to T12 which are similar to prior examination No new lesions are seen. There is no abnormal enhancement. The vertebral body heights in the thoracic spine are intact and the alignment is normal. There is disc desiccation, small bulge and Schmorl's node at the T9-T10 level. There is no significant spinal canal or neural foraminal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1.No significant interval change in the demyelinating lesion in the brain and cervical and thoracic spinal cord.2.No evidence of PML.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 66 years old with history of marginal zone lymphoma s/p rituximab treatment and chondrosarcoma s/p resection with possible metastatic liver lesions on recent CT. Evaluate and comment on potential for accessibility for biopsy. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 19 cm in length and smooth in contour.A 1.5 x 0.8 cm T2 hyperintense lesion in hepatic segment 7 has progressive, peripheral, nodular discontinuous enhancement consistent with hemangioma. An additional subcentimeter T2 hyperintense lesion laterally in segment 7 fills in on postcontrast images also consistent with hemangioma. A 0.9 x 0.9 cm T2 hyperintense lesion in segment 6 shows minimal peripheral enhancement on delayed images, it is too small to accurately characterize but hemangioma is favored.No intra or extrahepatic biliary ductal dilatation. The hepatic vasculature appears patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodular thickening of the left adrenal gland is nonspecific and unchangedKIDNEYS, URETERS: Nonobstructing left renal calculus. There are a few bilateral simple renal cysts and additional renal lesions too small to accurately characterize. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a small duodenal diverticulum. Colon diverticulosis, no evidence of acute diverticulitis.BONES, SOFT TISSUES: T2 hyperintense, enhancing lesion are seen in the T9 and L1 vertebral bodies consistent with hemangiomas. Postsurgical changes are seen along the anterior abdominal wall.OTHER: No significant abnormality noted.

Output: 1.The two previously described segment 7 lesions have imaging characteristics of hemangiomas. The segment 6 lesion is too small to accurately characterize but is also favored to represent hemangioma. No suspicious hepatic lesions.2.Nonobstructing left renal calculus.


Instruction: Generate impression based on findings.

Input: Clinical question: Subdural hematoma. Signs and symptoms: Headaches Non-enhanced head CT:There is revisualization of an extra-axial isodense lesion measuring 31.1-mm at the base and 10.7-mm in thickness. There is no appreciable interval change since prior exam in the size, density or the extent of this finding. The finding could represent a subdural home her prior MRI was also suggested of possible meningioma. There is no evidence of new hemorrhage. There is no evidence of edema, mass effect, midline shift or hydrocephalus. Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of new finding since prior exam. 2.Extra-axial right frontal lesion which could represent a subdural. Possibility of a meningioma cannot be entirely ruled out and follow-up exam is recommended.


Instruction: Generate impression based on findings.

Input: There has been anterior cervical fusion from C4 through C7.There are no fractures. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild anterior cord flattening without intrinsic cord signal abnormality. There is moderate left and mild-to-moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral facet hypertrophy, and left facet hypertrophy. There is T2 abnormality within the cord at this level which demonstrates associated focal cord atrophy. There is severe left and moderate right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. T2 hyperintensity is noted within the cord at this level with associated slight focal cord atrophy. There is moderate to severe left and mild-to-moderate right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is a suggestion of cord T2 hyperintensity and minimal focal cord atrophy. There is moderate to severe left neural foraminal and moderate right neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex and uncinate hypertrophy. There is severe bilateral neural foraminal stenosis.Degenerative changes throughout all the visualized thoracic levels from T1 through T5 demonstrate central canal and bilateral neural foraminal encroachment.

Output: 1.C3/4: Moderate left and mild-to-moderate right neural foraminal stenosis.2.C4/5: There are is T2 abnormality within the cord at this level which demonstrates associated focal cord atrophy. There is severe left and moderate right neural foraminal stenosis.3.C5/6: T2 hyperintensity is noted within the cord at this level with associated slight focal cord atrophy. There is moderate to severe left and mild-to-moderate right neural foraminal stenosis.4.C6/7: There are is a suggestion of cord T2 hyperintensity and minimal focal cord atrophy. There is moderate to severe left neural foraminal and moderate right neural foraminal stenosis.5.C7/T1: Severe bilateral neural foraminal stenosis.6.Degenerative changes throughout all the visualized thoracic levels from T1 through T5 demonstrate central canal and bilateral neural foraminal encroachment. If the patient has symptoms referable to the thoracic spine, a dedicated MRI of the thoracic spine could be obtained if the clinically beneficial.


Instruction: Generate impression based on findings.

Input: 63 years Male (DOB:7/31/1952)Reason: syncope History: seizurePROVIDER/ATTENDING NAME: FERNANDO D. GOLDENBERG FERNANDO D. GOLDENBERG MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.There is susceptibility effect present along the surface of the right superior frontal gyrus anteriorly.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.There is extracranial origin of the posterior inferior cerebellar arteries bilaterally.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. There is mild narrowing at the origin of the left internal carotid artery which is not significant based on NASCET criteria.

Output: 1.There are blood products present within right frontal lobe sulci anteriorly.2.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.3.There is no evidence for intracranial aneurysm.4.There is no evidence for cerebral infarction or intracranial mass lesion.


Instruction: Generate impression based on findings.

Input: 38 years Female (DOB:12/18/1977)Reason: rule out vascular stenosis History: acute onset left weaknessPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. There is fetal origin of the right posterior cerebral artery with a small right P1 segment. The left posterior communicating artery is small. The right vertebral artery is larger than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left vertebral artery has an aortic arch origin.

Output: There is no evidence for acute ischemic cerebral infarction.There is no evidence for intracranial cerebrovascular occlusion and no evidence for intracranial aneurysm.There is no evidence for extracranial cerebrovascular occlusion.


Instruction: Generate impression based on findings.

Input: Persistent headaches. There is colpocephalic appearance of the lateral ventricles with enlargement of the occipital horns and atria with mild adjacent FLAIR hyperintensity. There is mildly diminished supratentorial white matter, particularly involving the periatrial white matter. There is associated mild thinning of the posterior aspect of the corpus callosum. No evidence of hydrocephalus. No intracranial mass or mass effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Sella and orbits are essentially within normal limits with possible small Rathke's cleft cyst involving the pituitary. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No intracranial mass or mass effect.2. Colpocephalic configuration of the ventricles and diminished periventricular white matter, findings which may be related to periventricular leukomalacia related to perinatal insult. 3. Tiny area of hypoenhancement involving the posterior inferior aspect of the pituitary gland which may represent a small Rathke's cleft cyst.


Instruction: Generate impression based on findings.

Input: History of pancreas divisum status post partial gastrectomy/Bilroth 2 in May 2015 for perforated gastric ulcer, complicated by acute pancreatitis and pancreatico-cutaneous fistula status post IR drainage. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size, measuring 18.7 cm in the craniocaudal dimension. It is normal in signal intensity. No discrete lesion is evident.Demonstrated again is marked extrahepatic biliary ductal dilatation measuring 2.1 cm (series 5 image 1), with moderate intrahepatic biliary ductal dilatation, appearing similar to the prior study. The common bile duct tapers smoothly at the level of the ampulla without an obstructing stone or mass evident. Distended gallbladder without acute inflammation. Probable small gallstone.SPLEEN: No significant abnormality noted.PANCREAS: Internal drainage catheter appears to extend from the main pancreatic duct into the gastric lumen. The main pancreatic duct is irregularly dilated up to 8 mm (series 4/17), not significantly changed from the prior study. The previously seen focal narrowing at the pancreatic body tail junction has improved.Again it appears that the main pancreatic duct merges with a smaller duct in the uncinate process which extends anteriorly and enters the more proximal duodenum at the expected location of the minor papilla. It also communicates with a complex fistula deep to the ventral incision site where there is a 2.3 x 1.1 cm fluid collection (series 4/22) draining into the ventral soft tissues, new from the prior.There is moderate parenchymal atrophy and decreased intrinsic T1 signal intensity and postcontrast enhancement of the pancreatic parenchyma compatible with parenchymal dysfunction.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Tortuous abdominal aorta with infrarenal aneurysmal dilatation better evaluated on prior CT.BOWEL, MESENTERY: Postsurgical changes from a Billroth II procedure.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable marked extrahepatic and moderate intrahepatic biliary ductal dilatation to the level of the ampulla without a discrete stone or obstructing mass evident.2.Irregular beaded appearance of the pancreatic duct is likely related to chronic pancreatitis. The main pancreatic duct again appears to communicate with a smaller duct in the uncinate process and extends anteriorly where it appears to drain into the more proximal duodenum at the minor papilla and communicates with the complex fistulous tract now associated with a new 2.3 cm fluid collection which drains into the ventral incision, consistent with a pancreatico-cutaneous fistula.


Instruction: Generate impression based on findings.

Input: Other benign neoplasm of connective and other soft tissue of unspecified site [215.9], Reason for Study: ^Reason: eval progression of cervical neuroma History: frequent falls There is intradural extramedullary nodular enhancing lesion especially on the left side from C4 to C7.The extent and MR characteristics do not show any significant interval change since prior exam.The left parotid gland centrally necrotic mass as well as multifocal cervical lymph nodes do not show any significant interval change either since prior exam.The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. C4-C5: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. C5-C6: minimal bulging of disc with minimal bilateral ligamentum flavum thickening, no neuroforaminal narrowing or spinal stenosis. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. No change of extramedullary intradural enhancing lesion which likely represent neurogenic tumor in terms of size, extent and enhancement pattern since prior exam.2. No change of left parotid gland mass and multifocal cervical lymph nodes since prior scan.3. Spinal cord signal intensity is normal.4. Multilevel degenerative changes of intervertebral discs and ligamentum flavum as described above.


Instruction: Generate impression based on findings.

Input: Neck mass. 37-year-old male. CT of the soft tissues of the neck with infusion:Images through the skull base, cavernous sinuses, paranasal sinuses and mastoid air cells are unremarkable.Images through the neck demonstrates a low-density mass with extensive internal vascular enhancement in left neck immediately posterior to the left carotid bifurcation. There is anterior displacement of distal left common carotid, proximal left internal and external carotid arteries. The mass measures 72 mm in cranial cephalad access and 42-mm x 38 0.7-mm in its axial dimension. On axial images a tapered cephalad extension of this mass reaches the anterior aspect of body of C1 vertebrae. Prior MRI examination demonstrated intense enhancement of this tumor however the enhancement on the CT examination is very patchy and not solid as it was noted on MRI. This mass demonstrates a very well demarcated margin and with no evidence of any edematous changes of adjacent fascia planes. There is significant mass-effect and lateral displacement of the left internal internal jugular which at the level of maximum compression is almost nondetectable. There is no evidence of encasement of the left carotid by this mass. Left internal jugular home for her superior and inferior to this tumor remains open.The differential for this tumor remains and is a chemodectoma, a schwannoma or a metastatic lymph node.A small right submandibular lymph node measuring 12 mm times 15-mm in transaxial dimension is present. This shows no enhancement or necrosis. Multiple smaller scattered nonenhancing and not a pathologic nodes are also noted.There is symmetrical prominence collecting tonsils with no enhancement or necrosis. Limited images of the apices of the lungs are negative for pathology.Limited images of the mediastinum are also negative. 70 cc of Omnipaque 350 was utilized for the above study.

Output: 1. Large well-demarcated low-density mass with patchy internal vascular enhancement in the left neck. Finding is believed to represent a schwannoma, additional possibility of chemodectoma, metastatic lesion cannot be entirely ruled out.2.Small additional nonenhancing and nonpathologic lymph nodes as detailed.3.Prominent adenoids and collecting tonsils with no abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 74 year old male with a history of chronic systolic heart failure, HTN, HLD and gout who presents for cardiac evaluationMEDICATIONS: aspirin, valsartan, carvedilol, tamsulosin. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is mildly enlarged with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 113 ml/m2 (normal range: 74+/-15), the LVEDV is 252 ml (normal range 142+/-34), the LV end systolic volume index is 63 ml/m2 (normal range 25+/-9), the LVESV is 140 ml (normal range 47+/-19), the LV mass index is 59 g/m2, and the LV mass is 131 g. The left ventricular dysfunction is global. Native myocardial T1 times are within normal limits. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 93 ml/m2 (normal range 82+/-16), the RVEDV is 207 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 91 ml (normal range 54+/-17).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 no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with mildly reduced systolic function (LVEF 45%) without myocardial fibrosis, inflammation, infiltration.4. Normal RV size and systolic function (RVEF 56%).


Instruction: Generate impression based on findings.

Input: Reason: any evidence of gall bladder disease or abdominal masses? History: woman with NF1 land 2 severe episodes of flank pain ABDOMEN:LIVER, BILIARY TRACT: Gallbladder appears normal. No focal hepatic lesions.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: Numerable cutaneous neurofibromas.OTHER: Lesions involving multiple sacral and bilateral L4 nerve roots as well as left sciatic nerve likely represent plexiform neurofibromas.

Output: 1.No intra-abdominal masses or evidence of biliary disease.2.Cutaneous and plexiform neurofibromas.


Instruction: Generate impression based on findings.

Input: Migraine with aura, not intractable, without status migrainosus [G43.109], Reason for Study: ^Reason: Patient with new left eye visual obscuration c/w migraine but Hx of hyperlipidemia - so need MRI to look for stroke and MRA to look for narrowed vessel Brain MRINo evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The right lateral ventricle especially occipital horn is slightly prominent which is non specific and likely to be within normal limits. Otherwise, ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Mucosal thickenings are seen on bilateral maxillary sinuses.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: Status post right hip scar revision now with possible wound infection. History of osteomyelitis of hip. Pain, erythema, swelling.IMAGE ACQUISITIONS: Computed tomography of the pelvis performed following intravenous administration of 120 cc of Omnipaque 350, with transverse, coronal, and sagittal reformatted images of the pelvis and right hip. Absence of the right femoral head and neck with tubular sclerosis in the proximal femoral diaphysis likely represents the sequela of removal of a total hip arthroplasty device. Within the subcutaneous fat just lateral to the proximal aspect of the right femur and iliotibial band is a fluid collection that is approximately 7.5 x 5.5 cm in transverse dimension and nearly 20 cm in craniocaudal dimension. Multiple foci of air density are noted within this collection, which may be due to recent intervention, although we cannot exclude an abcess with a gas forming organism. On coronal image 61 of series 80240, the fluid appears to communicate via a thin track with a smaller collection of fluid in the hip joint. While no gross bone destruction is evident at this time, portions of the posterior cortex of the proximal femur are indistinct; the relatively fatty appearance of the underlying marrow, however, argues against active osteomyelitis. Please note that MRI would be more sensitive for detection of osteomyelitis than CT.Mild osteoarthritis affects the left hip. Mild to moderate degenerative disk disease affects the visualized lower lumbar spine. Moderate facet joint osteoarthritis affects the visualized lower lumbar spine.There is diffuse fatty atrophy of the musculature of the right hip and proximal thigh. A few mildly enlarged inguinal lymph nodes are noted on the right.The visualized intrapelvic structures are unremarkable given limitation of lack of enteric contrast material.

Output: Fluid collection in the lateral aspect of the proximal thigh and as described above which may represent an abscess.


Instruction: Generate impression based on findings.

Input: 51 years Female (DOB:7/10/1965)Reason: r/o intracerebral path History: dizziness x 6 months now, not nec getting better. on antivert prnPROVIDER/ATTENDING NAME: ANNE E. HONG ANNE E. HONG The CSF spaces are appropriate for the patient's stated age with no midline shift. Some metal artifact is present along the skin surface of the right frontal scalpNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for acute ischemic cerebral infarction or intracranial mass lesion.


Instruction: Generate impression based on findings.

Input: Reason: lumbar spinal stenosis and neuroforaminal stenosis History: b/l low back pain and groin numbness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disk desiccation presentAt L5-S1 there is no significant compromise to neural foramina. There is bilateral facet hypertrophy present at this level. There is partial effacement of the fat at the lateral recess and left worse than right at this level This has not changed since prior exam.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level associated with disk dessication.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level associated with disk dessication.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level associated with disk dessication.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a mild left lateral disk protrusion at this level.

Output: 1.There is mild encroachment of the nerve roots of the left lateral recess at L5-S1 related to a combination of disk disease and facet hypertrophy.


Instruction: Generate impression based on findings.

Input: Clinical question of CVA. Signs and symptoms: Left-sided facial numbness. Nonenhanced head CT:No detectable acute intracranial process.CT is insensitive for early detection of acute ischemic strokes.Examination demonstrates small focus of low attenuation in the left paramedian pons which is not a specific however it could represent an age indeterminate lacunar infarct. Consider MRI if concern for a stroke remains high.Unremarkable cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.Paranasal sinuses are unremarkable.There is evidence of an old blowout fracture of left floor of the orbit as well as lamina papyracea.

Output: 1.Minimal small vessel ischemic strokes of indeterminate age.2.No acute intracranial hemorrhage, mass effect or hydrocephalus.


Instruction: Generate impression based on findings.

Input: 19 years old male with history of craniopharyngioma now with increased headache, evaluate ventricular size. Patient is status post right frontal craniotomy, with placement of ventriculostomy catheter having tip in the third ventricle and small amount of encephalomalacia abutting the distal catheter; this is not significantly changed in appearance from the 2007 comparison study. Lateral and third ventricles are effaced secondary to decompression.Cystic focus with internal calcification in the interhemispheric fissure is unchanged in size from recent prior MRI study.There is no evdence of intracranial hemorrhage, mass or edema. The remaining ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No hydrocephalus or change in ventriculostomy catheter position since 2007.


Instruction: Generate impression based on findings.

Input: 63-year-old female with liver lesion seen on outside ultrasound. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Prominence of the central intrahepatic biliary ducts with mild dilation of the common bile duct measuring up to 10 mm, which demonstrates distal smooth tapering; this may be related to fasting state as no distal obstructing stone or lesion is evident.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: No focal hepatic lesions.


Instruction: Generate impression based on findings.

Input: There is near normalization of the previously demonstrated small triangular shaped area of peripheral diffusion hyperintensity is seen in the left corona radiata. There is no new restricted diffusion to suggest the presence of acute ischemia.Redemonstrated is encephalomalacia in the right temporal lobe lobe with ex vacuo dilatation of the right lateral ventricle. As before, there are areas of high T2/FLAIR hyperintensity in the subcortical and the periventricular white matter bilaterally, including the right occipital periventricular white matter somewhat asymmetrically, consistent with chronic ischemic disease.The ventricles and the sulci are prominent suggestive of volume loss, unchanged in extent. Punctate susceptibility is seen in the right temporal lobe, suggestive of chronic blood products in the area of previous infarct. Redemonstrated are bilateral chronic small vessel infarcts.A new small air-fluid level is noted within the right maxillary sinus. Fluid is noted within a few left mastoid air cells, unchanged.

Output: 1.There is near normalization of the previously demonstrated small triangular shaped area of peripheral diffusion hyperintensity is seen in the left corona radiata. There is no new restricted diffusion to suggest the presence of acute ischemia.2.Stable chronic small vessel ischemic disease.3.Stable, old, right temporal lobe infarct.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:10/21/1959)Reason: hx LBP and right leg pain. Post epidural injection developed left thigh pain. Eval for disc degeneration or abnormality History: LBP, bilateral leg painPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level which is relatively stable compared to the prior exam. There is a minor disc bulge at this level. There is some T2 signal hyperintensity along the annulus of the disc posteriorly at this level.At L4-5 there is no significant compromise to spinal canal. There is mild loss of disc space height, disc bulge and disc desiccation at this level associated with a right-sided facet and ligamentum flavum hypertrophy. This was also the case on the prior exam. There is narrowing of the right neural foramen at this level with mild encroachment of the right-sided exiting nerve roots as a result of combination of facet hypertrophy and disc bulge.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are some degenerative changes present in the lower lumbar spine with mild encroachment of the right-sided exiting nerve roots within the neural foramen at L4-5 related to disc bulge and facet hypertrophy. This is stable and compared to a prior exam from 6/26/2015.


Instruction: Generate impression based on findings.

Input: Male, 53 years old. Left knee pain MENISCI: There is a horizontal tear of the posterior horn of the medial meniscus extending to the undersurface. A more vertically oriented tear is noted through the anterior horn of the medial meniscus, and the body of the medial meniscus shows extensive degeneration and medial displacement. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is near complete articular cartilage loss involving the medial femoral condyle and medial tibial plateau, with extensive underlying marrow edema of both the femur and tibia. Lateral tibiofemoral cartilage is intact. There is minimal cartilage fraying of the medial patellar facet.LIGAMENTS: The cruciate and collateral ligaments are intact. Increased signal adjacent to the medial collateral ligament is likely due to underlying meniscal pathology. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Extensive complex tearing of the medial meniscus as described above.2.Near complete articular cartilage loss of the medial femoral condyle and medial tibial plateau with extensive underlying bone marrow edema.


Instruction: Generate impression based on findings.

Input: Palpable mass above the sternum. A skin marker overlies the anterior aspect of the sternum presumably corresponding to the patient's palpable area of concern. There is soft tissue prominence underlying the marker, however, no discrete mass lesion is identified, within the limitations of this noncontrast examination. These findings may represent a lipoma which are often difficult to definitively measure/delineate due to the lack of inherent contrast with the surrounding subcutaneous fat. The remainder of the imaged musculature and soft tissues of the chest are unremarkable.

Output: Soft tissue prominence along the anterior aspect of the manubrium of the sternum likely representing a lipoma as described above. Otherwise unremarkable MRI of the chest.


Instruction: Generate impression based on findings.

Input: Audiogram demonstrated normal hearing in the left ear and new severe to profound loss in the right. Developmental delay, aortic coarctation, and webbed neck. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. However, there is encephalomalacia involving the left lateral cerebellum. The supratentorial brain parenchyma and pituitary gland otherwise appear unremarkable. There is no evidence of abnormal 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 diffuse mild paranasal sinus mucosal thickening. There are bilateral staphylomas related to high myopia. The cranial appears to be microcephalic.Internal Auditory Canals: The exam is severely limited by motion artifact. There is a diffusely narrow right internal auditory canal, measuring 3 mm in diameter. There is deficiency of the right modiolus, with a scala communis and deficiency of the apical turn. In addition, the right endolymphic duct is enlarged. The left inner ear structures appear to be normal. There is scattered fluid within the bilateral middle ears and mastoid air cells. There is no evidence of mass or abnormal enhancement is within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals.

Output: 1.Narrow right internal auditory canal with apparent deficiency of the right cochlear and vestibular nerves, as well as findings suggestive of mild incomplete partition type 2.2.Bilateral tympanomastoid effusions. 3.A small area of encephalomalacia involving the lateral superior left cerebellar hemisphere may represent a prior infarct. 4.Findings suggestive of pansinusitis.5.Findings suggestive of microcephaly. The constellation of some of the imaging findings and reported clinical features is suggestive of Turner syndrome.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A 25 year old female with history of non-ischemic cardiomyopathy (LVEF of 38%), hypertension, hyperlipidemia, obesity and insuline resistance. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is mildly dilated with mild to moderately reduced systolic function. The left ventricle is hypertrabeculated and associated with myocardial thinning. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 95 ml/m2 (normal range: 65+/-11), the LVEDV is 198 ml (normal range 109+/-23), the LV end systolic volume index is 56 ml/m2 (normal range 18+/-5), the LVESV is 117 ml (normal range 31+/-10), the LV mass index is 45 g/m2 (normal range 67+/-11), and the LV mass is 94 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No findings to support an active myocardial or pericardial inflammatory process.No myocardial iron overload was seen.No intracavitary thrombus was seen.Global Relative Enhancement1.7Normal <4T2 STIR Edema Ratio (ER)1.7Normal <2Left AtriumThe left atrium is normal in size. The LA volume is 65 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 64 ml/m2 (normal range 69+/-14), the RVEDV is 133 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 65 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 mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsNon-significant lymph nodes are noted in the 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. The left ventricle is mildly dilated with mild to moderately reduced systolic function (LVEF 41%). The left ventricle is hypertrabeculated and associated with myocardial thinning. These findings suggest the diagnosis of left ventricular non-compaction. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with normal systolic function, the RVEF is 52%. 4. There is moderate 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: brain abscess follow up The right parietal lobe ventriculostomy tube has been removed since prior exam. Instead, there is a new ventriculostomy tube inserted through the left frontal lobe. There is localized brain edema on the left frontal lobe ventriculostomy tube insertion site likely to be related to ventriculostomy tube insertion procedure.Comparing to prior scan, FLAIR high signal intensity the right parietal lobe ventriculostomy tube track appears to be a bit lessen. On Gad enhanced scan, there still is ventriculostomy tube track enhancement, however, the degree of enhancement also appears to be lessen than prior.Overall, leptomeningeal enhancement pattern appears to be bit prominent and somewhat nodular indicating meningeal irritation or inflammation. Comparing to prior exam, the pattern and degree of enhancement do not show significant interval change. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Normal enhancement of pituitary gland, no change since prior exam.The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval removal of right parietal ventriculostomy tube and new ventriculostomy tube inserted through the left frontal lobe. The new ventriculostomy tube track shows edema on FLAIR images which most likely to be related to the procedure. 2. Interval decrease of left ventriculostomy tube track enhancement since prior exam.3. No significant interval change of diffuse leptomeningeal enhancement pattern.4. Normal ventricular system size.


Instruction: Generate impression based on findings.

Input: 72-year-old with 3 to 4-cm left breast cancer, DCIS, MRI for staging and surgery planning There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Left Breast: Postprocedural hematoma is seen on the T1 precontrast images measures 13 x 16 x 13 mm in the left breast 8 o'clock position. The clip artifact is noted within the hematoma. Area of non-Mass enhancement is seen anterior and posterior to the hematoma with total extent of 37 x 34 x 17 mm (AP x ML x CC), which includes the hematoma as well. This approximately corresponds to the extent of suspicious calcifications seen on mammogram.Right breast: No abnormal enhancement is seen in right breast. Axillae: No abnormal lymph nodes are identified in either axillary region. The left low-lying axillary lymph node appears folded over itself, unchanged from prior mammograms dating back to 2012.

Output: 1. Area of non-Mass enhancement corresponding to DCIS in left breast 8 o'clock position with maximum extent of 3.7 cm in the AP dimension. This approximately corresponds to the extent of suspicious calcifications seen on mammogram.2. No abnormality in the right breast or bilateral axillary regions. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: lesion left kidney. lesion pancreas on prior CT scan. Evaluate characteristics and interval change History: lesion left kidney. lesion pancreas ABDOMEN:LIVER, BILIARY TRACT: Loss of signal on a phase images suggests steatosis.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a cystic lesion in the left upper pole which is increased in size since the prior MRI measuring 1.6 x 1.5 cm, previously 0.9 x 0.9 cm. There is mild increase intrinsic T1 signal. On postcontrast sequences, there is a small septation with nodular enhancement (20/54, 100/24, 11 704/60).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.Cystic lesion in the left upper pole has increased in size and has a septation with nodular enhancement. This lesion is consistent with a Bosniak 3 and while indeterminate, renal cell carcinoma remains on the differential.2.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: new lesions History: MS/ worsening weakness legs Brain MRIThere are multiple multiple new FLAIR high signal intensity lesions on the right periventricular white matter indicating interval aggravation of the demyelinating lesions.Previously seen multifocal bihemispheric periventricular white matter lesions were seen and unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.L-Spine MRI:For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are multifocal patchy high signal intensity lesions on the spinal cord especially at the level of T10, 11, 12 and L1 suggesting possible demyelinating lesions. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1 level.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: disc dessication, diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: central to left disc protrusion results left lateral recess stenosis abutting left S1 nerve root.

Output: 1. Interval increase in number of the right periventricular white matter demyelinating lesions as described above.2. Evidence of spinal cord demyelinating lesions suggesting spinal cord involvement.3. Disc herniation at the level of L5S1 with left lateral recess stenosis.


Instruction: Generate impression based on findings.

Input: 2-year-old male with sacral dimple. There is a fat signal lesion that measures up to 25 mm in length along the posterior aspect of the conus medullaris, which is slightly indented by the lesions and terminates at the L2 level. The rest of the spinal cord displays normal signal and morphology. However, there is an additional fat signal lesion that measures up to 3 mm in length along the filum terminale at the L3-4 level. There appears to be deficiency of the posterior elements of L5 and portions of the sacral spine. However, the reported overlying dimple is not apparent. The prone images are degraded by patient motion, thereby limiting the assessment of cord mobility. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. A lipoma along the posterior aspect of the conus medullaris measures up to 25 mm and a lipoma along the filum terminale at the L3-4 level measures up to 3 mm.2. The prone images are degraded by patient motion, thereby limiting the assessment of cord mobility.3. Apparent deficiency of the posterior elements of L5 and in portions of the sacral spine may indicate dysraphism. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 41 year old presents for research MRI ("Alan Penn study") prior to biopsy of right breast calcifications. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, a limitation to this study.No suspicious enhancement is seen in either breast. The biopsy clip from a previous biopsy is noted in the right upper central breast. The density of parenchymal type enhancement anterior to the clip is slightly greater than elsewhere in the breasts, though this area exhibits similar kinetic behavior to the rest of the breasts. No abnormal lymph nodes are identified in either axillary region.A few scattered high T2 signal liver lesions are most likely cysts.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: There are approximately 10 punctate foci of T2 and FLAIR hyperintensity within the supratentorial white matter, primarily within the bilateral frontal lobes. These are nonspecific in appearance and distribution and may be related to prior inflammation, ischemia or perhaps demyelination. No infratentorial lesions. There is no abnormal intracranial enhancement or diffusion abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles, sulci and basal cisterns are normal in size and configuration. There is no midline shift or herniation. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Mild cerebellar tonsillar ectopia is noted, with descent of the tonsils approximately 5 mm below the level of the foramen magnum. MRI ORBITS

Output: 1. Scattered punctate foci of T2/FLAIR hyperintensity within the supratentorial white matter are nonspecific in appearance and distribution and may be related to prior inflammation, ischemia or perhaps demyelination (although not typical for demyelination).2. There is significant motion degradation of the orbital MRI sequences which limits evaluation for optic neuritis. Within this limitation however no obvious signal abnormality within the optic nerves or orbital mass is evident.3. Low-lying cerebellar tonsils incidentally noted.


Instruction: Generate impression based on findings.

Input: Severe degenerative spondylosis affects the cervical spine as seen on prior CT. There is marked disc osteophyte complex and posterior element hypertrophy noted at the C3/4 level with severe spinal canal stenosis, indentation of the thecal sac and associated cord deformity. Abnormal T2/STIR cord signal at this level is noted bilaterally. There is also at least moderate spinal canal stenosis with indentation of the thecal sac at C4/5 and mild spinal canal stenosis of the lower cervical levels. Mild degenerative changes are seen in the thoracic and lumbar spine without evidence of high-grade spinal canal stenosis. Chronic right cerebellar infarct noted.

Output: 1.Examination is obtained per limited cord compression protocol with additional axial T2 images of the cervical spine. There is severe spinal canal stenosis with cord deformity at the C3-C4 level which appears chronic based on prior cervical spine CT dated 3/11/2013. There is associated abnormal cord signal at the C3/4 level which is favored to represent at least predominantly myelomalacia. Please refer to separate MRI cervical spine report for additional findings.2.No evidence of high-grade spinal canal stenosis in the thoracic or lumbar spine.Findings communicated to G. Piscitello at 2255 hours on 1/19/2016 by the on call radiology resident.


Instruction: Generate impression based on findings.

Input: s/p chiari decompression. dizziness with CT evidence of fluid collection on suboccipital craniotomy site. No evidence of acute ischemic or hemorrhagic lesion.There is evidence of bilateral suboccipital craniectomy and about 21mm x 49mm x 36mm sized CSF like fluid collection on the suboccipital craniotomy site without evidence of restricted diffusion but with minimal peripheral enhancement. This may indicated postoperative uncomplicated fluid collections on operation site.Ovoid shaped thin rim type of enhancement on bilateral tonsils on Gad enhanced images (best seen on series 1502, image 123/200) without evidence of surrounding edema may indicate post operative changes or due to Chiari malformation, Correlation with pre operative exam is recommended.CSF flow study using Phase contrast MRA technique shows pulsatile craniocaudal flow through anterior aspect of the foramen magnum and inferior aspect of cerebellar tonsil.Delineation of inferior vermis is not possible with bilateral cerebellar hemispheric interdigitation especially inferior aspect and partial continuity of cerebellar white matter tracks indicating possible partial vermian hypoplasia or partial rhombencephalosynapsis.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and are clear.Partial opacifications on bilateral mastoid air cells.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Fluid collections on bilateral suboccipital craniectomy sites without evidence of complication.3. Maintained craniocaudal pulsatile CSF flow anterior aspect of foramen magnum. Craniocaudal CSF flow was shown on the posterior aspect in particular inferior to cerebellar tonsil but the magnitude is less than that of anterior aspect CSF flow.4. Partial rhombencephalosynapsis or partial vermian hypoplasia as described above.


Instruction: Generate impression based on findings.

Input: 20 years, Male, calvarial lesion possibly due to testicular cancer. Germ cell tumor with brain and lung metastases, status post completion of whole brain radiotherapy in March 2014, last chemotherapy administered August 13, 2014, with undetectable beta-hCG and AFP. There is no restricted diffusion to suggest acute ischemia. There are scattered non-enhancing, susceptibility-inducing lesions within the bilateral frontal, parietal and temporal lobes and left cerebellum, unchanged from prior, possibly treated disease/microhemorrhages. For example, a lesion within the left cerebellum measures 4 mm on series 10, image 20, unchanged from prior. There are a few foci of susceptibility within the right frontal lobe and right parietal lobe which are new from prior. An enhancing left parietal calvarial lesion is increased in size measuring 1.1 x 0.3 cm (series 10, image 12), previously 0.5 x 0.3 cm. There is no midline shift or herniation. The ventricles are within normal limits in size and configuration. There is no hydrocephalus.There is no abnormal parenchymal or meningeal enhancement. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Increased size of left parietal calvarial enhancing lesion.2. Unchanged nonenhancing, hemosiderin stained lesions within the bilateral frontal, parietal and temporal lobes and left cerebellum, likely representing treated disease or treatment related change.3. Few new punctate foci of microhemorrhage within the right frontal and parietal lobes, as detailed above.


Instruction: Generate impression based on findings.

Input: 80 year-old male postop day number 1 status post ex lap with distal subtotal gastrectomy now with delay status post fall with altered mental status and hit head. Negative LOC. Evaluate for acute process/bleed. There is no evidence of intracranial hemorrhage, mass or edema. MRI of the brain could be obtained if there remains clinical concern for acute ischemic disease. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Male 40 years old Reason: 40 yo male found on us to have a an abdominal wall mass that is painful with movement. Needs MRI to evaluate extent of lesion History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Liver has signal loss on out of phase imaging compatible with fatty infiltration. No suspicious hepatic lesions. Hepatic and portal veins are patent. No biliary ductal dilatation.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: In the area of clinical concern marked by skin markers there is fat in the subcutaneous tissues without encapsulation there is slight distortion of the underlying muscle contour. No nodular enhancement is evident. No surrounding fluid collection or inflammation is evident.The abdominal rectus muscles are intact.OTHER: No significant abnormality noted.

Output: 1.Likely nonencapsulated lipoma in the left abdominal subcutaneous tissues. No suspicious mass.


Instruction: Generate impression based on findings.

Input: Stage IV NED melanoma: assess for metastatic recurrence. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 37-year-old female with a cystic suprasellar mass, radiation planning for craniopharyngioma status post surgery. Patient is experiencing vision changes. Redemonstrated is the patient's cystic lesion involving the third ventricle and suprasellar cistern. There has been interval enlargement, now measuring 3.4 cm AP x 2.4 cm transverse x 3.9 cm craniocaudal. Mass effect upon the lateral ventricles has increased although there remains no evidence of hydrocephalus. Previously demonstrated postbiopsy changes have nearly resolved. There remains a small amount of susceptibility hypointensity as well as enhancement underlying the biopsy entry site as well as some persistent mild soft tissue swelling in the overlying subcutaneous tissues. Associated vasogenic edema has decreased. Expected vascular enhancement is present.

Output: Redemonstrated is the patient's cystic lesion involving the third ventricle and suprasellar cistern. There has been interval enlargement, now measuring 3.4 cm AP x 2.4 cm transverse x 3.9 cm craniocaudal. Mass effect upon the lateral ventricles has increased although there remains no evidence of hydrocephalus.


Instruction: Generate impression based on findings.

Input: 38 year-old male status post MVC with loss of consciousness and head and neck pain. Rule out bleed. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Examination of the neck reveals normal alignment no acute fracture. Soft tissue density is seen at C4/C5 that may represent a disc protrusion. MRI is recommended for further evaluation.Degenerative disc disease also at C5/C6 with mild narrowing of the neural foramina bilaterally.

Output: Normal brain CT.Focal soft tissue density at C4/C5 that may represent disc protrusion. An MRI is recommended for further characterization. No fractures or malalignment is identified.