Instruction: Generate impression based on findings.

Input: The exam is mildly limited due to technically degraded STIR sequence. The last well formed disk space is referred to as L5-S1. There is mild straightening of the lumbar spine. Vertebral body heights are preserved. There is normal T2 signal in the disks with preserved disk heights. The osseous marrow signal is benign. The conus terminates at T12-L1 and is within normal limits. There is a tiny fatty filum measuring less than 2 mm in thickness.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: No disk herniation or spinal stenosis.L3-4: Minimal disk bulge and ligamenta flava thickening with no significant spinal stenosis.L4-5: Minimal disk bulge and facet arthropathy with no spinal stenosis.L5-S1: No disk herniation or spinal stenosis.

Output: Essentially unremarkable exam except for incidental fatty filum, which can be seen with tethered cord - please correlate clinically.


Instruction: Generate impression based on findings.

Input: Acute myeloid leukemia in relapse with bilateral lower extremity weakness and low back pain. The bone marrow is diffusely heterogeneous. There is lack of the usual lumbar lordosis and slight anterolisthesis if L2 on L3. The cervical and thoracic vertebral column alignment is otherwise within normal limits. There are disc bulges at L4-5 and L5-S1, as well as ligamentum flavum thickening that result in mild to moderate neural foraminal narrowing and spinal canal narrowing. Less prominent degenerative spondylosis in the rest of the lumbar spine do not results in significant spinal canal or neural foraminal narrowing. LIkewise, there is no significant cervical or thoracic spinal canal stenosis. The vertebral body heights are preserved. The spinal cord is unremarkable, aside from diffuse linear artifact on STIR. The paravertebral soft tissues are unremarkable. There are multiple bilateral renal cysts.

Output: 1. Diffuse bone marrow heterogeneity is likely attributable to acute myeloid leukemia.2. Degenerative spondylosis at L4-5 and L5-S1 result in mild to moderate neural foraminal narrowing and spinal canal narrowing. 3. No evidence of discitis-osteomyelitis.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Biopsy dated 1/29/2016 demonstrated 3+ 3 1-mm less than 5% right base, 3+ 3 1-mm 10% left mid, 3+ 3 2-mm 20% left lateral base, 3+ 3 1-mm less than 5% left lateral mid prostatic adenocarcinoma. PELVIS:PROSTATE:Prostate Size: 3.6 x 4.7 x 4.2 cmPeripheral Zone: There is diffuse mildly decreased T2 weighted signal intensity of the peripheral zone in addition to scattered linear signal hypointensity.In the lateral mid gland there is a focal 7 x 7 mm T2 weighted hypointense lesion (series 801/17) associated with restricted diffusion (series 1000 3/264) and mild relative hyper enhancement (2301/789). Sub-5 mm focus of T2 weighted hyperintensity and restricted diffusion in the left apex (series 801/11 and series 1003/144).No additional discrete suspicious lesion.Central Gland: Mild changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: Mild bulging of the prostate contour adjacent to the left lateral mid gland lesion.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent nonspecific external iliac lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dominant 7 mm lesion in the left lateral mid gland is suspicious for prostatic adenocarcinoma. The lesion bulges the prostatic margin.


Instruction: Generate impression based on findings.

Input: Renal cell with brain mets, post resection and SRS 7/2014 & whole brain RT 12/2014. There are postoperative findings related to right frontal craniotomy with persistent confluent high T2 signal, but no evidence of abnormal enhancement in the region of the right superior frontal resection cavity. There is interval decrease in size of the enhancing component of the hemorrhagic right parietal lobe lesion and associated vasogenic edema, which now measures 10 mm, previously 17 mm. There is also interval decrease in size of the right occipital lobe hemorrhagic ring-enhancing lesion and associated vasogenic edema, which now measures up to 7 mm, previously 9 mm. In addition, there is interval decrease in size of the enhancing left occipital lobe lesion and associated vasogenic edema, which now measures up to 6 mm, previously 10 mm. Furthermore, there is interval decrease in size of the hemorrhagic enhancing lesion located more laterally in the left occipital lobe lesion and associated vasogenic edema, which now measures up to 5 mm, previously 7 mm. Likewise, the hemorrhagic enhancing lesion in the right precuneus has diminished in size, now measuring up to 2 mm, previously 6 mm. There is an unchanged focus of susceptibility effect in the right superior parietal lobule. There is no evidence of intracranial hemorrhage or acute infarct. There is diminished effacement of the left lateral ventricle posteriorly. There is no midline shift or herniation. The major cerebral flow voids are intact. There is nonspecific fluid signal within the bilateral mastoid air cells, which may represent effusions. There is a right maxillary sinus retention cyst.

Output: Interval decrease in size of the brain metastases and associated vasogenic edema.


Instruction: Generate impression based on findings.

Input: Ultrasound report with possible gallbladder mass ABDOMEN:LIVER, BILIARY TRACT: Involving the gallbladder (see image 27 series 5) an corresponding to the masslesion seen on prior sonography is a hepatic segment 5/6 centrally necrotic mass measuring 5.9 x 4.8 cm. Mass is heterogeneous in appearance and demonstrates mild T2 hyperintensity. Mass demonstrates progressive postcontrast enhancement, suspicious for cholangiocarcinoma (see image 55 series 1501 and image 58 series 1/5/2004). No rounded T2 hypointense signal seen at level of gallbladder or mass to suggest underlying stone in when comparison made to prior ultrasound studies, there was no evidence of cholelithiasis. Gallbladder overall contracted and significant portion involved by tumor. Mild intrahepatic and extrahepatic biliary duct dilatation without definite distal CBD stone seen, see image 19 series 4. Metastatic lymphadenopathy present. Precaval lymph node measuring 2.8 x 2 cm, image 28 series 5. 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: Left para-aortic lymph node measuring 2.2 x 1.6 cm. Other smaller lymph nodes also seen, see image 89 series 1501.BOWEL, MESENTERY: Mass located in close proximity to hepatic flexure of colon (see image 69 series 1503), no definite underlying invasion but early serosal invasion not excluded, no upstream bowel dilatation seen to suggest obstruction. On coronal image 20 series 4, intervening fat plane between hepatic flexure of colon and liver preserved in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Findings compatible with gallbladder/liver mass as described, appearance suspicious for primary gallbladder adenocarcinoma (although no associated gallstone depicted). Given the progressive postcontrast enhancement demonstrated, cholangiocarcinoma is another concern. Upper abdominal/retroperitoneal lymphadenopathy present. Metastatic disease a differential consideration as well but considered less likely. 2. Mass situated in close proximity to hepatic flexure of colon, no definite underlying invasion but early serosal invasion not excluded. No bowel obstruction.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with dementia. No evidence of restricted diffusion, parenchymal edema or mass effect is seen. However, substantial diffuse cerebral volume loss is seen, with particular atrophy of the hippocampi. The cerebellum is spared. No pathologic intracranial enhancement is seen. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. There is mild T2 hyperintense rimming of the ventricles, and the atrophic hippocampi are also mildly T2 hyperintense. Scattered foci of susceptibility are nonspecific and may reflect chronic microhemorrhage or mineralization. A few scattered foci of T2 hyperintensity in the periventricular white matter are nonspecific.

Output: Diffuse cerebral atrophy is seen with particular involvement of the hippocampi. These findings would be compatible with a chronic neurodegenerative process such as Alzheimer's disease. No definite acute lesions are detected.


Instruction: Generate impression based on findings.

Input: 47-year-old female history of ESRD on HD, now status post kidney transplant 2005 presenting with left-sided abdominal pain and hematuria. Noncontrast renal stone protocol requested. ABDOMEN: Exam is not sensitive for detecting lesions in the solid organs of the upper to lack of oral or IV contrast dedicated nature the protocol.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The native right kidney is atrophic. The native left kidney has high density material in the collecting system consistent with blood. There is a 4.5-cm diameter lesion off the posterior aspect of the left kidney with the average density of 12 Hounsfield units likely representing a cyst. On the posterior aspect of the cyst is a small exophytic 1.1-cm lesion seen on axial series 4 image 52 and coronal image 47 where in average density of 28 Hounsfield units. There is also rim-like thick calcification along the posterior wall of the dominant lesion bordering on the smaller lesion. No other definite lesions are seen in the kidney. Given hematuria and a small exophytic lesion consider contrast enhanced CT or MRI to rule out renal malignancy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes consistent with gastric surgery. Dilated to the nature of the surgery.BONES, SOFT TISSUES: Focal large area of calcification or ossification in the subcutaneous fat of the right back series 4 image 55 possibly post traumatic.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Left adnexal mass with fat fluid level and multifocal calcifications on the soft tissue plug and in the rim in the pattern consistent with ovarian teratoma dermoid.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes clips anterior abdominal pelvic wallSurgical pins both hips.

Output: Left adnexal mass consistent with dermoid / teratoma. Blood in collecting system of native left kidney with large lower pole cyst and small exophytic mass. This could be evaluated better with IV contrast enhanced scan. Postsurgical changes stomach and hips.


Instruction: Generate impression based on findings.

Input: Right knee pain for 2 years MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No evidence of internal derangement.


Instruction: Generate impression based on findings.

Input: 83-year-old female with history of hypertension, coronary artery disease status post CABG, diabetes mellitus, PE on Coumadin. Patient status post fall. Patient hit head on side of rail per witnessed. INR equals 2.4. Evaluate for subdural hematoma. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of hypoattenuation in the periventricular and subcortical white matter distribution consistent with small vessel ischemic disease common age indeterminate. If there is clinical concern for ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for ischemia, MRI may be considered.


Instruction: Generate impression based on findings.

Input: Code 65-year-old female with history of NHL. Status post transplant. Follow-up on a small subdural hematoma identified on MRI of brain. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected. No evidence of subdural is identified as was noted on prior MRI exam. The cortical sulci, ventricular system and all CSF cisterns remain within normal limits.

Output: Normal CT of brain.


Instruction: Generate impression based on findings.

Input: 68-year-old female. Cirrhosis, complex liver cyst, elevated CEA 19-9. Evaluate for HCC. Evaluate complex cyst seen on ultrasound. Evaluate pancreas for lesions. ABDOMEN:LIVER, BILIARY TRACT: 1 cm right hepatic lobe cyst with a thin septation, unchanged from 2012, most likely a benign cyst. No suspicious hepatic mass. Smooth contour of the liver. Edematous diffuse wall thickening of a collapsed gallbladder, which can be due to chronic liver disease. No biliary ductal dilatation.Perigastric and esophageal varices. Enlarged T10 portal vein. Patent hepatic veins and hepatic artery.SPLEEN: Mild splenomegaly measuring 13.7 cm.PANCREAS: Normal signal intensity and morphology the pancreas. No pancreatic ductal dilatation. No suspicious pancreatic mass is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild cortical atrophy of the left kidney.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic disease of the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small Tarlov cysts in the upper sacrum. Mild degenerative changes in the thoracolumbar spine. Multiple T2 hyperintense foci scattered in the spine, likely focal fat or hemangiomas.OTHER: No significant abnormality noted.

Output: 1.No suspicious hepatic mass. 1 cm cystic lesion in the right hepatic lobe with a thin septation, most likely a benign cyst given stability from 2012.2.No suspicious pancreatic mass is identified.


Instruction: Generate impression based on findings.

Input: Female 57 years old Reason: r/o suspicious lesions History: h/o multinodular goiter RIGHT LOBE MEASUREMENTS: 5.8 x 2.8 x 3.1 cmLEFT LOBE MEASUREMENTS: 5.3 x 1.9 x 2 cmISTHMUS MEASUREMENTS: 5 mmRIGHT LOBE: Multiple nodules in the right lobe of the thyroid. Largest nodule is in the mid to superior pole and measures 2.6 x 2.1 x 2.1 cm. This nodule has a hypoechoic halo and complex internal echoes. This likely represents a colloid nodule.LEFT LOBE: Multiple nodules in the left lobe of the thyroid largest measuring 9 x 7 x 9 m. These are complex appearing cystic nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes in the neck.OTHER: No significant abnormality noted.

Output: Multinodular goiter with largest nodule in the mid to superior aspect of the right lobe of the thyroid.


Instruction: Generate impression based on findings.

Input: Male 50 years old Reason: Change in nodule History: Nodular goiter with previous FNA showing Hashimoto's RIGHT LOBE MEASUREMENTS: 5.4 x 1.7 x 2 cmLEFT LOBE MEASUREMENTS: 4.3 x 2.8 x 1.6 cmISTHMUS MEASUREMENTS: 8mmRIGHT LOBE: Heterogeneous right lobe of the thyroid compatible with patient's known history of thyroiditis.LEFT LOBE: Heterogeneous left lobe of the thyroid. Previously measured nodule in the left lobe is again noted and now measures 2.6 x 2.1 cm, not significantly changed from previous study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Previous described, solid, well-defined nodule posterior to the right thyroid lobe now measures 1.7 x 1.1 cm and suspicious for a parathyroid adenoma, unchanged.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneous echotexture of the thyroid with possible right parathyroid adenoma and left-sided thyroid nodule, unchanged.


Instruction: Generate impression based on findings.

Input: Reason: hx of CBD stricture. Last ERCP 10/13/14 with removal of plastic stent ABDOMEN:LIVER, BILIARY TRACT: Intrahepatic biliary duct dilation has resolved. Pneumobilia limits evaluation of the common duct. The common duct measures up to 6 mm in diameter.Status post cholecystectomy.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: Small hiatal hernia is present. Colonic diverticulosis is noted without complication.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No intrahepatic biliary duct dilation. Pneumobilia limits evaluation of the common duct.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with relapsed multiple myeloma. Evaluate for bony lesions. Cervical:Ill-defined nonspecific STIR hyperintensity is seen within the C6 vertebral body. Elsewhere within the cervical spine, marrow signal characteristics are somewhat heterogeneous which is felt to be degenerative in nature. No definite additional concerning marrow replacement is seen. The visualized spinal cord demonstrates normal signal characteristics. No epidural abnormalities are suspected.C2-3: Right facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: Right facet hypertrophy. Mild posterior disc-osteophyte complex formation. Effacement of the ventral thecal sac with a mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation resulting in effacement of the ventral thecal sac and slight flattening of the ventral cord. Mild to moderate generalized spinal canal stenosis. Severe bilateral foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation resulting in slight effacement of the ventral thecal sac but no significant generalized spinal canal stenosis. Moderate left and severe right foraminal narrowing. C6-7: Mild posterior disc-osteophyte complex formation. No significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. C7-T1: Facet hypertrophy. Mild posterior disc-osteophyte complex formation. Mild bilateral foraminal narrowing. Thoracic:Hyperintensity and subtle T1 hypointensity is seen within the T2 and T4 vertebral bodies suspicious or pathologic marrow replacement. There may be scattered additional very small foci of T1 hypointensity within the vertebral bodies, but image resolution does not permit definitive diagnosis in this regard. Left lateral fusion instruments and strut grafts are noted spanning from T9 through L1, and artifact from these devices does obscure osseous evaluation to some degree. Despite this, it does appear that the left transverse process of T10 is expanded which probably reflects marrow space disease.Alignment is anatomic. Vertebral body heights are preserved. The visualized thoracic spinal cord shows no abnormal signal. No epidural abnormalities are suspected. Minimal scattered degenerative disc disease is seen without significant spinal canal or foraminal stenosis, though assessment of the foramina is somewhat limited in the instrumented region due to artifact.Lumbar:There are five lumbar type vertebral bodies with a transitional S1. Spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are somewhat heterogeneous. Superimposed upon this, there are numerous very small foci of T1 hypointensity involving every lumbar level. Larger foci of marrow replacement on the order of 1 cm are seen within the left sacrum and the iliac wings.The distal spinal cord, conus and cauda equina demonstrate normal morphology. No epidural abnormalities are seen.Facet hypertrophy and ligamentum flavum thickening become progressively worse at lower lumbar levels. However, there is no significant disc bulging or disc herniation. The spinal canal remains patent throughout. Mild left neuroforaminal narrowing is seen at L5-S1.

Output: 1.Pathologic marrow signal is seen within the C6 vertebral body, the T2 and T4 vertebral bodies, the left T10 transverse process, and the sacrum and iliac bones highly suspicious for metastatic disease. There may be additional scattered very small foci of marrow replacement within the lumbar spine and elsewhere which could also indicate metastatic disease.2.Postoperative findings compatible with lateral instrumented fusion and partial corpectomy are seen spanning from T9 through L1. Elsewhere, vertebral body height and morphology are within normal limits. No compression deformities are identified. No epidural tumor is seen, and no tumor related spinal canal encroachment is detected.3.Degenerative disease is seen in the cervical spine with scattered spinal canal stenosis ranging from mild to moderate and scattered foraminal narrowing.


Instruction: Generate impression based on findings.

Input: There is straightening of the cervical spine which is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Bilateral uncinate hypertrophy (right greater left) causing mild right neural foraminal stenosis.C4/5: Mild posterior osteophyte disc complex and uncinate hypertrophy without stenosis.C5/6: Minimal disc bulge without stenosis.C6/7: UnremarkableC7/T1: Unremarkable

Output: C3/4: Mild right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 20 years old, with episodes of loss of consciousness, concern for seizure disorder. A 9 x 6 mm oval cystic lesion is evident at the margin of the right frontal horn. The rim of this lesion is mildly FLAIR hyperintense but the central component suppresses similar to CSF.Elsewhere, numerous scattered punctate foci of T2 hyperintensity are evident in the cerebral white matter, none of which is associated with any significant mass effect.No other abnormal extra-axial collections are detected. No evidence of intracranial hemorrhage is seen. The ventricular system is patent and within normal limits for size.

Output: 1. A subcentimeter cyst is evident along the margin of the right frontal horn. The differential diagnosis would include a congenital periventricular or connatal cyst. The relevance of this finding to the patient's presenting complaint is uncertain but it is likely to be an unrelated incidental finding.2. Numerous scattered punctate foci of T2 hyperintensity are evident within the cerebral white matter, more than what would be considered within normal limits for a patient of this age. The differential diagnosis for such a finding is broad and would include the sequelae of prior inflammation, demyelination, vascular disease, or migrainous headache as the most common potential etiologies.3.No other specific findings are seen which would account for the patient's suspected seizures.


Instruction: Generate impression based on findings.

Input: Left asymmetrical sensorineural hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There are secretions in the left sphenoid sinus. There are bilateral lens implants.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Female, 84 years old, with back and hip pain, assess for evidence of metastases and compression. History of lung cancer. A mild levoscoliotic curvature is evident. There are also trace retrolistheses of T12 on L1 and L1 on L2.Mild wedging of the posterior L5 vertebral body is seen with no more than 20% loss of vertebral body height. There may be some loss of height of the left lateral L4 vertebral body as well but this is difficult to ascertain with certainty.Marrow signal characteristics are diffusely heterogeneous. However, within the left posterior aspect of the L4 vertebral body, a fairly broad region of hyperintense STIR and hypointense T1 signal is seen with extension into the left pedicle. Less intense but still noticeable STIR hyperintense signal is seen along the superior endplate of L5 and extending into the left L5 pedicle.The intervertebral disk at L3-4 is mildly STIR hyperintense and there is an associated Schmorl's node deformity along the L3 inferior endplate. The L3-4 endplates demonstrate fatty degenerative signal alteration.Evidence of degenerative disk disease is seen at all levels. Including within the lower visualized thoracic levels. In the lumbar spine, severe loss of disk height is seen at L2-3 and at L4-5. Additional level specific findings are as follows:L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Mildly bulging disk asymmetric to the right. Effacement of the right lateral recess but no significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening, particularly on the right. Mild bulging disk. Mild generalized spinal canal stenosis with particular effacement of the right dorsal thecal sac. Moderate right and mild left neuroforaminal narrowing. L3-4: Severe facet hypertrophy and marked ligamentum flavum thickening. Moderate bulging disk. Severe generalized spinal canal stenosis with crowding of the cauda equina. Severe right and moderate left foraminal narrowing. L4-5: Severe left and moderate right facet hypertrophy. Marked ligamentum flavum thickening. Disk bulging and osteophytic spurring asymmetric towards the left foraminal and extraforaminal zones. There may also be bony and/or soft tissue expansion of the left posterior lateral L5 endplate into the left L4-5 foramen. Moderate generalized spinal canal stenosis. Severe left neuroforaminal narrowing with nerve root impingement. Moderate right neuroforaminal narrowing. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disk asymmetric to the left. No significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. Numerous bilateral cystic lesions are seen, some of which are hemorrhagic.

Output: Signal abnormality is seen within the left L4 and to a lesser degree the L5 vertebral bodies. There may be some associated bony and/or soft tissue expansion from the lateral aspects of both vertebral bodies towards the left L4-5 neural foramen which is severely narrowed. Given the history, findings are considered suspicious but not definitive for the presence of metastatic disease. Findings may also reflect severe degenerative edema and/or compression of the left lateral vertebral body. Sequelae of infection would be a much less likely possibility. Given the uncertainty, CT imaging of the lumbar spine may be helpful in better visualizing the bony anatomy and in detecting any underlying osseous lytic process.Moderate to severe degenerative findings are seen at additional levels, for example at L3-4 where there is a severe generalized spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Changes are noted from previous craniotomy involving the skull bilaterally. Encephalomalacia is present involving the anterior right temporal lobe with adjacent gliosis as well as susceptibility abnormality from presumed hemosiderin staining.There are multiple foci of T2 hypointensity with matching susceptibility abnormality throughout the supratentorial and infratentorial brain. More foci of hypointensity are noted with susceptibility technique. The largest of these lesions resides in the left periatrial white matter measuring approximately 11 x 14 mm in transaxial dimension on T2 imaging. None demonstrate perilesional edema. There are no associated developmental venous anomalies.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. No diffusion-weighted abnormalities are identified to suggest the presence of acute ischemia. 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.

Output: 1.MRI evidence for multiple cerebral cavernous malformations. None demonstrate perilesional edema.2.Encephalomalacia is present involving the anterior right temporal lobe with adjacent gliosis as well as susceptibility abnormality from presumed hemosiderin staining from prior cavernous malformation resection.


Instruction: Generate impression based on findings.

Input: 65 years, Male, history of small cell lung cancer. Extensive confluent T2/FLAIR hyperintensity is seen in the bilateral subcortical and periventricular white matter, which is nonspecific, but may reflect post-treatment related leukoencephalopathy and/or chronic small vessel ischemic disease. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. There is T1 shortening in the calvarium, particularly at the skull base, which may reflect sequela of prior radiation treatment. No destructive osseous lesions.

Output: 1. No evidence of intracranial metastatic disease.2. Extensive white matter signal abnormality which may represent post-treatment related leukoencephalopathy or chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Evaluate for change in mass, edema. Posterior fossa meningioma which worsening drowsiness and headaches. No evidence of intracranial bleed. Again seen is a left-sided posterior fossa lesion exerting mass effect upon the left cerebellar hemisphere with effacement of the extra-axial space and fissure. It is not as well bowel weighted on the noncontrast CT as in recent contrast-enhanced brain MRI. No hydrocephalus. There is minimal mass effect upon the fourth ventricle. The supratentorial compartment demonstrates stable appearance with no evidence of intracranial bleed, stable mild to moderate diffuse bilateral periventricular and subcortical white matter hypodensities.

Output: No interval change in the appearance of the head CT when compared to 12/31 2008. The evaluation of the posterior fossa meningioma is not well achieved by this noncontrast CT alone. A more adequate/accurate evaluation can be achieved with an MRI of the brain with contrast, if clinically indicated. There is no evidence of intracranial bleed or hydrocephalus.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with back pain status post lumbar instrument fusion, status post epidural hematoma evacuation. Evaluate for hematoma. Evidence of posterior instrumented fusion is again seen with pedicle screws on the right at L4-S1, and on the left at L5 and S1. Interbody devices have also been placed at L4-5 and L5-S1. Evidence of laminectomy/facetectomy is also seen on the right at L4-5 and on the left at L5-S1.Since the prior examination, the previously seen large fluid collection within the superficial soft tissues of the lumbar region has resolved. A fluid collection which was evident more deeply within the right L4-5 operative bed, extending to the epidural space, has also significantly improved with only a small amount of residual fluid or edema present. Previous encroachment upon the thecal sac has improved as well.Marrow signal abnormality compatible with edema is seen involving nearly the entirety of the L4 and L5 vertebral bodies, a finding which has progressed from the prior examination. There may be some edema in the prevertebral soft tissues, but this is equivocal. No definite evidence of any new epidural or paraspinal fluid collection is seen. Edema persists within the right psoas musculature.Straightening of the cervical lordosis is again seen. Vertebral body heights are largely preserved with the exception of postoperative change at L4 and L5. No other areas of marrow signal abnormality are seen.At L3-4, facet arthropathy, ligamentum flavum thickening, and a disc bulge with central annular fissure contribute to mild spinal canal narrowing. The foramina are not significantly compromised.At L5-S1, posterior element hypertrophy and bulging disc material resulting in a moderate narrowing of the spinal canal, but improved from the prior examination. Moderate right and mild left foraminal narrowing is seen.At L5-S1, posterior element hypertrophy and disc bulging asymmetric to the left lateral recess is seen. No significant generalized spinal canal stenosis is seen. The neural foramina are mildly narrowed.

Output: 1.Since the prior examination, the previously demonstrated subcutaneous and epidural fluid collections within the operative region have resolved or nearly completely resolved. No findings are seen to suggest new or progressive bleeding. The thecal sac remains narrowed at the L4-5 level though this is improved relative to the prior study.2.Progressive edema is seen within the L4 and L5 vertebral bodies when compared to the prior examination. There may be mild edema within the prevertebral soft tissues but this is equivocal. No new fluid collections are seen. In the absence of leukocytosis or an abnormal ESR, these findings may simply represent edema reactive to surgical instrumentation. Infection is considered less likely but cannot be eliminated as a possibility based on imaging. At least one follow-up MRI can be considered if the patient's symptoms do not improve.


Instruction: Generate impression based on findings.

Input: 67-year-old male with vertigo and left-sided fullness. Evaluate for mass. Asymmetric fullness of the left cavernous sinus and left intracranial internal carotid and middle cerebral arteries raises the question of left cavernous-carotid fistula. MRI/MRA could be performed to help exclude this possibility.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.

Output: Asymmetric fullness of the left cavernous sinus and proximal internal carotid and middle cerebral arteries and raises the question of cavernous carotid fistula. MRI/MRA could be obtained to further evaluate as clinically indicated.


Instruction: Generate impression based on findings.

Input: 67-year-old female with pancreatic IPMN, evaluate interval change ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Common bile duct is mildly tortuous but unchanged in size. Status post cholecystectomySPLEEN: No significant abnormality noted.PANCREAS: A bilobed 7 mm T2 hyperintense cystic lesion within the pancreatic tail is stable (401/14). An additional 3 mm lesion in the pancreatic body/tail is also unchanged (701/23).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cystic lesions in the pancreatic tail likely represent side branch IPMNs and are stable.


Instruction: Generate impression based on findings.

Input: 38 years, Female, constant headache for 3 weeks. There is evidence of dissection involving the distal right cervical internal carotid artery with presence of dissection flap and narrowing of the lumen. There is T1 hyperintensity related to the mural thrombus. Flow-void of the right cervical internal carotid artery is narrowed related to the dissection. The flow-void of the cavernous and supraclinoid internal carotid artery is normal in caliber. Brain parenchyma appears unremarkable. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Sella 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. There is dissection involving the visualized portion of the distal right cervical internal carotid artery. There is narrowing of the adjacent right ICA flow-void without occlusion. CTA or MRA head and neck can better assess the full extent of the dissection although cranially appears to extend to the level of the petrous ICA segment.2. Brain MRI is otherwise unremarkable. No evidence of infarct or intracranial mass. Dr. Ali discussed findings with Dr. Vela at 1025 hours on 6/1/2016


Instruction: Generate impression based on findings.

Input: 60-year-old with strong family history of breast cancer There is scattered fibroglandular tissue in both breasts.Mild 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: The patient is a 44-year-old male who presents for a pulmonary vein CT prior to planned atrial fibrillation ablation by catheter-based pulmonary vein isolation. The quality of the study is suboptimal. There is a relatively low contrast opacification of the left atrium pulmonary veins. Within the limits of this study the pulmonary vein dimensions are as follows:Left superior pulmonary vein: 19.3 x 12.8mmleft inferior pulmonary vein 11.4 x 20.1 mmright superior pulmonary vein 26.6 x 17.2 mmright inferior pulmonary vein 19.5 x 15.6 mmLeft atrial volume 123 cc

Output: 1. Increased left atrial volume. 2. Mildly enlarged pulmonary vein diameter. 3. Poor opacification of the left atrium and pulmonary veins.Interpretation of the lungs and other soft tissues of the thorax and upper abdomen will be included in the radiologist report.


Instruction: Generate impression based on findings.

Input: 30 year old female with a history of myxoid liposarcoma presents for evaluation after excision of this lesion. Markers were placed on the skin surface and the mid and distal thigh posteriorly, presumably denoting the site of scarring. The previously seen soft tissue mass in the posterolateral distal thigh has been resected. Band like scarring traverses the overlying subcutaneous fat. The biceps femoris has been resected distally. Crescentic intermediate signal intensity tissue extends from the aforementioned subcutaneous scar to the posterior margin of the vastus lateralis margin which likely represents additional scarring. There is a small collection of fluid signal intensity within this scar with peripheral enhancement that we suspect represents a small seroma. It is elongated and measures approximately 1cm in the transverse dimension and 5.5 cm in the cranial-caudal direction. Although there is mild enhancement of the aforementioned scar tissue following gadolinium administration we see no discrete mass to suggest tumor recurrence. The sciatic nerve abuts the margin of the aforementioned scar tissue, but we see no abnormal signal intensity within the nerve. Bone marrow signal intensity is normal. There is a small knee joint effusion with synovitis, which is nonspecific.

Output: Surgical changes of myxoid liposarcoma excision including scarring and a small seroma, but we see no specific findings of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Other abnormalities of gait and mobility [R26.89] / Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system [D49.7], Reason for Study: ^Reason: balance issues, pituitary mass History: balance issues, hx of pituitary adenoma There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is about 9 mm sized enhancing lesion with the surrounding FLAIR high signal intensity at the left temporo-occipital lobe. There is no other enhancing lesion on this scan. MR characteristics of this lesion is non specific. The differential diagnosis include demyelination, inflammation, tumorous condition or subacute ischemic lesion. Follow up imaging study including MR spectroscopy can be considered.There is disproportional volume loss of pons, medullar, bilateral middle cerebellar peduncle as well as bilateral cerebellar hemispheres comparing to supratentorial structures. There is no abnormal enhancement, nor abnormal signal intensity on Gradient echo images. These findings suggest possible diagnosis of multiple system atrophy. 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 mastoid air cells are clear.Mucosal thickenings on bilateral maxillary sinuses and ethmoid sinuses.

Output: 1. Abnormal enhancing lesion with surrounding edema at the left temporo-occipital lobe as described above. Differential diagnosis include demyelination, inflammatory, tumorous and subacute ischemic lesion.2. Possible diagnosis of multiple system atrophy.


Instruction: Generate impression based on findings.

Input: Right medullary thyroid now with rising calcitonin, possible left level 4/5 nodes. There are postoperative findings related to total thyroidectomy without evidence of measurable locoregional tumor or abnormal lymph nodes in the neck. The major salivary glands are unremarkable. There is atherosclerotic plaque at the bilateral carotid bifurcations and left vertebral artery origin. There is multilevel degenerative spondylosis. The imaged intracranial structures are unremarkable.

Output: Postoperative findings related to total thyroidectomy without convincing evidence of measurable locoregional tumor recurrence or lymph node metastases in the neck.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Incidental note is made of an absent right parotid gland with fat residing in the expected parotid location. Otherwise the visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: UnremarkableC6/7: UnremarkableC7/T1: Unremarkable

Output: 1.Incidental note is made of an absent right parotid gland with fat residing in the expected parotid location. The differential diagnosis for this finding would include fatty replacement, resection, or agenesis of the parotid gland.2.Otherwise negative noncontrast cervical spine MRI.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for intracranial hemorrhage. Signs and symptoms: Known brain metastases, increasing seizure frequency. Nonenhanced head CT:Examination demonstrates small foci of cortical increased density in the right anterior parietal and posterior frontal lobes, suspected for small hemorrhage/hemorrhagic tumor and or mineralization from prior treatment. The largest of these lesions measures 8.2 x 5.5 -mm in size. There are no prior exams for comparison.Examination also demonstrates fairly extensive periventricular and subcortical low attenuation of white matter with no apparent mass effect which may represent posttreatment changes / encephalomalacia / residual edema from metastatic brain lesions. There is a well demarcated area of CSF density in the left frontal lobe with apparent communication with the left frontal horn. This finding is under a left frontal craniotomy and may represent area of encephalomalacia/ surgical cavity. There is no evidence for midline shift or hydrocephalus. Ventricular system however is mildly dilated. Images through posterior fossa are unremarkable.Follow-up with an enhanced MRI is recommended.

Output: Constellation of intracranial abnormalities as detailed above. Please see above comments.


Instruction: Generate impression based on findings.

Input: Hypoxic, cardiac arrest, patient's obtunded. Evaluate for stroke. There is no evidence of intracranial hemorrhage, mass or edema. There is apparent volume loss in the right aspect of the cerebellar vermis which correlates with an area of signal abnormality on the MRI dated 3/6/2008 and is suggestive of atrophy.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The right mastoid air cells and maxillary sinus are completely opacified. Extensive mucosal thickening is also seen in the remaining visualized paranasal sinuses.

Output: 1. No evidence of acute cortical stroke or intracranial hemorrhage.2. Probable atrophy of the right cerebellar vermis.3. Pansinus inflammatory changes.


Instruction: Generate impression based on findings.

Input: There is a left cavernous sinus region enhancing, dural-based mass that measures up to approximately 25 mm. There is negligible mass effect upon the left medial temporal lobe and no evidence of vasogenic edema. There is prominence of the sulci and ventricles due to cerebral volume loss. There is mild nonspecific scattered periventricular and subcortical white matter T2 signal, likely due to mild age indeterminate small vessel ischemic disease. There are also punctate areas of encephalomalacia in the corona radiata bilaterally. There is no midline shift. There is no evidence of acute infarction or intracranial hemorrhage. Normal flow-voids are demonstrated in the major intracranial vascular structures. The orbits are unremarkable. The skull is intact. There is a small amount of fluid within the left mastoid air cells. There is a punctate right sphenoid sinus retention cyst.

Output: 1. Left cavernous sinus region enhancing, dural-based mass that measures up to approximately 25 mm likely represents a meningioma.2. Mild chronic small vessel ischemic disease and bilateral corona radiata lacunar infarcts, but no evidence of acute infarction.3. Diffuse cerebral volume loss.4. Nonspecific small amount of fluid within the left mastoid air cells.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 62-year-old male with history of HCV and head and neck cancer ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis is present. Normal liver morphology. Low T2 diffuse signal (with T1 signal increasing on out of phase images of the liver) compatible with iron deposition disease. No focal liver lesions are evident. Vessels are widely patent. SPLEEN: Low T2 signal of the spleen increasing on out of phase T1, compatible with iron deposition disease. 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: Percutaneous gastrostomy tube is in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Focal airspace opacity in the left lung base.

Output: 1.No focal liver lesion is evident. Findings of iron deposition disease. 2.Left lower lobe air space opacity. CXR may be of clinical use to better visualize and determine significance.


Instruction: Generate impression based on findings.

Input: Female, 20 years old, with chronic nausea. Assess for a central etiology. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is seen. Normal variant developmental venous anomalies are evident in the left frontal operculum and in the left cerebellar hemisphere.No evidence of parenchymal edema, mass, or mass effect is seen. There are no findings to suggest intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

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


Instruction: Generate impression based on findings.

Input: Pain. Evaluate for osteoarthritis. Note is made of increased bone marrow signal abnormality about the second tarsometatarsal joints indicating degenerative change. There is a well-circumscribed lesion within the mid diaphysis of the third metatarsal which demonstrates decreased signal abnormality on T1-weighted images and increased signal abnormality on fluid sensitive sequences with peripheral low signal intensity likely representing sclerosis. This has benign imaging characteristics and may represent an enchondroma, although this could be better characterized with radiographs, if available. There is no cortical destruction or soft tissue extension. The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance. There is nonspecific subcutaneous edema about the dorsal aspect of the second and third tarsometatarsal joints. The ligaments of the ankle appear intact. There is nonspecific edema within Kager's fat pad.

Output: Osteoarthritis of the foot and other findings as described above


Instruction: Generate impression based on findings.

Input: Right lower extremity radiculopathy. There is sclerosis about the right L2 pedicle. Given the history of breast cancer, further evaluation of the lumbar spine with MRI suggested. Again seen is degenerative changes of L5-S1 and mild to moderate facet joint osteoarthritis of the lumbar spine. Vertebral body heights and intervertebral spaces are preserved. Alignment is near anatomic.

Output: Sclerosis about the right L2 pedicle. Given the history of breast cancer, further evaluation of the lumbar spine with MRI suggested.


Instruction: Generate impression based on findings.

Input: Left knee pain A large mass with aggressive features is seen arising from the medial femoral condyle and distal tibial metaphysis which extends into the adjacent soft tissues. It measures approximately 8.0 x 6.7 x 10 cm in the greatest transaxial and craniocaudal dimensions. The mass is iso- to hypointense to skeletal muscle on T1WI and slightly hyperintense to skeletal muscle on fat saturated T2 sequences and scattered areas of signal heterogeneity. There is extension of the mass to the weightbearing surface of the medial femoral condyle with irregularity of the subchondral bone plate, possibly representing a pathologic fracture.There is soft tissue edema of the thigh, including the VMO. There is a large joint effusion with both discrete and ill-defined foci of low signal intensity scattered throughout, likely representing a combination of blood products, cartilaginous fragments, and synovitis; however, cannot exclude the possibility of intra-articular seeding of tumor. There is a small Baker's cyst with fluid extending along the popliteal tendon. There is slight displacement of the VMO by the mass; the mass does not appear to extend into the popliteal vessels. A few slightly prominent lymph nodes are noted within the popliteal fossa which are all less than 1 cm.Note that evaluation of the articular cartilage and menisci is degraded by motion artifact and the large field of view provided to completely image the mass. Within these limitations, full-thickness cartilage defects are noted along the medial patellar facet with delamination of the articular cartilage of the femoral trochlea.The ACL, PCL, and LCL are intact. The MCL courses proximally along the medial aspect of the mass but is not seen at its proximal attachment. The extensor mechanism is unremarkable.

Output: Large soft tissue mass with aggressive features arising from the distal femur highly suspicious for primary malignancy such as osteosarcoma. Correlation with conventional radiographs and referral to orthopedic oncology is recommended.Note that at the time of the study, the patient was currently admitted at Jackson Park Hospital (773-947-7500) and transferred for the purposes of routine knee MRI at University of Chicago Medical Center. These findings were discussed with Dr. B. Najeeb (resident for Dr. Syed Ali, the primary attending caring for the patient at Jackson Park Hospital) via telephone at 4:25 pm on the date of the exam. Also note that the order for MRI was initially placed by ancillary services prior to the patient's admission by Dr. Edward Pillar (708-924-8000) who was also made aware of the findings.


Instruction: Generate impression based on findings.

Input: Elbow pain Exam is slightly limited by motion artifact.LIGAMENTS: The ulnar and lateral collateral ligaments are intact.TENDONS: There is thickening and intermediate signal of the distal biceps tendon at its insertion on the radius indicating tendinosis with a possible small interstitial tear noted just proximal to the insertion. There is no fluid-filled surface tear identified, however. There is mild soft tissue inflammation about the biceps tendon distally although the biceps muscle is normal. The brachialis tendon is normal. The triceps tendon is normal.There is minimal edema within the medial epicondyle of the distal humerus with a small focus of increased signal within the common flexor tendon at its origin (best seen on series 7 image 7). A tiny amount of fluid is also seen superficial to the common flexor tendon origin. These changes likely represent focal degeneration with associated reactive marrow change. There is mild intermediate signal intensity within the common extensor origin also likely reflecting mild tendinosis.ARTICULAR SURFACES AND BONE: Small defects in the capitellum posteriorly likely represent normal variation. There is no significant osteoarthritis and the remaining bone marrow signal is otherwise normal. SURROUNDING STRUCTURES: The remaining soft tissues of the elbow appear normal.

Output: 1. Mild to moderate insertional tendinosis of the biceps with possible small interstitial tear just proximal to the insertion.2. Mild tendinosis of the common flexor and common extensor origins.


Instruction: Generate impression based on findings.

Input: 71-year-old female status post right TKA with history of CVA. As increased irritability and decreased responsiveness. Rule out subdural hematoma or infarction. The examination demonstrates some periventricular hypodensity consistent with small vessel ischemic disease. In the left temporal region there is an area of hypodensity which may or present area of acute ischemia. The appearance is somewhat atypical however with a central area of relative hyperdensity. I cannot exclude the possibility of prior hemorrhage or even underlying mass lesion.. No significant mass-effect is seen. I would recommend obtaining an MRI of the brain with contrast to further evaluate this region.Bone windows reveal no osseous abnormality.

Output: Small vessel disease an area of atypical density along the left temporal lobe. Possibilities include an area of subacute ischemia versus evolving hematoma (possibly evolution of hemorrhagic transformation of an infarct) or less likely mass lesion. MRI of the brain with contrast is recommended to fully evaluate.


Instruction: Generate impression based on findings.

Input: 26-year-old female with AML in remission There is mild edema and enhancement along the myotendinous fibers of the iliopsoas and distal piriformis that is nonspecific, but may represent mild strain or inflammation. No fluid collection is evident. No joint effusion or evidence of synovitis. The remaining musculature is within normal limits. Again seen is increased marrow signal abnormality within the subtrochanteric femur that is predominantly isointense to muscle on T1-weighted sequences and hyperintense to muscle on T2 weighted sequences, which is nonspecific and could reflect the patient's known leukemia or sequelae of its treatment. The region of signal abnormality is slightly smaller on the current study compared with the prior dated 11/15/14. There is also a subcentimeter focus of signal abnormality within the supraacetabular right ilium that was likewise present on the prior study.

Output: 1. Edema and enhancement of the distal iliopsoas and piriformis myotendinous fibers that is nonspecific, but could represent strain or inflammation. We see no fluid collection or abscess.2. Marrow signal abnormality as described above, appearing similar or slightly less extensive than on the prior study.


Instruction: Generate impression based on findings.

Input: 84-year-old male preop planning for resection of a left extra-axial mass. PMH of metastatic prostate cancer. Redemonstrated along the left frontal convexity is a large multilobulated heterogeneously enhancing extra-axial dural based mass with some mass effect on the adjacent brain parenchyma, some surrounding vasogenic edema and 3 mm of rightward midline shift. The mass measures approximately 2.3 x 2.5 cm. There is some adjacent meningeal thickening and enhancement as well as enhancement, thickening and replacement of the adjacent right frontal calvarial marrow indicating osseous involvement.There is no evidence of intracranial hemorrhage or acute infarct. There is additional scattered periventricular and subcortical white matter hypoattenuation which is nonspecific. The basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. A small right maxillary sinus mucous retention cyst or polyp is seen.

Output: 1.Multilobulated heterogeneously enhancing left frontal extra-axial mass with adjacent brain parenchymal mass effect, vasogenic edema, and 3 mm rightward midline shift. There is also left frontal meningeal thickening and enhancement as well as thickening, enhancement and replacement of the adjacent right frontal calvarial marrow suggesting osseous involvement. Given the patient's history of metastatic prostate cancer, these findings are suspicious for a metastatic lesion. An unusual meningioma is an alternative explanation.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 66 years Male (DOB:9/20/1950)Reason: evalaute for spinal stenosis History: neuorclaudication symptomsPROVIDER/ATTENDING NAME: MONICA B. VELA MONICA B. VELA 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 a dextrocurvature to the lumbar spine present.At L5-S1 there is moderate right-sided facet hypertrophy present at this level and mild left-sided facet hypertrophy. There is loss of disc space height this desiccation and a diffuse disc bulge at this level. There is a very mild encroachment of the nerve roots of the right lateral recess at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and bilateral facet and ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a left far lateral disc protrusion present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a left far lateral disc protrusion associated with the left-sided endplate osteophytes which displaces the left-sided exiting nerve root after it exits the neural foramen. There are associated endplate reactive changes.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are multilevel degenerative changes present in the lumbar spine with some mild encroachment of the nerve roots at the right lateral recess at L5-S1. Mild degree of spinal stenosis present at L4-5. There are some displacement of the left-sided exiting nerve root at L2-3 related to a left far lateral disc protrusion. There is a sigmoid curvature to the lumbar spine.


Instruction: Generate impression based on findings.

Input: 39-year-old female with history of right upper quadrant pain and elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis, gallbladder wall thickening and trace pericholecystic fluid compatible with acute cholecystitis in the absence of chronic liver disease, which can show similar findings without acute cholecystitis.. Mild intrahepatic biliary ductal prominence but without excessive dilation to suggest obstruction and the common bile duct measures 6 mm, within normal limits. There is a convex termination to the distal common bile duct on thin cut MRCP series (image 7 of series 9) , however no stones or filling defects are evident on the axial or other sequences and this is most likely a normal sphincter with spasm.1 cm hepatic dome lesion demonstrates discontinuous nodular enhancement on post contrast imaging and is compatible with a benign hemangioma. A similar appearing 6 mm lesion is also present in the periphery of segment 8. 8 mm segment 6 lesion does not demonstrate any appreciable enhancement and likely represents a simple cyst.SPLEEN: Splenomegaly.PANCREAS: The pancreas and pancreatic duct appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with acute cholecystitis. No significant intra or extrahepatic biliary ductal dilation to suggest biliary obstruction.2.Splenomegaly.3.Benign hepatic lesions as above.


Instruction: Generate impression based on findings.

Input: Reason: 19-year-old male with history of NK/T-Cell lymphoma s/p transplant with recurrent osteomyelitis now with bilateral foot pain History: 19-year-old male with history of NK/T-Cell lymphoma s/p transplant with recurrent osteomyelitis now with bilateral foot pain There is perhaps soft tissue irregularity along the lateral aspect of the ankle which may represent ulceration. There is minimal nonspecific enhancing subcutaneous edema most pronounced along the lateral aspect of the ankle which may represent a cellulitis in the correct clinical context, but this is of questionable clinical significance. There is no evidence to suggest osteomyelitis of the underlying bone. Note is made of multiple serpentine foci of signal abnormality within the distal tibia, talar dome, calcaneus, navicular, cuboid, and bases of the first and fourth metatarsals consistent with osteonecrosis/bone infarcts. No osteochondral defects are identified. There is nonspecific diffuse edema affecting the imaged musculature of the ankle and foot involving both the flexor and extensor compartments. While these findings are nonspecific they may represent a myositis. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.

Output: 1. Extensive bone infarcts affecting the right ankle and midfoot as described above. There is no evidence of osteomyelitis.2. There is diffuse edema within the imaged musculature of the right ankle and foot which is nonspecific but may represent a myositis.3. Minimal soft tissue ulceration and subcutaneous edema may reflect a cellulitis in the correct clinical context, however, no focal fluid collection is seen to suggest abscess formation.


Instruction: Generate impression based on findings.

Input: 53 year old with history of right lumpectomy for breast cancer, and history of left breast benign biopsy at two sites presents for screening MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right breast is deformed from prior lumpectomy at lateral aspect with multiple metallic artifacts in the right axillary region.There are two metallic artifacts n the left breast, at retroareolar region and 9:00 position, corresponding to the marker clips from prior benign biopsy.Multiple enhancing masses and foci are present in the left breast; the largest mass measures 8 mm at the central part of the breast, likely fibroadenoma. None of them shows suspicious type of kinetic pattern.No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Multiple benign masses in the left breast. Annual breast MRI is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 29-year-old man with history of status epilepticus and severe, intermittent lumbago. There is no restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. The brain parenchyma appears normal for age and, specifically, the temporal lobes appear normal volume.There is no abnormal parenchymal or meningeal enhancement. The major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is mild mucosal thickening in the left maxillary sinus. Bone marrow signal and extracranial soft tissues are within normal limits. MRI LUMBAR SPINE

Output: 1.Brain images slightly limited by motion artifact but no acute intracranial abnormality.2.Normal lumbar spine.


Instruction: Generate impression based on findings.

Input: 62 years Male (DOB:4/27/1953)Reason: optic nerve atrophy and VF defects both eyes History: decreased visionPROVIDER/ATTENDING NAME: JEFFREY W NICHOLS JEFFREY W NICHOLS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of partial empty sella.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The optic nerves and the optic chiasm are small.The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: 1.Optic nerve atrophy2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Diagnosis: Disorder of brain, unspecifiedClinical question: cerebellar brain lesion, 6 months follow up , evaluate for changes or growth.Signs and Symptoms: projectile vomiting, brain lesion The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a well-circumscribed 9 x 7 mm coronal dimension lesion along the left posterior aspect of the medulla. It is bright signal on FLAIR and T2 MRI and has lower T1 signal when compared to the adjacent brain tissues and is not associated with susceptibility effect. It is associated with enhancement following gadolinium administration, however, there appears to be a more cystic component surrounding a mural nodule. It does have some local mass effect. It has not changed in size or signal characteristics when compared to the prior examNormal 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: A small mass with a cyst and mural nodule appearance located along the left posterior lateral aspect of the medulla is stable when compared to previous exams. Stability suggests that it is not aggressive. Differential considerations do include neoplasm however, and infection such as cysticercosis in the appropriate clinical setting, may have a cystic mural nodule appearance though would be expected to evolve over time.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for soft tissue mass, subcutaneous on the right upper paraspinal back, likely lipoma; evaluate for depth and size. Signs and symptoms: Large subcutaneous nodule. Nonenhanced thoracic spine MRI:There is normal anatomical alignment the vertebral column. Examination demonstrate a well demarcated foci of marrow signal changes in the vertebral bodies of T6 consistent with a skeletal capillary hemangioma an unremarkable signal intensity of vertebral column otherwise. Mild degenerative changes of the thoracic spine are noted. There is however no evidence of spinal canal or neural foraminal compromise/stenosis at any level. There is normal signal intensity and caliber of thoracic cord.Examination demonstrate a subcutaneous right paramedian loculated fatty signal intensity consistent with a lipoma. The superior extent of the lipoma goes beyond the field of study approximately C7 and inferiorly to T3 -- T4 disk level. The finding measures maximum of 82-mm in transverse diameter from midline to the right T2 level. The largest AP diameter of the lipoma measures approximately at 24-mm and the visualized cranial cephalad axis of lipoma measures at 56-mm. finding is seen subcutaneous space and results in sulcal mass effect and flattening deformity of the underlying musculature without evidence of extension into the deeper tissues.

Output: 1.Right paramedian upper thoracic subcutaneous lipoma measuring at 82mm (transverse) x 24-mm (AP) x 56 mm (cc). It extends from approximately C7 inferiorly to the T3 -- T4 disk level.2.Unremarkable nonenhanced MRI of the thoracic spine otherwise other than mild degenerative changes, however without spinal canal or neural foraminal compromise/stenoses at any level.


Instruction: Generate impression based on findings.

Input: Known left breast cancer on neoadjuvant chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Biopsy proven cancer in the left 2:00 far posterior depth is again noted with hydromark biopsy clip artifact. Residual faint enhancement near the skin measures 1.2 x 0.7 x 1.5 cm. This is significantly decreased from prior measurements of 2.5 x 2.6 x 3.1 cm. The biopsied left axillary lymph node is also again seen with hydromark artifact. At this point, this node measures about 9 mm, previously up to 1.5 cm. Multiple additional lymph nodes in the left axilla are also decreased in size, including in the subpectoral region, where the largest node now measures only up to 8 mm, previously a subpectoral node measured 2.1 cm.No abnormal enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in the right axillary region.

Output: Significant response to therapy with measurements as above.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: There are recent post ablation changes in the brain including mild pneumocephalus. There are faint intrinsic T1 hyperintense blood products with no definite superimposed enhancement in the rostral, genu, and body of the right corpus callosum at the known laser ablation sites, with surrounding rim of FLAIR hyperintensity and diffusion restriction likely relating to expected post procedural ischemic changes. There is a new linear FLAIR hyperintense tract in the right frontal lobe representing laser electrode tract, as well as linear susceptibility along the right temporal and occipital lobes consistent with laser fiber tract. There is mild mass effect on the right lateral ventricle without significant midline shift. There is trace extra-axial FLAIR hyperintensity along the parietal occipital lobes bilaterally, likely representing postoperative blood products. There may be minimal subarachnoid blood products right parietal convexityThere are remote postsurgical changes from right frontoparietal craniotomy for right anterior temporal lobe resection with resulting encephalomalacia. There are also remote postsurgical changes related to left frontoparietal craniotomy with smaller left anterior temporal lobe encephalomalacia. There is diffuse thin linear dural enhancement which is likely postsurgical. There is no acute infarct or suspicious intracranial enhancement otherwise. Prominence of the pineal gland with focal FLAIR hyperintensity is again seen, likely relating to intrinsic cysts.

Output: 1. Expected post laser ablation changes within the right corpus callosum and elsewhere within the brain as detailed above with no evidence of significant hemorrhage or large infarct. Mild localized mass effect on the right frontal horn.2. Changes from remote craniotomies with right much greater than left temporal lobe encephalomalacia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 88 year old woman with history of aortic aneurysm repair in 2009 now with enlarged aortic root on transthoracic ultrasound who presents for cardiac MRI for further evaluation of thoracic aorta size and morphology Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 46%%, the LV end diastolic volume index is 84 ml/m2 (normal range: 65+/-11), the LVEDV is 183 ml (normal range 109+/-23), the LV end systolic volume index is 45 ml/m2 (normal range 18+/-5), the LVESV is 98 ml (normal range 31+/-10), the LV mass index is 28 g/m2 (normal range 67+/-11), and the LV mass is 61 g (normal range 114+/-24). There is diffuse hypokinesis.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 40%%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 150 ml (normal range 110+/-24), the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8), and the RVESV is 90 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is at least mild to moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trivial significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaAortic graft material is noted in the proximal ascending aorta, without concomitant findings to suggest infection. There is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is dilated.Annulus: 23 x 33 mmSOV: 54 x 46 x 49 mmAsc Ao (4 cm from annulus): 32 x 32 mm (in the region of the aortic graft) however dilates to 39 mm just beyond the aortic graft.Aortic arch: 41 x 42 mmDescending Ao: 35 x 39 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is dilated, measuring 39 mm. 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. There are small renal and hepatic hyperintense lesions, statistically representing cysts. Small pleural effusions are present.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function[LVEF 46%]2. The right ventricle is normal in size with mildly reduced systolic function [RVEF 40%]3. Dilated thoracic aorta as noted above, most severe at the sinus of Valsalva4. Dilated pulmonary artery 5. At least moderate aortic regurgitation


Instruction: Generate impression based on findings.

Input: 66-year-old male patient with liver lesion and portal vein thrombosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with macronodular changes. No intra or extrahepatic biliary ductal dilatation. The portal vein is diminutive in appearance and remains patent. The hepatic veins and hepatic arteries are patent. No suspicious lesions are identified. Perigastric and esophageal varices are again noted.SPLEEN: Splenomegaly, measuring up to 16 cm in craniocaudal dimension. Subcentimeter hypervascular lesion in the spleen is nonspecific and is unchanged compared to prior and compatible with a hemangioma.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: Perihepatic and perisplenic ascites appears slightly increased compared to prior examination.

Output: 1.No suspicious hepatic lesions identified in a cirrhotic liver.2.Diminutive portal vein, remains patent.3.Slight interval increase in perihepatic and peristaltic ascites.


Instruction: Generate impression based on findings.

Input: Female, 48 years old. Right thigh soft tissue mass, enlarging over the past year. A marker was placed along the anteromedial aspect of the right mid thigh. Deep to the marker is a mass of predominantly fat signal intensity measuring approximately 8 x 6 cm in transverse dimension and approximately 9 cm in oblique craniocaudal dimension. Within the fatty mass are small round and curvilinear foci of intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images, showing minimal if any enhancement, with the exception of a 1 cm focus of enhancement anteriorly within the mass just below the skin surface. The mass does not invade the musculature of the thigh, and we see no additional masses.Severe osteoarthritis affects the knee. A 1 cm focus of intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images within the intertrochanteric region of the femur showing mild enhancement is nonspecific. Uterine fibroids are incompletely imaged.

Output: 1.Fatty mass in the anterior subcutaneous fat containing some nonadipose elements. This may simply represent a subcutaneous lipoma with benign nonadipose elements due to repeated trauma. An angiolipoma is also considered in the differential diagnosis, but lack of enhancement would be atypical. An atypical lipomatous tumor is also considered in the differential diagnosis.2.A 1 cm round enhancing focus in the intertrochanteric region of the right femur is nonspecific. We suspect that this is benign and of no clinical significance, perhaps representing a small benign cartilaginous rest. However, if the patient has a known primary tumor, then a skeletal scintigram could be considered to evaluate for potential metastatic disease.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage or mass. There are punctate foci of restricted diffusion in the left superior frontal sulcus and precentral gyrus. There is otherwise a small area of encephalomalacia in the left precentral gyrus. Additional scattered punctate foci and confluent areas of T2 hyperintensity within the periventricular and subcortical white matter without associated restricted diffusion. 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. There are bilateral maxillary osteointegrated dental implants and sinus lift surgery.

Output: Punctate foci of restricted diffusion in the left superior frontal sulcus and precentral gyrus may reflect acute to early subacute ischemia superimposed upon an otherwise small chronic infarct involving the left precentral gyrus and a background of diffuse mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 29 years, Female, status post left frontal craniotomy with pathology confirmed meningioma. First surgery August 2009, with reoperation October 2013. Status post proton therapy completed February 2014. Patient is status post left frontotemporal craniotomy, with unchanged localized encephalomalacia within the left inferior frontal gyrus. There is increase enhancement within the overlying bone flap and underlying dural layer at the craniotomy site extending along the orbital ridge, measuring 3.0 x 1.7 cm (series 1101, image 83; series 1201, image 7), previously 2.4 x 2.1 cm. There is an unchanged T2 hyperintense fluid collection within the left middle cranial fossa, compatible with an arachnoid cyst. There is no restricted diffusion to suggest acute ischemia. No intracranial hemorrhage is identified. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits.

Output: 1.Status post left frontotemporal craniotomy with increased enhancement within the overlying bone especially inner table side and underlying dural layer at the craniotomy site and extending along the left orbital ridge, which is suspicious for local recurrence versus post treatment related revascularization and resorption of bone flap.2.Unchanged localized inflammation within the left inferior frontal gyrus.


Instruction: Generate impression based on findings.

Input: Continued episodes of back pain and some discomfort and limited mobility in her back starting from a car accident in January of this year. There is mild anterior wedging of the T12 and L1 vertebral bodies with what may represent trace clefts, but no substantial bone marrow edema. The vertebral body heights are preserved at the other levels. There is no significant loss of disc space height. The vertebral column alignment is within normal limits. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The cauda equina nerve roots are unremarkable. The paravertebral soft tissues are unremarkable. There is a small amount of pelvic free fluid, which is likely physiological.

Output: Mild anterior wedge compression fractures of the T12 and L1 vertebral bodies without spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Susceptibility artifact somewhat limits evaluation of the tissues immediately surrounding the craniotomy site secondary to a metallic plate. There are postoperative findings related to recent resection of left cerebellar lesion, with foci of gas and blood products within the resection cavity. There is persistent T2 hyperintensity in the surrounding cerebellum, but decreased mass effect on the fourth ventricle when compared to the prior MRI. There is persistent herniation of cerebellar tissue through the previous craniotomy defect. There is a stable amount of blood products and a small fluid collection at the craniotomy site. There are persistent areas of peripheral enhancement surrounding the resection cavity, which are suspicious for residual disease. There is an unchanged appearance of the known right parietal lesion with surrounding edema, measuring 13 x 13 mm in axial cross-section. The subcentimeter right cerebellar lesion is again identified, but is less conspicuous than on the previous MRI. Normal flow-voids are demonstrated in the major intracranial vascular structures. There are nonspecific fluid levels in the maxillary and sphenoid sinuses. There is staphylomatous deformity of the bilateral globes.

Output: 1.Postoperative findings related to recent resection of left cerebellar mass with areas of peripheral, but irregular enhancement in the resection bed, particularly anteriorly, which are suspicious for residual tumor.2.Persistent right parietal and cerebellar metastatic lesions.


Instruction: Generate impression based on findings.

Input: 79-year-old male with waxing and waning altered mental status. Please note that mild motion artifact limits evaluation. Focus of increased DWI signal in the left posterior frontal lobe likely represents artifact from susceptibility in this area. No definite evidence of diffusion restriction to suggest infarct. Severe enlargement of the ventricles and sulci likely reflects atrophy. Moderate to severe periventricular and subcortical T2 hyperintensities are nonspecific but likely represent chronic small vessel ischemic disease. Focus of susceptibility in the left high convexity is likely related to chronic hemosiderin deposition. A few additional punctate foci of susceptibility are present which are nonspecific. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. Mild mucosal thickening of the bilateral maxillary sinuses with a left maxillary mucous retention cyst/polyp.

Output: Moderate to severe chronic small vessel ischemic disease. No acute infarct.


Instruction: Generate impression based on findings.

Input: History of left parotid space rhabdomyosarcoma, off therapy, assess for progression. Brain: This is a motion degraded exam. There is no evidence of intracranial mass. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The cerebellar tonsil remains low lying especially on the left. There is left parieto-occipital plagiocephaly. There is mucosal thickening in the bilateral maxillary sinuses, ethmoid sinuses, left more than the right sphenoid sinus, progressed from prior. There is persistent trace fluid in the bilateral mastoid air cells. The orbits and scalp soft tissues are grossly unremarkable.Neck: There are post surgical findings in the left parotid region, but no evidence of underlying measurable mass lesions. There is a persistently prominent right level 2A lymph node, measuring 18 x 11 mm in axial cross-section. Other smaller cervical lymph nodes are also unchanged. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The airways are patent. The osseous structures are intact.

Output: 1. Post-treatment findings in the left parotid gland without discernible recurrent tumor.2. Stable nonspecifically enlarged right level 2A lymph node.3. No evidence of intracranial mass.4. Increased paranasal sinus mucosal inflammation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: New onset severe headache. Evaluate for mass or other intracranial pathology. The brain parenchyma appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. No abnormal parenchymal or meningeal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Sella and orbits are grossly unremarkable. There is increased opacification of the left sphenoid sinus compared to CT from 5/27/2009. Unchanged mild mucosal thickening of the bilateral ethmoid, and left maxillary sinuses and improved mucosal thickening the right maxillary sinus. Remainder of the skull and extracranial soft tissues are unremarkable.

Output: 1. MRI of the brain is unremarkable. Specifically, no intracranial mass or mass effect. 2. Mild to moderate paranasal sinus disease, which is overall similar to prior, but there is interval increased opacification of the left sphenoid sinus.


Instruction: Generate impression based on findings.

Input: History of pancreatic ductal dilatation on endoscopic ultrasound without an obvious mass. Ampullary biopsy showed no mass. ABDOMEN:LIVER, BILIARY TRACT: Few scattered probable cysts. No focal lesion. Normally distended gallbladder. No intrahepatic biliary ductal dilatation. Mild prominence of the common bile duct to the level of the ampulla without a discrete lesion within the limitations of a nonenhanced study.SPLEEN: No significant abnormality noted.PANCREAS: Significant main pancreatic ductal dilatation up to 7 mm involving the pancreatic head and body with smooth tapering distally without pancreatic parenchymal atrophy or mural nodularity. Accounting for differences in technique the overall appearance is similar to the 6/15/2012 study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are atrophic with the parenchyma replaced with numerous hyperintense cysts reflecting acquired cystic kidney disease of dialysis. Evaluation is limited without contrast however no suspicious lesion is evident.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.Main pancreatic ductal dilatation which tapers distally without pancreatic atrophy or mural nodularity. Although evaluation is limited without contrast there is no discrete lesion evident. The overall appearance is similar to the 2012 CT accounting for differences in technique.2.Acquired cystic kidney disease with limited nonenhanced evaluation showing no suspicious lesion.


Instruction: Generate impression based on findings.

Input: 4 month old with retinoblastoma, evaluate for routine rule out of orbital disease and for trilateral (pineal or intracranial) disease. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: There is minimally enhancing lesion that measures approximately 2 x 7 mm in cross section along the posterolateral aspect of the right globe with apparent episcleral irregularity. The right optic nerve appears to be intact. The left orbit appears to be unremarkable.

Output: 1. Subcentimeter right intraocular retinoblastoma with suggestion of possible episcleral extension. 2. No evidence of left orbital tumor.3. No evidence of intracranial tumor to suggest trilateral retinoblastoma.


Instruction: Generate impression based on findings.

Input: 71 year old woman with AF, OSA, referred for MRI prior to AF ablation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 154 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 57 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There no late gadolinium enhancement present.Left AtriumThe left atrium is severely dilated. The LA volume is 125 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 138 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 61 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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. RSPV: 21x17mmRIPV: 17X14mmLSPV: 29X13mm with early branchingLIPV: 10x17mmPulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%.3. Severe bi-atrial enlargementI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 46 years Female (DOB:9/13/1969)Reason: assess for right lumbar radiculopathy History: radicular pain on the right LE and severe neuropathic pain in the right footPROVIDER/ATTENDING NAME: KOUROSH REZANIA KOUROSH REZANIA 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 right-sided facet hypertrophy present associated with some encroachment of the nerve roots of the right lateral recess.At L4-5 there is loss of disc space height this desiccation and endplate reactive changes associated with diffuse disc bulge. There is effacement of the fat at the right lateral recess and partial effacement of the fat at the left lateral recess at this level. There is narrowing of the neural foramina bilaterally but worse on the right versus the left side where there is some mild encroachment of the right-sided exiting nerve roots within the neural foramen. The endplate reactive changes are high signal on T1-weighted imaging and somewhat lower signal on T2 STIR imaging.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present in the lumbar spine which are worse at L4-5 where there is a diffuse disc bulge and encroachment of the nerve roots at the right lateral recess (most likely right L5 nerve roots). There are associated chronic endplate reactive changes present at this level.2.There is encroachment of the nerve roots at the right lateral recess at L5-S1 (most likely right S1 nerve roots) predominantly related to some facet hypertrophy.3.Exam is somewhat limited due to the patient's inability to also obtain the T1 axial images.