Instruction: Generate impression based on findings.

Input: Reason: complete rotator cuff tear of right shoulder History: shoulder tear ROTATOR CUFF: Note made of a full-thickness tear of the anterior fibers of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 10 mm in the AP dimension. There is approximately 6 mm of retraction of the proximal tendon fragment. There is thickening and intermediate signal intensity within the supraspinatus indicating mild to moderate tendinosis. The supraspinatus muscle appears intact. There is perhaps undersurface fraying of the articular surface fibers of the infraspinatus. No full-thickness tear or retraction is evident. The infraspinatus muscle appears intact.The subscapularis and teres minor muscles and tendons appear intact. There is thickening and intermediate signal intensity within the subscapularis indicating moderate tendinosis.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and intermediate signal intensity within the anterior and inferior glenoid labrum likely representing degeneration/degenerative tearing within the limitations of this non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Full-thickness tear of the supraspinatus with minimal retraction as described above. Undersurface fraying of the infraspinatus and rotator cuff tendinosis. Other findings as described.


Instruction: Generate impression based on findings.

Input: History of CNS lymphoma s/p R-CHOP x 6, R-CEOP x 6, 2 cycles Ara-C and methotrexate, now 100 days post auto SCT. There is mild diffuse enhancement along the right trigeminal nerve. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. There is new extensive confluent cerebral white matter T2 hyperintensity. There is no abnormal brain parenchymal enhancement. There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a small left maxillary sinus retention cyst.

Output: 1. Mild diffuse enhancement along the right trigeminal nerve may represent lymphomatous involvement.2. New extensive cerebral white matter abnormality is likely treatment-related, such as methotrexate encephalopathy.


Instruction: Generate impression based on findings.

Input: Congenital talipes equinovarus. Evaluate for cord tethering, syrinx or Chiari malformation. Brain:The cerebral white-matter appears decreased in volume, especially centrally. There is asymmetric expansion of the posterior left lateral ventricle, which may reflect more pronounced white-matter volume loss or might be in part relate to normal variation. Anterior subarachnoid space prominence and ventricular prominence also in part likely relate to benign enlargement of subarachnoid spaces of infancy. Myelination is delayed for age. Otherwise, there is no definite parenchymal signal abnormality but there is diffuse thinning of the corpus callosum. There is no Chiari malformation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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.Complete spine: The study is limited by motion artifact. Mild broad-based rightward convex spinal curvature might be positional. Sagittal alignment is preserved. Note, the S1 is partially lumbarized which is a common variation. The vertebral bodies and intervertebral discs are unremarkable there is no significant narrowing of the spinal canal or the neural foramina. The spinal cord is of normal shape and signal, without a syrinx. The conus medullaris is normal in morphology and its tip lies at L2-L3 level which is normal. In prone positioning, there is appropriate ventral displacement of the nerve roots. Focal T2-hypointensity projecting anterior to the tip of the conus medullaris on axial T2-weighted imaging (image #14 of series #2801) with no definite abnormality on sagittal imaging or the other sequences is likely artifactual. There is no fat signal intensity in the distal thecal sac.The vitamin E capsule marker overlies the intergluteal cleft at S1-S2 level with no definite underlying soft tissue abnormality or posterior osseous defect. While the right testicle is in the scrotum, the left one is not, and might be undescended.

Output: 1.Cerebral white-matter volume is decreased along with findings of delayed myelination or hypomyelination, which are nonspecific findings.2.No Chiari malformation.3.Spine imaging shows no abnormality but is limited by motion artifact. There is no MR suggestion of cord tethering. Of note, S1 is partially lumbarized; if surgery is to be contemplated, correlation with imaging of the entire spine is recommended.4.Suggestion of undescended left testicle. Correlation with scrotal ultrasound is recommended.


Instruction: Generate impression based on findings.

Input: Evaluate for cord compression. Lower extremity weakness, falls, urinary frequency, pain. Thoracic:Vertebral body heights in the thoracic spine are normal. Alignment is normal. Bone marrow signal is within normal limits. Limited evaluation of the cervical spine on the sagittal counting sequence again demonstrates a low T1 and T2 signal structure dorsal to the C2-C3 disc space which may represent focus of ligamentous calcification or extruded disc material. There appears to be at least mild spinal canal stenosis at this level.At multiple levels in the thoracic spine, again seen is low T1 and low T2 signal involving the dorsal spinal canal likely representing ligamentum flavum calcifications. These lesions are seen at T2-T3, T3-T4, T4-T5, and T6-T7 levels in the upper thoracic spine without significant spinal canal stenosis. A larger focus which extends from the upper T9 to the upper T10 level which results in moderate to severe spinal canal stenosis and compresses the thoracic cord; no significant change. There is abnormal T2 signal within the cord at the T9-T10 level similar to prior although better imaged on the current study. More inferiorly, mild spinal canal narrowing is seen at T10-T11, moderate spinal canal narrowing at the T11-T12 level, and moderate to severe canal narrowing at the T12-L1 level at the level of the conus related to ligamentous flavum calcifications. Abnormal T2 signal in the cord at the T12-L1 level is also noted, and also similar to prior.Mild foraminal narrowing is seen associated with the aforementioned calcifications. No high-grade foraminal stenosis. No abnormal enhancement. Right thyroid nodule.Lumbar spine:The most inferior well-defined disc space is labeled L5-S1. Vertebral body heights in the lumbar spine are normal. Alignment is grossly maintained. Conus is in normal position at the mid L2 level. Bone marrow signal is benign. No suspicious enhancement.Multilevel degenerative changes are seen as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: Small left foraminal disc protrusion and facet arthropathy contribute to mild narrowing of the left neural foramen. There is also mild spinal canal narrowing related to ligamentum flavum thickening and facet arthropathy. Right neural foramen is patent.L3-L4: Right foraminal disc protrusion with moderate narrowing of the right neural foramen. There is mild spinal canal and mild left neural foraminal narrowing.L4-L5: There is moderate to severe spinal canal stenosis related to disc protrusion, ligamentum flavum thickening, and facet arthropathy. There is moderate left and mild to moderate right neural foraminal stenosis.L5-S1: Central disc protrusion without significant spinal canal narrowing. There is moderate to severe right neural foraminal stenosis related to facet arthropathy and mild to moderate left neural foraminal narrowing.

Output: 1. Again seen is high-grade spinal canal stenosis at the T9-T10 and T12-L1 levels related to what likely represents ligamentum flavum calcifications with compression of the cord as well as T2 cord signal abnormality. These findings are similar to prior MRI from 7/22/2015. There is lesser degree of spinal canal stenosis related to the same process at additional levels as detailed above.2. Degenerative changes in the lumbar spine with moderate to severe spinal canal stenosis at the L4-L5 level. There is also neural foraminal stenosis at multiple levels in the lumbar spine as detailed above.


Instruction: Generate impression based on findings.

Input: 67-year-old with strong family history of breast cancer, maternal grandmother, 2 aunts and sister. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Stable benign enhancing foci in the left breast at the 3 o'clock position.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Male 30 years old Reason: HCC and CCA screening History: AIH and PSC with cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Liver remains slightly nodular contour with mildly widened fissures. Stricture in the left hepatic lobe duct measures approximately 10 mm is unchanged. Several of the peripheral ducts have an irregular beaded appearance. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: Spleen is mildly enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable left hepatic lobe stricture without suspicious hepatic lesion.2.Nodular contour irregularity of the liver with prominent fissures.


Instruction: Generate impression based on findings.

Input: Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: Demyelination? Structural abnormality? History: R side facial numbness, previous MRI brain with R periventricular white matter lesions There are multifocal high signal intensity lesions on T2/FLAIR involving bilateral corpus callosum, periventricular white matter especially bilateral trigone, bilateral temporal lobe white matter and right middle cerebellar peduncle and right anterosuperior aspect of the pons. These lesions are discrete not associated with surrounding edema or mass effect. Constellation of these findings suggest demyelinating disease such as multiple sclerosis. Differential diagnosis include ADEM and migraine related white matter lesions though less likely. To evaluate the activity of these lesion, if clinically indicated, contrast enhanced MRI can be considered.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickenings are seen on bilateral maxillary sinuses and ethmoid sinus.

Output: 1. Multifocal various sized T2/FLAIR high signal intensity lesions suggesting demyelinating disease such as multiple sclerosis. Differential diagnosis include ADEM and migraine related white matter lesion although less likely.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Metastatic base of tongue cancer, with known epidural tumor at T1-T5, presenting with increasing back pain and new 4/5 weakness in right quadricep. No urinary symptoms, normal rectal tone. Had kyphoplasty at T3 on 12/2. Evaluate for cord compression. There is multifocal narrowing of the spinal canal, most pronounced at the level of C3-4, in addition to indentation of the cord at T3-4 without evidence of acute cord compression. There are numerous osseous metastases throughout the spine, similar in extent as on the prior exam. There has been interval kyphoplasty of the T3 pathologic compression fracture, with persistent approximately 50% loss of height and apparent retropulsion of cement inferiorly in the disc space, which mildly indents the spinal cord. No new pathologic fractures are identified. There are multiple epidural metastases, which do not appear significantly changed from the prior exam. Specifically, epidural tumor extends from T1 through T5 and is present at T10 and L2 with extension into the right neural foramina at these levels, as well as at S1 to S3. There is an intrathecal metastatic lesion at the level of L3-4 measuring up to approximately 30 mm, with compression of the cauda equina, which appears similar to the prior exam. There is multilevel degenerative spondylosis in the lower lumbar spine with associated minimal spinal canal and neural foraminal narrowing. There is edema within the upper thoracic and lower lumbar paraspinal muscles, perhaps related to denervation effects. There is partly imaged mediastinal and left axillary adenopathy.

Output: 1. Numerous metastases to the axial skeleton with epidural extension, particularly at in the upper thoracic region, with possible mild spinal cord compression and at T10 and L2 with associated neural foraminal narrowing, as well as at S1 to S3. However, the lack of contrast and axial images limit the assessment.2. Interval kyphoplasty of the T3 pathologic compression fracture with apparent retropulsion of cement and indentation of the spinal cord.3. Intrathecal metastatic lesion at the level of L3-4 measuring up to approximately 30 mm, with compression of the cauda equina.4. Partly imaged mediastinal and left axillary adenopathy related to metastatic disease.


Instruction: Generate impression based on findings.

Input: Female 67 years old with Hx of bulging disk Hypoplastic ribs are noted at the T12 level, smaller on the left. There 5 lumbar-appearing vertebrae.6 mm of grade 1 anterolisthesis of L5 on S1. The left-sided L5 pars interarticularis is not well visualized, however, if there is clinical concern for defect, recommend further evaluation with CT lumbar spine. The vertebral body heights are preserved, with a small Schmorl node noted at the inferior L2 endplate. No vertebral body marrow abnormalities noted. Mild loss of disc height at L2-3 with diffuse disc desiccation most prominent in the lower lumbar spine. The distal spinal cord and conus demonstrate normal signal morphology and terminates at the mid L1 level. Incidental nonenhancing T2 hyperintense right renal cyst measuring up to 3.5 x 3.1 cm as well as multiple bilateral subcentimeter parapelvic cysts noted. T11-12: No significant central or foraminal stenosis noted on sagittal images.T12-L1: No significant central or foraminal stenosis.L1-L2: Mild bilateral facet arthropathy without significant central or foraminal stenosis.L2-L3: Mild disc bulging and bilateral facet arthropathy with partial flattening of the ventral thecal sac without significant central or foraminal stenosis.L3-L4: Disc bulging with mild ventral indention of the thecal sac and prominence of the epidural fat. Moderate bilateral facet arthropathy. Mild central and mild bilateral foraminal stenosis.L4-5: Disc bulging and prominence of the epidural fat with moderate bilateral facet arthropathy and ligamentum flavum hypertrophy. Moderate-severe central and mild-moderate bilateral foraminal stenosis.L5-S1: Grade 1 anterolisthesis with uncovering of the disc and disc bulging as well as severe bilateral facet arthropathy causing impingement of the descending left S1 nerve root on the facet joint. There is narrowing of the left lateral recess. Ventral left-sided annular fissure noted. Moderate central and mild left foraminal stenosis.

Output: Spondylosis as described above with moderate-severe central stenosis at L4-5 as well as moderate central stenosis at L5-S1 causing impingement of the descending left S1 nerve root. Correlate clinically for left S1 radiculopathy.


Instruction: Generate impression based on findings.

Input: Reason: grade II oligodendroglioma w/ 1p19q deletion. History: brain tumor. The patient is status-post right-sided craniotomy for right temporal lobe surgery. Anterior aspect of the right temporal lobe has been surgically removed. The appearance of a surgical cavity and the adjacent structures is stable when compared to prior exam. T2 and flair MRI signal hyperintensity surrounding these surgical site are stable and suspect the least in part be related to gliosis. No convincing evidence for cerebral blood volume or permeability elevation is appreciated surrounding the original tumor bed.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A punctate focus of susceptibility is present in the left centrum semiovale. In isolation this is of uncertain clinical significance.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Status post right temporal lobe surgery for oligodendroglioma. There is no convincing evidence for recurrence.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: followup on extent of cervical stenosis and prior described vertebral disk bulge History: LEFT UE intermittent muscle weakness, spasms, tingling, especially when lying flat The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small central disk protrusion at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is right-sided facet hypertrophy at this level associated with a disk bulge and some mild narrowing of the right neural foramen. This facet hypertrophy appears to have not changed substantially when compared to the prior exam.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally and encroachment of the exiting nerve roots left worse than right. This was also present on the prior exam.At C6-7 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally and encroachment of the exiting nerve roots. This was also present on the prior exam. There are some endplate reactive changes present at this level which have mildly progressed since the prior examAt C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is a left-sided perineural cyst present at T1-2.The vertebral artery flow voids appear to be intact.

Output: 1.Degenerative changes are present in the cervical spine which have not substantially changed when compared to the previous exam. There is neural foramen encroachment of exiting nerve roots at C4-5 on the right, C5-6 on the left and bilateral at C6-7. There are some endplate reactive changes present at C6-7 which have mildly progressed since the prior exam.


Instruction: Generate impression based on findings.

Input: Female 23 years old; Reason: Numbness to proximal aspect of left dorsal forearm which is improving. The forearm appears normal without findings to account for the patient's pain.

Output: The forearm appears normal without findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Encounter for examination for normal comparison and control in clinical research program [Z00.6], Reason for Study: ^Reason: Metastatic esophageal cancer please assess for CNS involvement prior to starting therapy on a clinical trial There is no evidence of acute ischemic or hemorrhagic lesion.There is relatively well-circumscribed round homogeneous enhancing lesion on just lateral and superior aspect of the right anterior clinoid process (series 12, image 13). The lesion shows slightly low signal intensity on T2 without susceptibility artifacts. There is no surrounding edema. There is no MR evidence of flow void. There is no mass effect seen.This lesion is likely represent extra axial lesion such as a small meningioma. The chance of an aneurysm from supraclinoid segment ICA is less likely. Exophytic intra axial lesion including possible metastatic lesion is also less likely but cannot completely exclude the possibility. Scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Small retention cyst in the left maxillary sinus, left posterior ethmoid sinus and sphenoid sinus rule out occult.

Output: 1. No evidence acute ischemic or hemorrhagic lesion.2. A small nodular enhancing lesion on the superior posterior aspect of the right anterior clinoid process is seen. Diagnostic possibility is a small meningioma. Differential diagnosis include a small arterial aneurysm and exophytic nature metastatic nodule.Comment: To exclude possibility of arterial aneurysm, CTA of head can be considered. Regarding possible metastatic lesion, either a follow up MRI or thin sectioned brain MRI with and without contrast enhancement can be considered.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: NSCLC. s/p WBRT >1yr ago. History: ? L occipital lesion increasing in size? Comparing to prior scan, there are some enhancing nodules are not seen on current scan and there are some new lesions appear. Specifically, previously seen 1) subtle enhancing right superior frontal sulcus lesion is not seen, 2) right parieto-occipital lesion is not seen, and 3) the left occipital enhancing lesion appears to be slightly smaller than before.On the other hand, there are new enhancing lesions at 1) the left superior parietal lobule, 2) right parieto-occipital lesions, 3) right occipital lobe cuneus just above the calcarine fissure, 4) right occipital lobe lingual gyrus. There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Interval development of new enhancing nodules as well as interval disappearance of previously noted enhancing nodules as described above.


Instruction: Generate impression based on findings.

Input: 34 year old female patient status post craniectomy for Chiari. Post-surgical changes of a suboccipital craniectomy with interval resolution of a previously seen extradural postoperative fluid collection. The posterior fossa structures are well decompressed. There is biphasic CSF flow at the level of the neo-foramen Magnum and cerebellar tonsils both ventrally and dorsally, appearing similar to the prior study.Redemonstration of a partially empty sella.Again seen is mild developmental narrowing of the cervical spine without otherwise significant spinal canal or neural foraminal stenosis. Vertebral body heights are preserved. There is mild loss of the cervical lordosis which may be in part positional. There is no syrinx or cord signal abnormality.

Output: 1. Post-surgical changes of a suboccipital craniectomy with decompressed posterior fossa structures and preserved biphasic CSF flow at the neo-foramen Magnum.2. No cord signal abnormality or syrinx.3. Partially empty sella which is non-specific but can be seen with intracranial hypertension in the appropriate clinical setting. This finding has been present since MRI from 3/24/2014.


Instruction: Generate impression based on findings.

Input: Clinical question: Intraventricular brain cyst, evaluate for change/size, one year follow up. Signs and symptoms: As above. Nonenhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrate evidence of acute or new finding since prior exam. Mildly expansile trigone of right lateral ventricle at the site of a previously fenestrated intraventricular cyst remains identical in size and extent to prior exams.Right posterior temporal approach for fenestration of the cyst remains stable and with revisualization of a linear encephalomalacia along the surgical approach similar to prior exam.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise and stable since prior study. Normal visualization of signal voids of major intracranial arterial branches. Normal signal intensity of the intracranial venous sinuses.Unremarkable calvarium, orbits, mild chronic sinus disease and unremarkable mastoid air cells and middle ear cavities.

Output: 1.No acute or new finding since prior study.2.No detectable interval expansion of previously fenestrated right intraventricular cyst.3.Stable linear encephalomalacia along the course of surgical approach in the right posterior temporal.4.Stable and unremarkable brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is intermediate signal intensity within the distal fibers of the supraspinatus tendon at its insertion upon the greater tuberosity indicating mild to moderate insertional tendinosis. We see no gadolinium entering the tendon to indicate a discrete tear. There is mild fraying of the bursal surface fibers of the supraspinatus anteriorly. The supraspinatus muscle is normal. Small cysts are noted within the underlying greater tuberosity which are of doubtful clinical significance. The teres minor tendon and muscle are normal. There is increased signal intensity within the subscapularis tendon which we suspect represents iatrogenic contrast infiltration although a partial tear cannot be excluded. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: .Osteoarthritis affects the acromioclavicular joint. There is no gadolinium or fluid signal within the subacromial/subdeltoid bursa to confirm a full-thickness rotator cuff tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a mildly displaced tear of the superior labrum with increased signal intensity extending into the biceps anchor. The superior labral tear also involves the superior half of the anterior labrum which is best seen on the ABER view. The anterior inferior labrum and posterior labrum appear intact.BICEPS TENDON: A focus of increased signal intensity is again noted within the biceps anchor likely reflecting extension of the SLAP tear. The remaining biceps tendon is intact.

Output: Superior labral tear with other findings described above.


Instruction: Generate impression based on findings.

Input: Lack of coordinationClinical question: evaluate for CVASigns and Symptoms: evaluate for CVA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of high signal on T2 and FLAIR are present basal ganglia, brainstem and thalami .There is a hypointense focus on susceptibility imaging is present in the pons. There are additional punctate foci of low signal on susceptibility imaging in the periventricular white matter. Incidental noted is made of partial empty sella.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.There is anterior subluxation of C1 on C2 associated with narrowing of the spinal canal.

Output: 1.There is subluxation of C1 on C2 associated with what appears to be spinal stenosis. Please correlate with clinical findings. Additional imaging may be of further benefit.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. Additional lesions in the basal ganglia, brainstem and thalami are also likely vascular related.3.There is no evidence for acute ischemic cerebral infarction.4.A microhemorrhage is present within the pons. This is likely from an old hemorrhage.5.At the time of the dictation a page with callback # was sent to the hospitalist - Bryan Campbell - to report the above findings.


Instruction: Generate impression based on findings.

Input: 48 years Female (DOB:4/7/1967)Reason: lesion? History: worsening headaches and severe dizzinessPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Several punctate subcortical white matter lesions are present which are hyperintense on T2 and FLAIR MRI. These are probably of little clinical significance and are frequently seen at this age. They're nonspecific.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.There is diffuse marrow replacement identified in the calvarium.

Output: 1. No intracranial lesions are appreciated to explain the patient's headaches.2.Diffuse marrow replacement is a nonspecific finding but can be seen with sickle cell anemia or other forms of anemia myeloproliferative disorders etc. Given the patient's history of sickle cell trait is most likely related to this.


Instruction: Generate impression based on findings.

Input: 61 years, Female, new onset headaches No intracranial mass or mass effect. No intracranial hemorrhage. There are multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic changes. No diffusion abnormality to suggest recent ischemia. There is global parenchymal volume loss which appears advanced for patient's age. No hydrocephalus. No extra-axial collections. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is minimal mucosal thickening involving the paranasal sinuses which are otherwise clear. There is moderate opacification of the right mastoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial mass or mass effect.2. Mild to moderate chronic small vessel ischemic disease.3. Global parenchymal volume loss which appears mildly prominent for age.


Instruction: Generate impression based on findings.

Input: Multiple fiducial markers on scalp for the purpose of localization.There is 21.6mm x 23.5mm sized well circumscribed extra axial mass on the right CP angle extending into the left internal auditory canal. The mass demonstrated inhomogeneous low signal intensity on T2 images, low signal intensity on T1 images and showed intense enhancement on Gad infusion. The MR characteristics are consistent with vestibular schwannoma. The differential diagnosis include meningioma and facial nerve schwannoma. Brainstem at the level of middle cerebellar peduncle appears to be compressed due to mass, however, there is no abnormal brain parenchymal signal abnormality.Although the 4th ventricle also appears to be slightly deformed, there is no evidence of ventricular enlargement. The gray-white matter differentiation is normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Left CP angle tumor most likely left vestibular schwannoma with differential diagnosis of meningioma, facial nerve schwannoma and metastasis.2. Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 45-year-old female with arm pain, assess for humerus intramedullary lesions The muscles and tendons of the rotator cuff are intact. There is mild increased T2 signal and enhancement within the proximal subscapularis muscle, which may represent a strain. A small joint effusion is noted. The glenoid labrum appears grossly intact. The tendon of the long head of the biceps is normally situated within the bicipital groove. The AC joint is within normal limits.The bone marrow signal is within normal limits without evidence of intramedullary lesion. On postcontrast images there is no abnormal enhancing lesion.

Output: No evidence of intramedullary lesion as clinically questioned. Findings suggestive of a mild strain of the subscapularis muscle.


Instruction: Generate impression based on findings.

Input: Male, 58 years old, with brain metastasis status post resection, radiosurgery planning exam. Postoperative findings are seen compatible with resection of a lesion from the left posterior temporal lobe. A small resection cavity is evident with thin rim enhancement. A small rim-enhancing lesion measuring up to 9 mm in diameter is evident along the left occipital lobe, not significantly changed from prior. No additional enhancing lesions are seen. No evidence of significant generalized mass effect is detected. Ventricular size and morphology are within normal limits.

Output: 1.Postoperative findings compatible with resection of a lesion from the left posterior temporal lobe.2.Small rim-enhancing lesion along the left occipital lobe, likely an additional small metastasis.


Instruction: Generate impression based on findings.

Input: Esophageal cancer. There is interval decrease in size and enhancement of the heterogeneous mass in the left temporo-occipital region, now measuring up to 25 mm, previously 34 mm. Likewise, there is interval decrease in size and enhancement of the heterogeneous mass in the left frontal lobe, now measuring up to 17 mm, previously 28 mm. In addition, the right frontal lobe lesion has also decreased in size, now measuring up to 5 mm, previously 12 mm, and no longer enhances. There is no evidence of intracranial hemorrhage or acute territorial infarct. 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 skull, orbits, and scalp soft tissues are unremarkable. However, there is fluid within the bilateral middle ears and mastoid air cells and mild scattered paranasal sinus mucosal thickening.

Output: Interval decrease in size of the brain metastases.


Instruction: Generate impression based on findings.

Input: 36-year-old female with left ankle pain and swelling. TENDONS: The Achilles tendon is normal. The medial tendons appear normal. The peroneus longus tendon appears slightly enlarged as it courses behind and beneath the distal fibula, which may reflect mild tendinosis, but this is equivocal. The peroneus brevis tendon appears intact. Anterior tendons are normal. LIGAMENTS: The ligaments of the lateral collateral complex appear normal. The anterior tibiofibular ligament appears intact. The posterior tibiofibular ligament is less well-defined than usual on the axial sequences with a small adjacent collection of fluid signal intensity, suggestive of a ganglion. These findings may reflect degeneration or prior injury to the structure, but are not necessarily of any current clinical significance. The visualized components of the deltoid ligament complex appear intact.ARTICULAR SURFACES AND BONE: The bones appear normal. We see no osteochondral defect. There is a small amount of fluid within the tibiotalar, subtalar and talonavicular joints, not necessarily of any clinical significance. ADDITIONAL

Output: 1.Mild soft tissue edema as described above is nonspecific.2.Slight prominence of the peroneus longus tendon may reflect mild tendinosis, but this is equivocal.3.The posterior tibiofibular ligament is less distinct than usual, with an adjacent subcentimeter collection of fluid intensity, which may represent a small ganglion. This may represent degenerative change or prior injury, but is not necessarily of any current clinical significance.


Instruction: Generate impression based on findings.

Input: MRI brain: There is no evidence of acute infarct. No new intracranial hemorrhage or abnormal extra-axial fluid collections are identified. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear of abnormal fluid signal. The skull and extracranial soft tissues are unremarkable.MRA head: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. There is a fetal origin of the right posterior cerebral artery and a prominent left posterior communicating artery. The left vertebral artery is dominant. The distal vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.

Output: 1. No acute intracranial abnormality.2. No flow-limiting stenosis, occlusion, or aneurysm in the major cerebral arteries.


Instruction: Generate impression based on findings.

Input: 15 year old male with idiopathic ventricular tachycardia. Evaluation for possible etiology. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. There is mild hypokinesis of the basal inferior wall. The overall LV ejection fraction is 47%. The LVEDV is 147 ml (normal range 142+/-34), the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVESV is 78 ml (normal range 47+/-19) and the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9). The LV mass is 145 g (normal range 164+/-36) and the LV mass index is 73 g/m2 (normal range 85+/-15). There is a 1cm thick band of epicardial late gadolinium enhancement in a single basal to mid ventricular short axis slice along the inferior, inferolateral, and anterolateral wall. The pattern of LGE is not consistent with prior myocardial infarction. The myocardium that has late gadolinium enhancement also has evidence of increased signal of SSFP and T2-stir. Together this suggests that the most likely diagnosis is myocarditis in the inflammatory stage. Left AtriumThe left atrium is normal in size.. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%. The RVEDV is 140 ml (normal range 142+/-31), RV end diastolic volume index is 71 ml/m2 (normal range 82+/-16), the RVESV is 68 ml (normal range 54+/-17), and the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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. The left and right coronary arteries originate normally from the aortic root. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size with mildly reduced systolic function (LVEF 47%) with subtle basal to mid inferior wall hypokinesis. There is evidence of a circumferential band of epicardial late gadolinium enhancement involving the basal to mid ventricle along the inferior, inferolateral, and anterolateral wall. The pattern of LGE is not consistent with prior myocardial infarction and the most likely diagnosis is myocarditis in the inflammatory stage. 2. Normal right ventricular size and systolic function (RVEF 52%)3. Normal origin of the coronary arteries. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness and decreased sensation. Brain: There is ill-defined T2 hyperintensity in the anterior pons, left greater than right, without significant mass effect. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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.Spine: The cervicothoracic spinal cord signal abnormality is less conspicuous. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Ill-defined T2 hyperintensity in the anterior pons may represent an inflammatory or demyelinating process, for example, but is incompletely characterized since intravenous contrast could not be administered.2. The cervicothoracic spinal cord signal abnormality is less conspicuous and may also represent an inflammatory or demyelinating process, but is incompletely characterized since intravenous contrast could not be administered.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with von Hippel-Lindau disease and multiple hemangioblastomas. Brain:Findings are redemonstrated compatible with prior left suboccipital craniotomy and mastoid approach surgery. A resection cavity is demonstrated involving the right aspect of the vermis and medial cerebellar hemisphere. Bands of T2 hyperintensity traversing both the cerebellar hemispheres have not significantly changed. Also unchanged is mild T2 hyperintensity within the right cerebellar tonsil, along the surgical cavity margins, and within the left aspect of the cervico-medullary junction. A few punctate foci of susceptibility along the margins of the resection cavity are unchanged. No new abnormality is detected within the posterior fossa. Allowing for surgical alteration of the left mastoid region, no evidence of recurrent inner ear tumor is seen.Supratentorially, there are scattered small foci of white matter T2 hyperintensity which have not significantly changed and are non-specific. No evidence of parenchymal edema or mass effect is seen. No intracranial hemorrhage or abnormal extra axial fluid is detected. The ventricles are stable and normal in size.A left globe prosthesis is in place. Findings in the right globe are seen suggesting choroidal detachment, similar to prior.Cervical spine:There is evidence of posterior element resection at most levels of the cervical spine, unchanged.As above, T2 hyperintensity persists on the left at the level of the cervico-medullary junction without significant interval change. No new areas of cord signal abnormality are seen, though assessment of the cervical cord is somewhat limited by motion artifact.The cervical lordosis is mildly straightened. Vertebral body heights are preserved. No concerning signal abnormality is detected.Posterior disk osteophyte formation is seen at most levels of the cervical spine with significant loss of disk height at C5-6 and C6-7. Level specific findings are as follows:C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild posterior disk osteophyte. No significant spinal canal stenosis or neuroforaminal narrowing.C4-5: Mild posterior disk osteophyte. No significant spinal canal stenosis or neuroforaminal narrowing.C5-6: Posterior disk osteophyte formation along with ligamentum flavum thickening results in a moderate spinal canal stenosis and mild cord deformation. Severe left and moderate right foraminal narrowing. No significant interval changes. C6-7: Left facet hypertrophy. Mild posterior disk osteophyte. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Thoracic spine:The thoracic kyphosis is mildly exaggerated at T12 secondary to mild vertebral body wedging without change. No evidence of any worrisome marrow replacement or marrow edema is seen.No definite evidence of any spinal cord signal abnormality is seen. Morphology of the cord is within normal limits. Although again, assessment of the cord is compromised by motion artifact.A small central disk protrusion is present at T8-9 along with a left paracentral protrusion at T11-12. No significant spinal canal or neuroforaminal stenosis is detected.Innumerable bilateral renal cystic lesions are identified, some of which contain heterogeneous material and/or fluid-fluid levels. Findings are grossly similar to those seen on the prior examination, though this examination is not adequate for assessment of individual lesions.Lumbar spine:Alignment is anatomic. Vertebral body heights are preserved. No concerning marrow replacement or edema is seen.The visualized spinal cord, conus and cauda equina are within normal limits. No definite spinal masses are detected. L1-2: Mild bulging disk with a right paracentral protrusion. No significant generalized spinal canal stenosis. No foraminal narrowing. No interval changes. L2-3: Mild bulging disk. No significant spinal canal stenosis or neuroforaminal narrowing.L3-4: Mild bulging disk. No significant spinal canal or neuroforaminal stenosis. L4-5: No spinal canal stenosis or neuroforaminal narrowing. L5-S1: Bulging disk and central disk protrusion with slight decrease in the size of the protrusion. No significant generalized spinal canal stenosis. No significant foraminal narrowing.

Output: 1.Evidence of prior surgery is again seen involving the left mastoid bone and the posterior fossa. Areas of signal abnormality involving the cerebellum and cervicomedullary junction are unchanged. No new mass lesion is appreciated within the limits of a noncontrast examination.2.Postoperative findings are again seen in the cervical C-spine. No areas of significant new spinal cord signal abnormality are noted, given the slightly motion degraded exam. No definite new spinal cord or intracanalicular lesions are seen within the limits of a noncontrast examination.


Instruction: Generate impression based on findings.

Input: Vague, non-dermatomal lower back pain. There appear to be 6 lumbar type vertebral bodies, in which the first nonrib-bearing vertebral vertebral body will be designated L1. Furthermore, there is partial sacralization of the right L6 vertebra, where there appears to be hypertrophy at the articulation with the sacrum. There is associated slight narrowing of the L5-6 neural foramen. Otherwise, there is no significant neural foraminal or spinal canal stenosis elsewhere in the lumbar spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The tip of the conus is approximately situated at the level of L1-L2. The paravertebral soft tissues are unremarkable. There is a 2.4 cm left ovarian physiologic follicle.

Output: Apparently there are 6 lumbar type vertebral bodies with partial sacralization of the right L6 vertebra, where there appears to be hypertrophy at the articulation with the sacrum and associated slight narrowing of the L5-6 neural foramen. This may represent a form of Bertolotti syndrome. Otherwise, there is no significant neural foraminal or spinal canal stenosis elsewhere in the lumbar spine. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The patient was placed in a prone position. A radiopaque grid was placed over the patient’s lower neck for needle localization. Using multidetector helical CT, axial 3 mm scans were obtained through the cervical spine demonstrating a left paraspinal mass adjacent to the T2 and T3 vertebral bodies. Additionally, the T2 vertebral body demonstrated diffuse marrow replacement on the prior MRI study and was to be targeted for biopsy.A trajectory was plotted into the T2 vertebral body using a left transpedicular approach. Subsequently, a parallel trajectory was plotted into the adjacent left paraspinal mass. The patient's neck was prepped with Betadine and draped in sterile fashion. The subcutaneous and deeper soft tissues were anesthetized with 1% lidocaine. A 13-gauge Bonopty needle was advanced into the posterior aspect of the left T2 pedicle. An inner drill cutting needle was utilized to advance the coaxial Bonopty needle into the posterior lateral aspect of the T2 vertebral body. A inner bone cutting needle was utilized to obtain a core bone biopsy from within this region of the vertebral body, placed in formalin, and sent directly to surgical pathology for diagnostic analysis. Subsequently, a 17-gauge x 9.9 cm coaxial needle was advanced into the soft tissue mass adjacent to the T2 vertebral body. An inner 18-gauge x 15 cm core biopsy needle was advanced with a 1 cm throw and 3 core biopsy samples were obtained. The samples were placed in formalin and sent directly to surgical pathology for diagnostic analysis. Final CT scanning demonstrated no evidence of hematoma, hemothorax or pneumothorax. Both coaxial needles were removed and adequate hemostasis was achieved with manual compression for 5 minutes. The patient tolerated the procedure well with no immediate complications. The patient remained neurologically at baseline at the end of the procedure. The patient was transferred back to the inpatient unit in stable condition.

Output: Successful CT-guided core needle bone biopsy of the T2 vertebral body and core needle biopsy of left paravertebral soft tissue mass.


Instruction: Generate impression based on findings.

Input: 71-year-old female with transient alteration of awareness and sodium of 117. Evaluate for cerebral edema. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse areas of periventricular white matter hypodensity consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Diffuse areas of periventricular white matter hypodensity consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Previously demonstrated left prevertebral/posterior mediastinal CSF signal intensity lesion at the T5-6 level is no longer identified and may have either resolved or collapsed. The thoracic spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The signal intensity the cord remains within normal limits.There are scattered degenerative changes in the thoracic spine most marked at T11-T12 with disc bulge, similar to prior. There is no significant neural foraminal or spinal canal stenosis. Remaining intervertebral discs show no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.

Output: Interval resolution or collapse of the previously demonstrated cystic lesion in the left prevertebral/posterior mediastinal space.Mild degenerative changes in the thoracic spine, similar to prior.


Instruction: Generate impression based on findings.

Input: Right posterior thigh radicular pain. There is multilevel degenerative spondylosis. In particular, there is facet joint arthropathy and a disc bulge with superimposed right foraminal disc protrusion at L4-5, with mild to moderate right neural foraminal stenosis, minimal left neural foraminal stenosis and mild to moderate spinal canal stenosis. There is also a prominent anterior disc-osteophyte at this level with associated edematous endplate reactive changes, as well as a subcentimeter right paraspinal facet synovial cyst. There is facet joint arthropathy and a disc bulge at L3-4, with superimposed left foraminal and far lateral disc protrusion with an annular fissure, which results in mild bilateral neural foraminal and spinal canal stenoses. At L5-S1, there is a minimal disc bulge, a subcentimeter right ligamentum flavum cyst, and bilateral mild facet hypertrophy with bilateral effusions, resulting in mild bilateral neural foraminal stenosis, but no significant central canal narrowing. There is no significant spinal canal or neural foraminal stenosis at T12 though L3. The imaged portions of the spinal cord and cauda equina nerve roots are unremarkable. There is no spondylolisthesis. There are unchanged mild endplate deformities and intravertebral disc herniations, without evidence of acute fracture. There are probable cysts in the bilateral kidneys.

Output: Multilevel degenerative spondylosis. In particular, there is facet joint arthropathy and a disc bulge with superimposed right foraminal disc protrusion at L4-5, with mild to moderate right neural foraminal stenosis, minimal left neural foraminal stenosis and mild to moderate spinal canal stenosis. There is also a prominent anterior disc-osteophyte at this level with associated edematous endplate reactive changes, as well as a subcentimeter right paraspinal facet synovial cyst. There is facet joint arthropathy and a disc bulge at L3-4, with superimposed left foraminal and far lateral disc protrusion with an annular fissure, which results in mild bilateral neural foraminal and spinal canal stenoses. At L5-S1, there is a minimal disc bulge, a subcentimeter right ligamentum flavum cyst, and bilateral mild facet hypertrophy with bilateral effusions, resulting in mild bilateral neural foraminal stenosis, but no significant central canal narrowing.


Instruction: Generate impression based on findings.

Input: Clinical question: Lung cancer. Please evaluate for metastases. Signs and symptoms: Lung cancer. Nonenhanced CT of brain:There is no evidence of intracranial hemorrhage, mass-effect, midline shift or hydrocephalus. Previously noted large area of vasogenic edema in the left frontal lobe under the left frontal craniotomy flap is no longer identified and only residual encephalomalacia is noted. Findings of a small vessel disease of indeterminate age. There is no definitive evidence of metastases lesion on this non-infused exam however to entirely exclude possibility of metastases disease post enhanced CT or MRI is recommended.

Output: 1.Findings of a small vessel disease and focal area of left frontal lobe cortical and subcortical encephalomalacia.2.No evidence of metastatic disease on this non-infused head CT. To entirely exclude metastases enhanced CT or an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of brain [D49.6], Reason for Study: ^Reason: brain lesion. Preop planning for biopsy History: headaches. Multiple fiducial markers attached on the scalp during the scan.There is ill defined mainly non enhancing, T2 high signal intensity mass on the left mesial temporal lobe involving para hippocampal and fusiform gyri although more sequences will be helpful for precise anatomical localization. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Left mesial temporal lobe ill-defined nonenhancing mass which shows T2 high signal intensity is described above.


Instruction: Generate impression based on findings.

Input: Reason: MS, new coordination issues on Tysabri, concern for MS flare History: fall, worsening coordination MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Some of these are perpendicularly oriented relative to the lateral ventricles. There is regression of the size of the T2 and flair signal change in the several of these lesions, for example, several in the centrum semiovale bilaterally as well as one adjacent to the trigone of the right lateral ventricle. Associated contrast enhancement on the prior exam has also regressed.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 cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is patchy and discontinuous signal hyperintensity present within the cervical spinal cord from the C2 vertebral level to the C6 vertebral level without spinal cord enlargement. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is a redemonstration of multiple lesions in the periventricular and subcortical white matter which are consistent with a diagnosis of demyelinating disorder. Compared to the prior exam some of the lesions appear smaller. Finding suggests that these lesions are now in a chronic stage.2.Multiple lesions are present throughout the cervical spinal cord which are suspicious for demyelination. Lack of contrast enhancement in the cervical spinal cord suggests that these are likely in the chronic stage


Instruction: Generate impression based on findings.

Input: Cerebral cysts [G93.0], Reason for Study: ^Reason: hx of colloid cyst s/p endoscopic removal. eval for recurrence History: none- surveillance No evidence of acute ischemic or hemorrhagic lesion.Susceptibility lesions along the ventriculostomy track through the right frontal lobe as well as at the level of right foramen of Monro are again seen, unchanged since prior scan.On gadolinium enhanced scan, the right hemispheric dura shows diffuse thin enhancement which corresponds to postoperative status. There is no evidence of abnormal brain parenchymal enhancement.Previously seen craniotomy site soft tissue swelling has been completely resolved.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Retention cyst is seen on the right maxillary sinus and in mucosal thickening was seen on the right frontal sinus, ethmoid sinus and sphenoid sinus.

Output: 1. Postoperative status of colloid cyst, postoperative no unusual finding.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with right-sided ataxia, weakness, nystagmus. An moderately sized region of restricted diffusion is seen affecting the inferior right cerebellum. Scattered foci of susceptibility are also seen in this region potentially indicating petechial blood product. Scattered small areas of restricted diffusion are also seen affecting the right lateral medulla, and more superiorly in the right cerebellum. Punctate foci of restricted diffusion are also seen at two sites in the right parietal lobe. There may be be a punctate focus of mild diffusion restriction within the left thalamus but this is equivocal.Scattered foci of FLAIR hyperintensity are seen within the cerebral hemispheres. No evidence of significant generalized mass effect seen. No abnormal extra-axial fluid collections are detected. The ventricles remain normal in size and morphology.

Output: 1.Moderately sized acute infarct of the right inferior cerebellum. Scattered foci of susceptibility in this area potentially indicate petechial blood product.2.Additional foci of restricted diffusion are seen within the right lateral medulla, more superiorly in the right cerebellum, and minimally in the right parietal lobe. A faint focus of possible diffusion restriction is seen in the left thalamus but this is questionable at best.3.No significant generalized mass effect is seen. No other areas of suspected intracranial hemorrhage are noted.


Instruction: Generate impression based on findings.

Input: Dedicated images through the sella demonstrate a normal height of the pituitary gland. No focal abnormal signal intensity or mass is seen within the pituitary gland. There is stable slight asymmetric prominence of the right-sided glandular tissue within the sella although again without discrete lesion. Coronal dynamic images do not indicate a hypoenhancing lesion. The pituitary stalk lies in the midline and appears blunted, with caudal displacement of the optic chiasm. There is an oval area of suprachiasmatic CSF signal intensity resulting in mass effect upon the upper surface of the optic chiasm. This measures 11 mm transverse x 7 mm CC x 9 mm AP. There is no corresponding enhancement. Suprasellar cistern, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable. No abnormal enhancement is seen intracranially.SPINE

Output: 1.Stable postoperative changes following Chiari decompression with similar degree of crowding at the level the neo-foramen magnum. CSF flow imaging was performed but may be technically limited, as no definitive flow is seen within the entire field-of-view.2.No definite pituitary lesion. A small oval cystic lesion is seen in the suprachiasmatic location with mass effect upon the adjacent chiasm, possibly representing a small incidental arachnoid cyst.3.Significantly worsened syringohydromyelia, which now again encompasses the nearly the entire thoracic cord as well. Slight increased focal cystic appearance within the area of syrinx along the upper cervical cord.


Instruction: Generate impression based on findings.

Input: Intractable epilepsy. Preoperative planning for electrode placement. The study is limited by motion. The postcontrast isotropic sequence was repeated but is still affected by motion, though to a lesser extent.Subtle T2 hyperintensity involving the head of the left hippocampus is unchanged. There is no definite associated volume loss. Poorly defined contrast enhancement involving the anterior aspect of the pons at midline is unchanged, even compared to the more remote examination of December 2, 2011 and is compatible with capillary telangiectasia.There is no significant abnormality or change regarding the remainder of the brain.There is a retention cyst in the left maxillary sinus. The other paranasal sinuses and the mastoid air cells are clear. The orbits are normal. There is no destructive skull lesion.

Output: 1.Limited examination, for surgical planning purposes.2.Focal T2 hyperintensity in the left hippocampal head has not changed.3.Incidental pontine capillary telangiectasia is also unchanged.


Instruction: Generate impression based on findings.

Input: Reason: R/o heel osteo in patient in ankle swelling History: R ankle swelling TENDONS: Minimal T2 signal abnormality is seen in the distal Achilles tendon suggestive of edema/inflammation.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is a subtle, 4 mm focus of T1 hypointensity and T2/STIR hyperintensity along the middle part of the posterior aspect of the calcaneus which is suspicious for a small focus of osteomyelitis.ADDITIONAL

Output: Signal abnormality along the posterior aspect of the calcaneus is suspicious for a small focus of osteomyelitis. Mild edema/inflammatory changes are noted in the distal Achilles tendon. There is mild soft tissue edema around the ankle.Findings were discussed with Dr. Blake Jones on 11/20/15 at 08:58 am.


Instruction: Generate impression based on findings.

Input: 64 year old male physician with remote history of coronary disease, recently presenting with severe LV dysfunction and found to have multivessel coronary disease with plans for CABG. He is referred for cardiac MR to evaluate viability. Left VentricleThe left ventricle is moderate-severely dilated with severely reduced systolic function. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 250 ml (normal range 142+/-34), the LV end systolic volume index is 95 ml/m2 (normal range 25+/-9), the LVESV is 182 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 110 g (normal range 164+/-36). There is no evidence for myocardial iron overload. There is hypokinesis of the apical inferior and inferolateral wall. The basal and mid inferior and inferolateral walls are thinned and akinetic. There is a stripe of late enhancement in the basal-mid septum and basal inferoseptum. There is prominent late gadolinium enhancement which is transmural and involves the basal to mid inferolateral wall, which suggests a previous infarction in this territory with no viability. There is subendocardial late gadolinium enhancement in the basal to mid inferior wall which encompasses <50% of the myocardium and suggests intermediate probability of viability. The remaining myocardium is viable. Left AtriumThe left atrium is moderately dilated. There is lipomatous hypertrophy of the interatrial septum.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 160 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 85 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe posterior mitral leaflet appears tethered. There is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a "bovine" brachiocephalic branching pattern. The aortic root is normal in size. The descending aorta has mild-moderate diffuse atherosclerosis.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trivial pericardial effusion.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. Moderate-severely dilated left ventricle with severely reduced EF (LVEF 27%). 2. There is thinning of the basal and mid inferior and inferolateral walls with associated akinesis. Associated hypointensity suggests associated calcified regions which would indicate that this is likely chronic infarct.3. There is transmural late gadolinium enhancement in the basal and mid inferolateral wall, involving the entirety of the myocardium, suggesting no viability in this territory. There is another region of late gadolinium enhancement which is subendocardial involving <50% of the basal and mid inferior wall, which suggests an intermediate probability of viability in this territory. This is consistent with ischemic cardiomyopathy.4. There is a stripe of late gadolinium enhancement seen in the basal septum, which is likely artifactual in nature.4. Normal size right ventricle with mildly reduced systolic function (RVEF 47%).5. Posterior mitral leaflet tethering with at least mild MR.6. Atherosclerosis of the descending aorta.


Instruction: Generate impression based on findings.

Input: T4b N2b parotid gland carcinoma with skull base and facial nerve invasion s/p parotidectomy with right radical neck dissection which revealed carcinoma originating from ex-pleomorphic adenoma with positive margins, perineural invasion and 10/50 positive lymph nodes, here for a regular follow up after C5/5 of TFHX completed on 2.28.13. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is persistent fluid within the right mastoid air cells.Neck: There are unchanged post-treatment findings related to radiotherapy, as well as right parotidectomy and neck dissection. There is persistent diffuse enhancement and mild enlargement of the mastoid, tympanic, and geniculate ganglion segments of the right facial nerve. There is an unchanged subcentimeter left thyroid nodule. Otherwise, there is no evidence of measurable mass lesions in the neck or significant cervical lymphadenopathy. The remaining major salivary glands are unremarkable. The major cervical flow voids are grossly intact. There is mild cervical spondyloarthropathy without significant spinal stenosis. There is T2 hyperintense signal within the subcutaneous tissues of the face bilaterally, which likely represents cosmetic filler.

Output: 1.Post-treatment findings in the neck with persistent right facial nerve enhancement, which is compatible with perineural tumor involvement.2. No evidence of significant lymphadenopathy in the neck.3. No evidence of intracranial metastases.4. Unchanged nonspecific left thyroid nodule.


Instruction: Generate impression based on findings.

Input: 35 year old woman with significant family history of non-ischemic cardiomyopathy and VT, referred for cardiac MRI to evaluate for structural heart disease. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 74 ml/m2 (normal range: 65+/-11), the LVEDV is 177 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 75 ml (normal range 31+/-10), the LV mass index is 41 g/m2 (normal range 67+/-11), and the LV mass is 97 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no evidence of myocardial edema. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The a borderline increase in native T1 myocardial relaxation time in the basal inferior and basal septum (1090-1100ms); the native T1 relaxation time is completely normal throughout the remainder of the myocardium. The clinical significance of this borderline finding is unclear. There is no evidence of myocardial iron overload. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 192 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 94 ml (normal range 35+/-13). There are no regional wall motion abnormalities noted.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.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. Normal size left ventricle with normal systolic function (EF 57%). There is no late gadolinium enhancement, nor is there evidence of myocardial edema. However, the native T1 myocardial time is borderline elevated in the basal septum and inferior wall. The remainder of the myocardium has completely normal native myocardial T1. The clinical significance of this borderline finding in the setting of a family history of dilated cardiomyopathy is not clear.2. Normal size right ventricle with normal systolic function (EF 51%). No regional wall motion abnormalities.3. Mild aortic regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 51 years old, with neck pain. Trace retrolisthesis of C5 relative to C6 is seen. Spinal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. Degenerative endplate signal change is seen at C5-6. A focal fatty lesion is evident within the T2 vertebral body which may represent a hemangioma. Spinal cord signal intensity and morphology are within normal limits. No epidural abnormalities are suspected.C2-3: Facet arthropathy. No spinal canal stenosis. Mild right foraminal narrowing. C3-4: Facet arthropathy. Mild posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Facet arthropathy, severe on the left. Mild posterior disc-osteophyte complex formation. Moderate left foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation. Mild spinal canal stenosis. Severe right and moderate left foraminal narrowing. C6-7: Facet arthropathy, severe on the right. Posterior disc-osteophyte complex formation. Mild to moderate spinal canal stenosis. Moderate bilateral foraminal narrowing. C7-T1: Facet arthropathy. No significant spinal canal stenosis. No significant foraminal narrowing.

Output: Multilevel disc degeneration is seen along with scattered facet arthropathy. No high-grade spinal canal stenosis is demonstrated. However, severe foraminal narrowing is evident on the right at C5-6, with scattered mild to moderate narrowing elsewhere.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow-up subdural hematoma. Signs and symptoms: History of subdural hematoma. CT of brain without the infusion:In comparison with the prior examination there is complete resolution of patient's bilateral subdural hematomas. The cortical sulci are better visualized on this study secondary to lack of mass effect by subdural. Patchy areas of periventricular and subcortical low attenuation are consistent with small vessel disease of indeterminate age. No hemorrhage is detected. A calcific density at the level of the left leaf of tentorium (axial image 10) is consistent with a small meningioma and was noted on prior MRI examination. This lesion measures 7.8-mm times 16-mm. Meningioma is in contact with the pons however with no mass effect or deviation.

Output: 1.No evidence of residual subdural or any new bleed.2.Small vessel disease of indeterminate age.3.Small meningioma along the edge of the left tentorial leaf with no change since prior MRI.


Instruction: Generate impression based on findings.

Input: History bilateral breast cancers. Prior benign MRI guided biopsy of the left breast. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. A few foci, including a focus in the left inferior breast that may represent a small normal morphology lymph node, are seen, none uniquely enhancing or suspicious in appearance. Post-operative changes are present in each breast and axilla, stable. No abnormal enlarged axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: There is normal alignment of the vertebral body signal with no abnormal signal. The conus medullaris is seen at the level of L2.At the level of T12-L1 there is no compromise of the neural foramina or the nerve root. At the level of L1-L2 there is no compromise of the neural foramina or the nerve root. At the level of L2-L3 there is no compromise of the neural foramina or the nerve root. At the level of L3-L4 there is no compromise of the neural foramina or the nerve root. Hypertrophy of the facet and the the ligamentum flavum is seen.At the level of L4-L5 there is a minimal disc bulge with no compromise of the neural foramina or the nerve root. Hypertrophy of the facet and the the ligamentum flavum is seen.At the level of L5-S1 there is broad-based disc protrusion with narrowing of the left neural foramina and encroachment of the exiting nerve root. There is facet hypertrophy and hypertrophy of the ligamentum flavum. Note is made of minimal retrolisthesis of L5 on S1.Note is made of a pelvic mass seen posterior to the bladder in front of the rectum with mixed signal intensity, most likely representing a fibroid uterus. Recommend further imaging and clinical evaluation.

Output: 1. Broad based disc protrusion with narrowing of the left neural foramina and encroachment of the exiting nerve root at the level of L5-S1.2. Pelvic mass that most likely represents fibroid uterus. Recommend pelvic imaging and clinical evaluation.


Instruction: Generate impression based on findings.

Input: Pre-operative evaluation for cranial stimulator placement. There are multiple left hemisphere depth electrode in unchanged position. There is confluent T2 hyperintensity surrounding portions of the depth electrodes in the left parietal lobe, where there is also volume loss.

Output: Preoperative planning MRI shows left hemisphere depth electrodes in position and left parietal lobe encephalomalacia.


Instruction: Generate impression based on findings.

Input: 52-year-old male with right hip pain. Evaluate for right hip AVN. There is avascular necrosis of the right femoral head with the necrotic zone involving nearly the entire epiphysis with edema extending into the intertrochanteric region. There is a large curvilinear subchondral fracture as well as collapse of the articular surface of the femoral head superiorly. Moderate articular cartilage loss is identified superiorly as well as a moderate-sized joint effusion. Although this study was not protocoled for detailed evaluation of the acetabular labrum, there is blunting of the anterior superior labrum with a small undersurface cleft likely representing a tear. The ligamentum teres appears intact. On the large field-of-view images, mild osteoarthritis affects the left hip, but we see no specific features of avascular necrosis affecting the left femoral head. Degenerative disc disease affects the lower lumbar spine. There is decreased signal intensity of the bone marrow of the lower lumbar spine, which is nonspecific and may reflect residual reconverted red marrow, but we cannot entirely exclude the possibility of a myeloproliferative disorder or marrow replacing process.

Output: Avascular necrosis of the right femoral head with other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: patient with b/l knee ulcerations and zygomycetes infection. Eval for extension of infection History: above There are multiple ulcerations including one situated anterior to the proximal tibia that extends deep to disrupt the superficial fibers of the distal patellar tendon, however, we see no findings to suggest patellar tendon rupture. There is also signal abnormality within the subcutaneous fat anterior to the patella likely representing additional ulceration with enhancement of the underlying soft tissues. Although there is perhaps mild edema within the underlying patella, we suspect this may reflect reactive osteitis and we see no frank bone destruction to confirm osteomyelitis. There is edema within the subcutaneous fat that becomes confluent, but we see no well-defined drainable fluid collection. There is a small joint effusion, but we see no findings to suggest a synovitis. The medial and lateral meniscus appear intact. The cruciate and collateral ligaments appear intact. The quadriceps tendon appears intact.

Output: Anterior soft tissue ulceration with focal disruption of the superficial fibers of the distal patellar tendon and other findings as described above.


Instruction: Generate impression based on findings.

Input: There are moderate confluent and punctate cerebral supratentorial and infratentorial white matter non-enhancing T2/FLAIR hyperintense lesions. Some of these lesions are low on T1 signal. There is moderate volume loss including the corpus callosum. There is questionable T2 hyperintensity of the right optic nerve, which appears to be present on the prior study, but not optimally evaluated on brain MRI. No enhancing lesion to suggest active demyelination. Subtle new increase in vascularity of the right cerebral hemisphere, which may be related to hyperemia from recent seizure activity. There is unchanged small enhancing lesion measuring 7-8mm within the inferior right fourth ventricle. There is no evidence of intracranial hemorrhage. No diffusion-weighted abnormality is identified. Partially empty sella. Flow voids are present within the major vessels indicating patency. There is no midline shift or herniation. There are small left posterior ethmoid and left maxillary sinus retention cyst. The skull and extracranial soft tissues are otherwise unremarkable.

Output: 1. No appreciable change in moderate confluent and punctate supratentorial and infratentorial white matter non-enhancing T2 hyperintense lesions which are compatible with known multiple sclerosis. No new lesions or enhancement to suggest active demyelination.2. Stable subcentimeter enhancing lesion in the inferior right fourth ventricle, which may represent asymmetric prominence of the normal choroid plexus versus neoplasm such as a small choroid plexus papilloma. Suggest continued attention on follow-up. Comparison with remote prior studies would be helpful if available.3. Asymmetrically increased vascular enhancement involving the right cerebral hemisphere, which may be related to hyperemia from recent seizure activity.


Instruction: Generate impression based on findings.

Input: Again seen are postsurgical changes of right transfrontal biopsy of pineal mass. Expected postsurgical changes include small amount of pneumocephalus and blood products including within the pineal gland and ventricular system. The pineal tumor again noted to obstruct the cerebral aqueduct. Interval third ventriculostomy is noted with defect involving the floor of the third ventricle suboptimally visualized, which is likely related to artifact. CSF flow sequence demonstrates a small jet of biphasic flow extending from the third ventricle to the pontine cistern indicating patency.There is mild decrease in the size of the lateral ventricles. For example third ventricle measures 8 mm in the transverse dimension, previously approximately 10 mm. Mild FLAIR hyperintensity in the periventricular region again seen related to transependymal flow and not yet resolved.No large hemorrhage, new mass effect, or edema. No midline shift or herniation.

Output: 1. Expected postsurgical changes of right transfrontal pineal tumor biopsy. Small defect is seen along the floor of the third ventricle with small jet of biphasic CSF flow extending from the third ventricle to the prepontine cistern suggesting patency.2. Mild decrease in the size of the lateral and third ventricles.


Instruction: Generate impression based on findings.

Input: Foot ulcer First ray: There is skin irregularity overlying the tuft of the great toe. Additionally, there is deformity and irregularity of the distal tuft of the great toe however there is no definite focus of abnormal low T1 signal to suggest osteomyelitis. The appearance may be secondary to prior/chronic infection or trauma.Second ray: There is deformity of the head of the second metatarsal with absence of portions of the proximal and middle phalanges. There is no definite evidence of osteomyelitis. Third ray: There is soft tissue ulceration, thickening, and edema within the plantar soft tissues at the head of the third metatarsal. However there is no definite evidence of osteomyelitis as there is no discrete focus of low T1 signal intensity.Fourth ray: The marrow signal of the fourth metatarsal is normal although there is periosteal reaction along the plantar aspect of the distal diaphysis of the metatarsal.Fifth ray: No evidence of osteomyelitis.There is diffuse soft tissue swelling of the dorsal foot. Within the limits of this exam, there is no discrete fluid collection or foci of soft tissue gas.

Output: No definite evidence of osteomyelitis but close follow-up is recommended.


Instruction: Generate impression based on findings.

Input: 69-year-old female with left breast carcinoma status post excisional biopsy with multiple positive, on oriented margins. Assess for residual disease. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Skin thickening is noted along the upper inner aspect of the left breast, likely postsurgical. A large seroma is appreciated within the upper inner quadrant of the left breast, approximately 9 to 10 o'clock position, extending from the cutaneous area of surgical change posteriorly to the pectoralis muscle. This seroma measures 5.8 x 2.1 x 0.9 cm and demonstrates minimal, thin peripheral rim enhancement, compatible with postsurgical change. No areas of abnormal enhancement are present in the left breast to suggest residual disease. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Postsurgical seroma at the 9 to 10 o'clock position of the left breast with no abnormal enhancement to suggest residual disease.2. No MR evidence for malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Again seen is a moderate compression fracture of the T12 vertebral body with additional loss of height compared to the recent MRI but no gross change from the most recent spine radiographs. Retropulsion results in minimal flattening of the ventral thecal sac but no central canal or foraminal stenosis. Low signal material is seen within the vertebral body from kyphoplasty cement. There are new mild superior endplate deformities at T9, T10, and T11 with some increased STIR signal along the superior endplate of T11. The remainder of the vertebral body heights are well-maintained as are the intervertebral discs. Innumerable foci of abnormal increased T2 signal are seen throughout the spine and in the imaged sacrum and bilateral iliac bones which enhance on postcontrast images. There is minimal retrolisthesis of L2 on L3 which is slightly more conspicuous when compared to the MRI dated 8/8/2015. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.Subcentimeter left renal cysts.

Output: 1.Stable, diffuse heterogeneous enhancing marrow signal compatible with multiple myeloma.2.New mild superior endplate deformities at T9, 10, 11. The mildly increased STIR signal in the superior endplate of T11 suggests a possible subacute compression fracture.3.Chronic moderate pathologic compression fracture at T12 with post-kyphoplasty changes, slightly progressed since prior MRI, with mild retropulsion but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Altered mental status, worsening left-sided weakness, rule out new ischemic stroke. There is no restricted diffusion to suggest acute ischemia. There is scattered punctate and confluent T2/FLAIR hyperintensity in the bilateral supratentorial subcortical and periventricular white matter which are nonspecific, but most likely related to chronic small vessel ischemic changes. There is mild global parenchymal volume loss. There is a punctate focus of susceptibility in the left frontal lobe white matter, likely related to chronic hemorrhage. There is no pathological enhancement. No evidence of intracranial mass effect, midline shift, or herniation. No hydrocephalus. No extra-axial collections. Calvarium and extra cranial soft tissues are grossly unremarkable.

Output: 1. No evidence of acute ischemia. 2. Bilateral cerebral white matter hypoattenuation foci are nonspecific but compatible with chronic small vessel ischemic changes.3. Nonspecific punctate focus of susceptibility in the left frontal lobe, related to chronic hemorrhage.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified disorders of muscleClinical question: assess for new strokeSigns and Symptoms: right face/arm/leg numbness MRI of the brainNo diffusion weighted abnormalities are appreciated.Incidental note is made of a developmental venous anomaly in the right cerebellar hemisphere.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening of the maxillary sinuses and left ethmoid air cells and opacification of the right frontal sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is large. The right A1 segment is hypoplastic. There is fetal origin of the right posterior cerebral artery associated with a relatively large right p1 segment. The left posterior communicating artery is small. The left vertebral artery is larger than the right vertebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: 21-year-old female with medial swelling, tenderness to palpation, inability to fully extend after trauma. Evaluate for MCL or meniscal injury. MENISCI: The medial and lateral meniscus are grossly normal.ARTICULAR CARTILAGE AND BONE: There is a small joint effusion extending to the suprapatellar recess. The articular cartilage appears normal. There is high T2 signal within the posterior femoral condyles and tibia and fibula, lateral greater than medial, most compatible with contusions. There is a depression along the lateral femoral condyle anteriorly compatible with a lateral femoral notch sign.LIGAMENTS: The proximal anterior cruciate ligament is not visualized and replaced with intermediate signal intensity on T2 compatible with an anterior cruciate ligament tear. The posterior cruciate ligament is intact. There is mild edema adjacent to the medial collateral ligament, which otherwise the ligament is grossly normal. The lateral collateral ligament is grossly normal.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Findings compatible with an anterior cruciate ligament tear.2. Findings most compatible with contusions along the posterior distal femur and proximal tibia and fibula, more prominent laterally.


Instruction: Generate impression based on findings.

Input: 81 years Male (DOB:12/10/1934)Reason: evaluate for structural abnormalities History: progressive weakness of L arm and L leg, atrophy, fasciculations, gait abnormality PROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is moderate to marked bilateral facet and ligamentum flavum hypertrophy present at this level associated with the mild diffuse disc bulge. There is effacement of the fat at the lateral recesses bilaterally at this level. There is mild encroachment of the exiting nerve roots within the neural foramina at this level.At L4-5 there is moderate bilateral facet hypertrophy at this level associated with some ligamentum flavum hypertrophy. There is a diffuse disc bulge at this level. There is effacement of the fat at the lateral recess at this level. There is crowding of the nerve roots within the thecal sac at this level. Overall there is a moderate degree of spinal stenosis at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.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.There are couple subcentimeter cysts in the left kidney.

Output: 1.There is a moderate degree of spinal stenosis at L5-S1 and L4-5 due to facet hypertrophy and a disc bulge.2.No spinal cord lesions are appreciated to explain the patient's symptoms