Instruction: Generate impression based on findings.

Input: Papilledema associated with increased intracranial pressure. There is marked constriction of the lateral aspects of the bilateral transverse sinuses. However, there is no evidence of venous sinus thrombosis. Prominence of the optic nerve sheaths bilaterally and the enlarged sella are more conspicuous on the dedicated prior brain MRI.

Output: Constriction of the bilateral transverse sinuses is a feature compatible with pseudotumor cerebri, along with other previously demonstrated associated neuroimaging findings. Otherwise, no evidence of venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: A 77 year old male with past history of ischemic heart disease (s/p CABG , s/p PCI), congestive heart failure, diabetes mellitus, hypertension, atrial fibrillation, peripheral artery disease, prostate cancer. The patient is now hospitalized due to heart failure exacerbation and cerebral circulation insufficiency while the echocardiography showed worsening of the left and right ventricular function. Left VentricleThe left ventricle is mildly dilated with severely decreased systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVEDV is 206 ml (normal range 142+/-34), the LV end systolic volume index is 99 ml/m2 (normal range 25+/-9), the LVESV is 178 ml (normal range 47+/-19), the LV mass index is 83 g/m2 (normal range 85+/-15), and the LV mass is 149 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is transmural late gadolinium enhancement in the distal anterior-septum and non-transmural in the distal inferior-septum. This finding suggest fibrosis compatible with previous myocardial infarction in the distal LAD territory and is probably not viable. There is a second pattern of mid-wall late gadolinium enhancement involving the basal anteroseptum. This pattern is most likely consistent with fibrosis due to a concomitant non-ischemic type of cardiomyopathy, this territory has indeterminate viability. The remainder of the myocardium is free of late gadolinium enhancement and is potentially viable. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is in the upper normal range with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVEDV is 203 ml (normal range 142+/-31), the RV end systolic volume index is 94 ml/m2 (normal range 31+/-9), and the RVESV is 169 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC is mildly dilated and the IVC is dilated. The coronary sinus is dilated.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires were noted. Mild bilateral pleural effusion was noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with severely decreased systolic function, the LVEF is 14%. 2. There is transmural late gadolinium enhancement in the distal anterior-septum and non-transmural in the distal inferior-septum. This finding is compatible with previous myocardial infarction in the distal LAD territory and is probably not viable. There is a second pattern of mid-wall late gadolinium enhancement involving the basal anteroseptum. This pattern is most likely consistent with fibrosis due to a concomitant non-ischemic type of cardiomyopathy, this territory has indeterminate viability. The remainder of the myocardium is free of late gadolinium enhancement and is potentially viable. 3. The right ventricle is in the upper normal range with severely reduced systolic function, the RVEF is 17%. 4. The left atrium is moderately dilated. 5. The right atrium is mildly dilated.6. There is moderate mitral regurgitation.7. There is mild to moderate tricuspid regurgitation.8. The aortic root is mildly dilated.9. The main pulmonary artery is mildly dilated.10. The SVC is mildly dilated and the IVC is dilated.11. There is mild bilateral pleural effusion (R>L).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 12-year-old female status post patellar dislocation. Assess for loose bodies. MENISCI: Again seen is a thin linear band of horizontally oriented intermediate signal abnormality within the posterior horn and body of the lateral meniscus which extends to the tibial articular surface within the posterior horn, and to the femoral articular surface within the body, compatible with a tear, which appears identical to the prior study. The anterior horn appears intact. The medial meniscus appears intact. ARTICULAR CARTILAGE AND BONE: Again seen is an osteochondral defect along the lateral aspect of the medial femoral condyle which appears similar to the prior study. The overlying articular cartilage appears slightly thinned but is otherwise intact. There are tiny cysts adjacent to the defect, but we see no fluid signal intensity along the defect to suggest instability. The articular cartilage of the lateral tibiofemoral compartment appears intact. There is edema within the inferomedial patella as well as within the anterolateral aspect of the lateral femoral condyle likely reflecting recent patellar dislocation. The superior aspect of the femoral trochlea is convex indicating femoral trochlear dysplasia. The tibial tubercle to trochlear groove distance is 12 mm which is within normal limits. We see no fluid-filled articular cartilage defects.LIGAMENTS: The patellar attachment of the medial patellofemoral ligament appears intact. The femoral attachment is not well visualized, but we see no edema within the vicinity of the ligament to indicate an acute tear. The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. The Insall-Salvati ratio is 1.3, indicating mild patella alta.ADDITIONAL

Output: 1. Findings indicating recent patellar dislocation, as described above, with associated femoral trochlear dysplasia and mild patella alta. We see no loose body within the joint.2. Osteochondral defect of the medial femoral condyle appearing similar to the prior study.3. Horizontal tear of the lateral meniscus appearing similar to the prior study, which is of uncertain current clinical significance.


Instruction: Generate impression based on findings.

Input: Craniotomy for laser ablation for astrocytoma. There are postoperative findings related to laser ablation with interval decrease in size and enhancement of a tectal plate mass that now measures approximately 12 x 18 mm in cross-section, previously 16 x 19 mm. There is no evidence of acute intracranial hemorrhage or acute infarct. The right cerebral convexity fluid collection has resolved. There is a right transfrontal Ommaya catheter that terminates adjacent to the right caudate nucleus. There are also postoperative findings related to endoscopic third ventriculostomy, with an apparent jet of cerebrospinal fluid into the third ventricle. Nevertheless, the third and lateral ventricles remain enlarged. There is no midline shift or herniation. There is a left cerebellar hemisphere developmental venous anomaly. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues appear unchanged. There is diffuse paranasal sinus mucosal thickening.

Output: 1. Postoperative findings related to laser ablation with interval decrease in size of a tectal pilocytic astrocytoma.2. Postoperative findings related to endoscopic third ventriculostomy, with an apparent jet of cerebrospinal fluid into the third ventricle. Nevertheless, the third and lateral ventricles remain enlarged. 3. The right transfrontal Ommaya catheter terminates adjacent to the right caudate nucleus.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for tendon rupture History: ankle pain for 4 weeks, s/p fall. TENDONS: The talus tendon is intact. The tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons are intact. The peroneal tendons are intact. The tibialis anterior, extensor hallucis longus, and extensor digitorum longus tendons are intact.LIGAMENTS: The visualized ligaments are intact, including the distal tibiofibular syndesmotic ligament and visualized components of the deltoid ligament.ARTICULAR SURFACES AND BONE: The bone marrow signal intensity is within normal limits. No fractures. ADDITIONAL

Output: Normal examinations.


Instruction: Generate impression based on findings.

Input: Male, 34 years old, with history of neurofibromatosis type I. Assess for any paraspinal neurofibromas. Does flank mass extend to spine. The left-sided paraspinal musculature and flank soft tissues are diffusely infiltrated by T2 hyperintensity which is largely ill-defined but in some areas rather nodular. Given the history, this is compatible with neurofibromas. These lesions begin at approximately the L1-2 level and continue down to the L5-S1 level. The disease is centered within the paraspinal and subcutaneous tissues at L4. Although these lesions extend towards the spinal canal they do not frankly invade it. Numerous additional scattered nodular hyperintense lesions are identified bilaterally in the paraspinal and prevertebral soft tissues. Numerous cutaneous nodules are also demonstrated.The sacral and lower lumbar nerve roots are diffusely nodular and T2 hyperintense compatible with the presence of neurofibromas. These lesions affect both the foraminal and extraforaminal portions of the nerves, but do not extend intracanalicularly. More superiorly, there are small neurofibromas associated with the exiting lumbar spinal nerve roots, particularly at L1-2 on the left.No large intraspinal lesions are detected. The visualized conus and cauda equina nerve roots are unremarkable.L1-2 through L3-4: No significant spinal canal or neuroforaminal stenosis.L4-5: Facet hypertrophy with small facet effusions. Mild bulging disk. No significant spinal canal or neuroforaminal stenosis.L5-S1: Facet hypertrophy. Bulging disk with a superimposed small right paracentral protrusion. The right ventral aspect of the thecal sac is mildly effaced, but no significant generalized spinal canal stenosis is seen. The neural foramina are mildly narrowed.

Output: 1.Large infiltrative left paraspinal and flank neurofibroma. This lesion extends towards the spinal canal but does not frankly invade it. 2.Innumerable neurofibromas are evident affecting the foraminal and extraforaminal sacral and lower lumbar nerve roots. Scattered smaller neurofibromas are also seen along the remaining lumbar neural foramina, and within the paraspinal and prevertebral soft tissues.3.No intracanalicular lesions are detected at this time. No areas of spinal canal stenosis are seen. There is a small disk herniation at L5-S1.


Instruction: Generate impression based on findings.

Input: Images are limited by extensive patient motion and areas of incomplete fat saturation on post contrast imaging. There is asymmetric thickened and enhancing posterior hypopharyngeal soft tissue from the upper C3 to C3-C4 levels more prominent to the right of midline, at the approximate level of the anterior hyoid bone. This extends from to the pharyngeal mucosal surface, with grossly intact prevertebral musculature. This measures approximately 1.8 cm transverse by 1.0-cm AP by approximately 1.7 cm CC. There is slight mass effect upon the adjacent piriform sinus which remains aerated. Associated T2 hyperintensity is noted in this location. Preservation of the retropharyngeal fat plane is difficult to determine on this limited MRI, but there may be violation suggested on the sagittal post-contrast images.PHARYNX/LARYNX: The nasopharynx, oropharynx, and hypopharynx are otherwise unremarkable. The larynx is unremarkable. The upper trachea and esophagus are unremarkable.GLANDS: The contrast-enhanced appearance of the submandibular, sublingual, and parotid glands bilaterally is unremarkable. There is heterogeneous enhancement and T2 hyperintensity in the left lobe of thyroid gland which is mildly enlarged. ORAL CAVITY: The oral tongue and the floor of mouth are unremarkable.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified.OTHER: The visualized intracranial structures are unremarkable. There is redemonstration of anteromedial right apical pulmonary opacity which is partially visualized, with similar configuration to that of the prior CT. There is mild-moderate mucosal thickening throughout the paranasal sinuses. There is focal opacity on the coronal images in the anterior right upper lobe consistent with an area of hypermetabolism on the prior PET CT. Evaluation for interval change in size is difficult due to differences in technique. Degenerative changes are again seen involving the cervical spine especially at C3-C4 and C4-C5, where there may be a posterior osteophyte disk complex with possible additional ossification of the posterior longitudinal ligament. There is flattening of the ventral cord and likely at least mild to moderate central spinal canal stenosis C3-C4. There may be moderate to moderate severe bilateral foraminal narrowing at these levels.

Output: 1. Severely limited exam due to extensive patient motion and areas of incomplete fat saturation. Abnormal signal and enhancement within the right paracentral and midline posterior hypopharyngeal soft tissues extending to the mucosal surface at the C3 to C3-C4 level. This correlates with previous area of increased uptake on PET CT, but does not appear to involve the prevertebral space, as normal musculature is visualized. This could relate to an additional primary neoplasm or inflammatory process. A follow-up contrast-enhanced CT of the neck may be helpful to evaluate for retropharyngeal involvement, and correlation with direct inspection is recommended given apparent involvement of the mucosal surface.2. Heterogeneous enhancement and abnormal signal in the left lobe of the thyroid gland which is enlarged. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.3. Partially visualized cervical spondylotic changes which may be further evaluated with dedicated MRI of the cervical spine if clinically indicated.4. Partially visualized pulmonary findings previously seen on PET/CT system patient's known malignancy, with direct comparison difficult due to differences in technique.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no suspicious intracranial enhancement, acute infarct, mass, or cerebral edema. There are no definite cortical dysplasias, heterotopic gray matter or evidence of mesial temporal sclerosis. There are few nonspecific periventricular and subcortical T2 hyperintensities in the supratentorial brain. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. LUMBAR: There is a large bulky structure in the pelvis which is incompletely imaged showing heterogeneous enhancement, likely representing a large fibroid uterus. There is apparent displacement of the fluid filled endometrial canal to the right of midline. In addition, there is partial visualization of a T2 hyperintense structures within the right upper pelvis which may be the location of the right ovary or may represent loops of bowel.The exam is mildly limited due to motion degradation on axial postcontrast images. The last well formed disk space is referred to as L5-S1. There is normal lumbar alignment and vertebral body heights. The disk heights are preserved. The osseous marrow signal is within normal limits for patient age. The conus terminates at mid L2 level. The conus shows normal signal intensity. There is mild developmental narrowing of the lumbar central spinal canal due to short pedicles and prominent dorsal epidural fat.There is subcutaneous edema in the deep posterior soft tissues lumbar region with enhancement, nonspecific, likely due to dependent edema although etiologies such as cellulitis are not excluded. There is no suspicious enhancement in the lumbar spine elsewhere.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: No disk herniation or spinal stenosis.L3-4: No disk herniation or spinal stenosis.L4-5: Mild disk bulge and facet arthropathy with no spinal stenosis.L5-S1: Mild disk bulge and moderate bilateral facet arthropathy causing no significant stenosis.

Output: 1.Essentially unremarkable MRI of the brain.2.Minimal lower lumbar spondylosis with no significant spinal stenosis.3.Nonspecific mild deep subcutaneous soft tissue edema of the posterior lower back with enhancement, likely representing dependent edema although etiologies such as cellulitis need to be excluded clinically.4.Extremely large bulky structure in the pelvis which is incompletely imaged showing heterogeneous enhancement likely represents a large fibroid uterus with presumed rightward displacement of the fluid-filled endometrial canal. However, this needs to be confirmed with ultrasound.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:Mildly prominent ventricles and sulci indicating volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. Moderate scattered periventricular and subcortical T2 hyperintensities are nonspecific but likely related to chronic small vessel ischemic disease. There is a small amount of cystic change in the left periventricular white matter lesions. T2 hyperintensities within the bilateral putamen likely reflect chronic lacunar infarcts. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Mild mucosal thickening of the bilateral maxillary sinuses, right greater than left.MRA BRAIN:No significant stenosis or aneurysm in the anterior or posterior circulation. Fetal origin of the left posterior communicating artery. Dominant left vertebral artery.

Output: 1.No acute abnormality.2.Mild to moderate chronic small vessel ischemic disease.3.No significant stenosis or aneurysm on MRA.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of pituitary gland [D35.2] / Benign neoplasm of craniopharyngeal duct [D35.3], OSH questionable lesion to Pituitary. Headaches. There is a 4 mm diameter hypoenhancing ovoid lesion in the right superior pituitary gland. The pituitary gland also appears slightly enlarged overall, measuring up to 10 mm. The pituitary exerts mild mass effect on the optic chiasm and pituitary stalk. The posterior pituitary T1 bright spot is perhaps slightly prominent. There is prominence of the visualized lateral and third ventricles and the partly imaged cerebellum appears to be somewhat dysmorphic.

Output: 1. A 4 mm diameter lesion in the superior right pituitary gland may represent a pituitary microadenoma.2. Prominence of the visualized lateral and third ventricles and possible dysmorphic appearance of the partly imaged cerebellum may be developmental in nature.


Instruction: Generate impression based on findings.

Input: Reason: Rule out derangement of left shoulder rotator cuff History: Injury and pain to shoulder ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor muscles and tendons are intact without evidence of tearing or atrophy.SUPRASPINATUS OUTLET: There is a tiny pocket of fluid in the acromioclavicular bursa. Degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small paralabral cyst abutting the anterior superior glenoid labrum. There is a very small volume of fluid in the subscapular recess of the glenohumeral joint. The anterior and posterior labrum are intact without evidence of tearing.BICEPS TENDON: The biceps tendon is intact without evidence of tearing. ADDITIONAL

Output: Small paralabral cyst without focal tearing or tendinopathy.


Instruction: Generate impression based on findings.

Input: History of supraglottic laryngeal cancer. Status post chemo/RT ending on 2 -- 8 -- 08. CT of the soft tissues of the neck with infusion:Images through the skull base and including cavernous sinuses remain normal. Paranasal sinuses and mastoid air cells are unremarkable.Images through the neck demonstrate extensive post therapy changes. Soft tissue thickening (right greater than left) is again identified with no interval change since prior exam as well as a study from 2 -- 3 -- 2009.Significant soft tissue thickening at the level of left cuneiforms sinus with mass effect is again identified. This finding is similar in appearance to the immediate prior study from 7 -- 5 -- 2009 as well as to -- 3 -- 2009. No distinct measurable tumor is identified however possibility of residual tumor within these regions cannot be entirely ruled out. Stable appearance of this findings on two prior consecutive studies is not suggestive of recurrence of tumor. Two entirely exclude recurrence of disease in this case an MRI is recommended.There is no evidence of any pathologic adenopathy in the neck. Limited images through the apices of the lungs and mediastinum are negative. No evidence of osseous metastatic lesions.CT of brain with infusionNo evidence of metastatic disease to the brain or the leptomeninges. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Calvarium is intact. 80 cc of Omnipaque 350 was utilized for the above studies.

Output: 1.Negative CT of brain and calvarium for metastatic disease. Normal CT of brain.2.Extensive post therapy changes. Soft tissue thickening in the supraglottic/glottic regions remains stable since prior two studies. Further follow-up with an MRI is recommended to entirely exclude possibly two of residual tumor.3.No evidence of pathologic adenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Reason: left knee quad tendon rupture - need to evaluate to mid-femur in addition to knee. History: above There is a full-thickness incomplete tear of the quadriceps tendon. The tendon of the vastus intermedius appears intact and can be followed to its insertion on the patella. There is a full-thickness tear of the middle layer of the quadriceps tendon composed of the fibers of the vastus medialis as well as the vastus lateralis, with approximately 2 to 3 cm of proximal retraction. There also appears to be a full-thickness tear of the rectus femoris at its patellar insertion, with minimal retraction. The more posterior "oblique" tendons of the vastus medialis and vastus lateralis can be followed to the medial and lateral retinacular structures, respectively.There is mild edema within the quadriceps musculature, indicating strain injury. Lobular fluid signal intensity is noted anterior to the vastus intermedius muscle extending cranially approximately 10 cm, likely a thin hematoma. There is mild undulating contour of the patellar tendon, which otherwise appears intact. The remainder of the musculature of the distal thigh and proximal leg appears normal.Please note, this study was not protocoled for detailed evaluation of the knee. However, there appears to be mucoid degeneration of the anterior horn of the lateral meniscus with signal abnormality in the underlying tibial plateau. There is additional edema in the subcutaneous fat, particularly anteriorly and laterally. A knee joint effusion is present.Large field-of-view images provided limited evaluation of the right knee, which demonstrates edema-like signal in the vastus medialis obliquus as well as the vastus lateralis, suggesting strain injuries.

Output: Left quadriceps tendon rupture as described above, involving the rectus femoris, vastus medialis, vastus lateralis, with sparing of the vastus intermedius.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with metastatic breast cancer presenting with weakness, lethargy and altered mental status. No evidence of parenchymal edema, mass effect or pathologic intracranial enhancement is seen. No restricted diffusion is detected. There are numerous scattered small foci of parenchymal T2 hyperintensity scattered throughout both hemispheres and within the pons, similar to the prior examination. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. Hypointense marrow signal within the left aspect of the clivus is unchanged.

Output: 1.No acute intracranial abnormality.2.No evidence of intracranial metastases.3.Findings compatible with chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Male, 58 years old, with cervical osteophyte seen on CT. Evaluate for stenosis. The cervical lordosis is mildly straightened. There is a trace retrolisthesis of C3 relative to C4. Alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. Allowing for endplate degenerative changes, the marrow signal is within normal limits. No evidence of edema is seen.The spinal cord shows normal signal intensity and morphology. No epidural abnormalities are suspected.Supraglottic mucosal edema is partially visualized likely related to prior therapy. Patchy opacification of the right mastoid air cells is seen.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild posterior disc-osteophyte complex formation particularly along the left uncovertebral joint. No spinal canal stenosis. Moderate left foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation asymmetric to the right. No spinal canal stenosis. Mild right foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation. No spinal canal stenosis. Moderate right foraminal narrowing. C6-7: Mild posterior disc-osteophyte complex formation. No spinal canal stenosis. Severe left and moderate right foraminal narrowing. C7-T1: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. No foraminal narrowing.

Output: Multilevel disc degeneration is seen. No significant spinal canal stenosis is detected. However, severe foraminal narrowing is seen on the left at C6-7 with mild to moderate foraminal narrowing elsewhere.


Instruction: Generate impression based on findings.

Input: Urothelial cancer status post nephroureterostomy and chemotherapy, needs surveillance imaging ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Spleen only partially imaged in coronal plane but without significant change accounting for differences in technique.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephroureterectomy. No enhancing soft tissue signal seen in renal bed to suggest local tumor recurrence.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal/left para-aortic, portacaval and mesenteric lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Apparent filling defect in left base of bladder on coronal image T2 is not visualized on other sequences and favored to be artifactual.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No evidence of local tumor recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: Male, 58 years old, with right-sided weakness. Assess for stroke or lesion. Brain:No evidence of restricted diffusion is seen. Numerous small foci of T2 hyperintensity are demonstrated within the subcortical and periventricular white matter of the cerebral hemispheres. Prominent patchy T2 hyperintensity is evident within the central pons.No evidence of parenchymal edema or mass effect is detected. On postcontrast images, there is no pathologic parenchymal or extra-axial enhancement. A small developmental venous anomaly is evident within the left precentral gyrus.No findings are seen to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is normal in size and morphology.Lumbar spine:Grade 1 retrolisthesis of L4 relative to L5 is demonstrated. Spinal alignment is otherwise unremarkable.Marrow signal characteristics are heterogeneous with evidence of predominantly fatty signal alteration involving the upper half of S1, the entirety of L5, most of the bottom portion of L4, and a small portion of the anterior/inferior endplates of L3 and L2. These areas partially suppressed on STIR images which suggests the presence of some edema in addition to fatty change.Degenerative disease is evident at every level, though it is most severe at L4-5 and L5-S1 where there is near complete loss of disk height and substantial signal change in the adjacent marrow which is also likely degenerative. Level specific findings are as follows:L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Mild to moderate facet hypertrophy and ligamentum flavum thickening. Bulging disk and prominent dorsal epidural fat contribute to a moderate spinal canal stenosis with some crowding of the cauda equina. Mild bilateral foraminal narrowing. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disk and prominent dorsal epidural fat contribute to a mild to moderate spinal canal stenosis with slight crowding of the cauda equina. Moderate right and mild left foraminal narrowing. L4-5: Moderate to severe facet hypertrophy and ligamentum flavum thickening. Markedly bulging disk with a superimposed right paracentral protrusion. The entire left aspect of the spinal canal is occupied by globular, markedly T1/T2 hypointense material which fills the spinal canal from the L4-5 disk level up to the midportion of the L4 vertebral body. Resulting severe spinal canal stenosis at this level with marked impingement of the cauda equina. Severe bilateral foraminal narrowing, worse on the right. L5-S1: Severe facet hypertrophy and ligamentum flavum thickening. Markedly bulging disk. Mild to moderate spinal canal stenosis. Severe bilateral foraminal narrowing, worse on the right.

Output: 1. No acute intracranial abnormalities. Scattered small foci of signal abnormality are demonstrated in the cerebral white matter with prominent signal abnormality in the pons. These findings could represent chronic microvascular ischemic disease, particularly if there are clinical risk factors. Otherwise, prominent involvement of the pons could also reflect demyelination, osmotic demyelination or a prior metabolic insult.2. Severe degenerative disease in the lumbar spine particularly affecting L4-5 and L5-S1 where complete loss of disk height and severe degenerative marrow signal abnormalities are seen.3. At L4-5, there is a bulging disk with right paracentral protrusion. In addition, a globular region of markedly T1/T2 hypointense material occupies the left half of the spinal canal from the level of the disk space up to the midportion of the L4 vertebral body. This material could represent a desiccated or calcified sequestered disk, dense fibrosis, or dystrophic calcification of some other cause. A severe spinal canal stenosis results at this level with marked impingement of the cauda equina nerve roots.4. Less severe spinal canal stenosis is demonstrated at L2-3, L3-4 and L5-S1. Severe foraminal narrowing is evident at L4-5 and L5-S1, particularly on the right.


Instruction: Generate impression based on findings.

Input: Clinical question: frontotemporal atrophy, question of vascular etiologySigns and Symptoms: PPAComments: Paired with MRI. | MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. This is a clear progression from the 12/14/2010 exam.There is loss of left hemispheric white matter mantle with enlargement of the left lateral ventricle. There is encephalomalacia present along the left anterior temporal lobe. There is also some encephalomalacia along the left middle frontal gyrus This is a clear progression from the 12/14/2010 exam.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.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 a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.No abnormal enhancing mass lesions are appreciated intracranially.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. The left posterior communicating artery is almost the same size as the left P1 segment. The right posterior communicating artery is very small. The left A1 segment is larger than the right A1 segment. The anterior communicating artery is relatively small. The right vertebral artery is larger than the left vertebral arteryMRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. Several centimeters distal to the carotid bifurcation on the left side the left internal carotid artery appears to smoothly narrow in the AP direction with approximately 70% stenosis.There is no significant stenosis along the course of the vertebral arteries. The right vertebral artery is larger than the left vertebral artery.The left lobe of the thyroid appears significantly enlarged and heterogeneous.

Output: 1.Since the prior examination there has been marked progression of loss of the left hemispheric white matter mantle and progression of periventricular white matter lesions bilaterally but mostly on the left side. Additionally since 12/2010 there is new encephalomalacia in the left anterior temporal lobe and left middle frontal gyrus. Differential considerations include vascular related process (see impression #2) as well as neurodegenerative process .2.There is 70% stenosis with smooth in narrowing of the left internal carotid artery distal to the bifurcation. One possibility is that this is related to a dissection of the left internal carotid artery with interval healing. This could also explain the intracranial findings which are ipsilateral to this lesion.


Instruction: Generate impression based on findings.

Input: 65 years Male (DOB:12/7/1950)Reason: assess for osteo, infection, degeneration, or other etiologies of chronic neck/left arm arm pain History: neck pain/stiffness, left arm pain, hx of C3-c7 laminectomyPROVIDER/ATTENDING NAME: DAVID M. LIEBOVITZ DAVID M. LIEBOVITZ The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.There is marrow replacement within the right T3 superior facet and pedicle as well as the inferior facet of T2 and the T2 spinous process. There are associated destructive changes within the right T2-3 facet joint facet joint and encroachment of the exiting nerve roots within the left T2-3 neural foramenThe patient status post cervical spine surgery with multilevel laminectomies and posterior instrumentation from C3 through C7.

Output: 1.There is a destructive process involving the right superior facet and right pedicle of T3 associated with adjacent involvement of the T2 spinous process and inferior facet. This results in encroachment of the right-sided T2-3 exiting nerve roots. Differential considerations include arthritis/degeneration or infection.2.Patient is status post cervical spine surgery. Please refer to MRI of the cervical spine from 9/23/2016 for further comments.


Instruction: Generate impression based on findings.

Input: 27-year-old female with history of uterine scar revision and cesarian scar ectopic pregnancy. Pain, abnormal bleeding. Please evaluate uterine wall thickness. PELVIS:UTERUS, ADNEXA: There has been interval repair of the anterior-inferior myometrial defect, and there is adjacent mild susceptibility artifact related to suture material. A subcentimeter minimal defect remains at this level (sagittal series 9 image 15). Normal enhancement of the uterine myometrium.Normal bilateral ovaries.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace free fluid in the dependent pelvis, likely physiologic.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval repair of the previously seen anterior-inferior myometrial defect, and a minimal defect persists. No acute complication is identified.


Instruction: Generate impression based on findings.

Input: Reason: MS; F/U progression History: Weakness legs There is redemonstration of a moderate degree of periventricular and subcortical white matter lesions which are hyperintense on T2 and flair MRI. Some of these are perpendicularly oriented relative to the lateral ventricles. Overall there is no significant change when compared to the previous examPineal gland appears stable when compared to the previous examThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a redemonstration of periventricular and subcortical white matter lesions which are stable when compared to prior exam. These are compatible to patient's diagnosis of demyelinating disorder.2.A pineal region lesion is stable when compared to previous exam.


Instruction: Generate impression based on findings.

Input: Left leg numbness and weakness. Assess for spinal canal stenosis. There are 5 lumbar-type, ribless vertebrae. The vertebral bodies are preserved in height. There is no suspicious osseous lesion. Fat-containing lesion in T12 vertebral body is compatible with a hemangioma. Disc heights are preserved. There is loss of T2 signal at L5-S1 disc associated with a small right central protrusion and annular fissure. There is no significant spinal canal stenosis. There is mild facet arthropathy at L4-L5 and L5-S1, associated with very mild bilateral, left relatively worse than right, L5-S1 neural foraminal stenoses. The conus medullaris is unremarkable. The tip of the conus is at the lower L1 level which is normal.

Output: 1.Mild degenerative changes in the lower lumbar spine. Facet arthropathy associated with very mild left more than right L5-S1 neural foraminal stenoses. 2.There is no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: GH deficiency, evaluate for pituitary abnormality The signal intensity in the brain parenchyma is normal. There is no mass, significant mass effect, or midline shift. The pituitary gland is normal in size with a normal posterior pituitary bright spot. There is no suprasellar abnormality. The midline structures are normal. The cerebellar tonsils are normal in position. There is lobulated CSF signal intensity posterior to the cerebellum in the extraaxial space, left greater than right, with associated prominent scalloping of the inner table of the calvarium. There is no evidence for intracranial hemorrhage or extra-axial collection. No diffusion-weighted abnormalities are identified. Flow voids are present within the major vessels indicating patency. There is mild mucosal thickening of the visualized ethmoid air cells. The adenoids are prominent, likely reactive.

Output: 1. Pituitary gland is normal in size with a normal pituitary bright spot and will be fully evaluated on future dedicated pituitary MRI. 2. Lobulated CSF signal intensity posterior to the cerebellum with associated scalloping of the inner table of the calvarium. Differential considerations include retrocerebellar cyst and mega cisterna magna.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:9/5/1971)Reason: left sided weakness etiology History: left sided weaknessPROVIDER/ATTENDING NAME: DIANE B CHANEY KOUROSH REZANIA MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate a subtle old orbital floor blowout fracture.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 small. The posterior communicating arteries are small but slightly larger on the left than the right side.. The right vertebral artery is slightly larger than the left vertebral artery.. There is extracranial origin of the right posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the right vertebral artery. The left common carotid artery originates from the innominate artery.The left vertebral artery appears irregular along the V2 segment but not occluded..

Output: 1.No evidence for intracranial aneurysm.2.The left vertebral artery appears irregular along the V2 segment, however, does not appear occluded. This could be a sign of underlying vasculopathy such as fibromuscular dysplasia.3.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.4.No evidence for acute ischemic cerebral infarction.5.No evidence for intracranial hemorrhage


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:10/4/1970)Reason: pre-op planning History: new cerebellar lesion, needs ORPROVIDER/ATTENDING NAME: DOROTA K HAVLIN EDWIN RAMOS There are multiple enhancing lesions present within the brain parenchyma. These are predominantly located in the posterior fossa. One in the lower half of the left cerebellar hemisphere is actually to combined lesions and measures 36 x 23 mm axial dimensions. One in the medial aspect of the right cerebellar hemisphere measures 28 x 29 mm axial dimensions. One in the pons measures 10 x 16 mm axial dimensions. One in the medial right occipital lobe measures 8 x 6 7 mm axial dimensions. One in the right centrum semiovale measures approximately 5 mm in diameter. One in the left frontal lobe in the middle frontal gyrus measures 9 mm diameter. One in the left inferior frontal gyrus measures 5 mm diameter. There is some vasogenic edema associated with some of these lesions especially the larger 1's. There is associated mass effect in the posterior fossa with compression of the fourth ventricle displacement of the cerebellar tonsils through the foramen magnum and compression of the brainstem against the clivus. There is associated ventriculomegaly.The patient is status post left frontal craniotomy.Incidental note is made of a developmental venous anomaly in the right frontal lobe.The calvarium has a mottled appearance with foci of the marrow replacement.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple lesions compatible with metastatic disease scattered within the brain parenchyma is detailed above. The largest lesions are located in the posterior fossa where there is significant mass effect with foramen magnum herniation and compression of the brainstem as well as compression of the fourth ventricle with associated ventriculomegaly.2.There are findings consistent with a calvarial marrow replacement. Possibility of bone metastases cannot be excluded. Perhaps a bone scan may be helpful.


Instruction: Generate impression based on findings.

Input: Abdominal pain. History of bile duct dilatation seen on prior imaging. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No focal lesions identified.There is stable mild fusiform dilatation of the common bile duct as well as the extrahepatic right and left hepatic ducts. No significant intrahepatic biliary ductal dilatation. The common bile measures 10 mm in maximum diameter. The duct gradually tapers down to a normal diameter prior to the level of the ampulla. The pancreatic duct is normal in caliber. Overall appearance is not significantly changed compared to prior.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is normal in signal and morphology. The main pancreatic duct is normal in size. No obstructing mass lesion is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys are normal in signal and morphology. No mass lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged T12 vertebral body hemangioma.OTHER: No significant abnormality noted.

Output: 1.Stable dilatation of the common bile duct and extrahepatic right and left hepatic ducts. This is not significantly changed dating back to 4/9/2009 and likely due to a benign etiology such as stricture or normal postcholecystectomy change. No mass lesion is evident.


Instruction: Generate impression based on findings.

Input: Cervical radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. There is no definite cord signal abnormality at any level aside from punctate focus involving the left aspect of the cord at the C5-C6 level.There is developmental narrowing of the cervical spinal canal with significant superimposed degenerative changes as detailed below: C2-3: Central disc protrusion with mild indentation on the ventral cord and ligamentum flavum thickening. There is overall moderate spinal canal stenosis at this level. Neural foramina are patent.C3-4: There is a disc osteophyte complex and ligamentum flavum thickening contributing to moderate spinal canal stenosis at this level and mild cord deformity. There is uncovertebral hypertrophy and mild facet arthropathy contributing to moderate bilateral neural foraminal stenosis, right greater than left.C4-5: There is disc osteophyte complex and ligamentum flavum thickening contributing to moderate spinal canal stenosis with mild cord deformity. There is uncovertebral hypertrophy and mild facet arthropathy contributing to moderate to severe right and moderate left neural foraminal stenosis.C5-6: There is disc osteophyte complex and ligamentum flavum thickening contributing to moderate to severe spinal canal stenosis with cord deformity, particularly on the left. There is uncovertebral hypertrophy and mild facet arthropathy contributing to moderate to severe right and moderate left neural foraminal stenosis. There is abnormal T2 signal involving the left lateral aspect of the cord at this level.C6-7: There is disc osteophyte complex which effaces the ventral thecal sac and contributes to mild to moderate spinal canal stenosis. There is minimal narrowing of the neural foramina related to uncovertebral hypertrophy.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Multinodular goiter is noted and better assessed on recent ultrasound. Right submandibular gland is not definitively seen and may be absent or diminutive.

Output: 1. Developmental narrowing of the cervical spinal canal with superimposed degenerative changes resulting in significant multilevel spinal canal stenoses from the C2-C3 to the C6-C7 level with mild cord flattening, worst at the C5-C6 level. There is also significant neural foraminal stenoses from the C3-C4 to the C5-C6 levels as detailed above. 2. Focal cord signal abnormality involving the left aspect of the cord at the C5-C6 level favored to represent sequela of compressive myelopathy.


Instruction: Generate impression based on findings.

Input: Progressive spasticity. Assess for progression of white-matter disease. The T2/FLAIR hyperintense lesions predominantly involving the putamina, the caudate nuclei as well as the central pons and, to a lesser extent, the thalami have not changed in distribution since the previous examination. The lesions are more conspicuous but this may relate to technique (today's examination was obtained on 3.0 Tesla system compared to 1.5 Tesla for the previous examination). A few similar lesions are present in the cerebral white-matter, of which the ones involving the inferior aspect of the left temporal lobe were not present previously. There is no associated diffusion restriction or contrast enhancement. Brain volume loss remains mild. There is no mass effect or midline shift. There is no abnormal leptomeningeal or nerve root contrast enhancement. Major intracranial vascular flow voids are preserved, reflecting gross patency. The intradural left vertebral artery shows persistent focal mural based irregularity, which may represent an atherosclerotic plaque but there is no significant stenosis.There is no destructive skull lesion. There is no gross orbital abnormality. There is mild maxillary, ethmoid and sphenoid sinus mucosal thickening that is worse on the right.

Output: The distribution of the nonenhancing T2-hyperintense lesions in the putamina, caudate nuclei, thalami, pons as well as cerebral white-matter does not appear significantly changed, with very minimal progression. Increased conspicuity of lesions likely in part relates to differences in technique.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, with seizures and spikes and EEG. Evaluate for focal abnormal areas. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The pituitary region is unremarkable. The corpus callosum is fully formed and intact. The brainstem and cerebellum and within normal limits. The medial temporal lobe structures are free of focal lesions.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable examination with no focal lesions identified.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine.Targeted CT examination demonstrates a cortically based lucent lesion within the proximal humeral metaphysis corresponding to the findings on recent MRI examination and radiographs. Using CT guidance, a 13 gauge OnControl biopsy needle was advanced into the lesion. One 13-gauge core biopsy specimen was obtained. A touch preparation was performed and handed to cytopathology to confirm specimen adequacy. The biopsy specimen was placed in formalin.The core biopsy specimen was hand carried to the Surgical Pathology labThe patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT guided biopsy of the right humerus.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, with right leg weakness and numbness, follow-up epidural hematoma. A T2 hyperintense, T1 intermediate collection is again seen within the dorsal epidural space at the L4-5 disc level with rim enhancement compatible with an epidural hematoma. On comparison with the prior examination, this collection is no larger and, in fact, may even be slightly decreased in size.As before, this collection contributes, along with a bulging disc and central disc protrusion as well as facet and ligamentum flavum hypertrophy, to a significant spinal canal stenosis which, again, is stable or perhaps mildly improved. There remains some degree of crowding of the cauda equina nerve roots at this level. Mild to moderate bilateral foraminal narrowing is seen, not significantly changed.No significant degenerative disc disease is seen from T12-L1 through L2-3. At L3-4, facet and ligamentum flavum hypertrophy and bulging disc along with prominence of the dorsal epidural fat contribute to a significant spinal canal stenosis and crowding of the cauda equina which are unchanged. Mild bilateral foraminal narrowing is seen.At L5-S1, facet hypertrophy, ligamentum flavum thickening and a bulging disc contribute to a mild generalized spinal canal stenosis. The right neural foramen is severely narrowed and the left neural foramen is moderately narrowed.The lumbar lordosis is straightened. A slight retrolisthesis of L3 relative to L4 is unchanged. No areas of concerning marrow signal abnormality are seen apart from patchy fatty replacement and fatty degenerative endplate change at L4-5.

Output: 1.An epidural hematoma dorsal to the thecal sac at L4-5 is stable to slightly decreased in size. There remains a significant spinal canal stenosis at this level with crowding of the cauda equina, though the degree of stenosis may also be slightly improved. Mild to moderate bilateral foraminal narrowing at this level is unchanged.2.A significant spinal canal stenosis is also unchanged at L3-4 secondary to disc degeneration and posterior element hypertrophy.3.Severe right neuroforaminal narrowing at L5-S1 is unchanged.


Instruction: Generate impression based on findings.

Input: 69-year-old male with history of rectal cancer and a fistula treated with chemoradiation in 2012. Evaluate for recurrence. PELVIS:PROSTATE/SEMINAL VESICLES: Prostamegaly again noted.BLADDER: Persistent circumferential bladder wall thickening, likely due to patient's benign prostatic hypertrophy and/or radiation therapy.LYMPH NODES: No evidence of lymph nodes in the perirectal space within the mesorectal fascia. No evidence of lymph nodes outside of the mesorectal fascia.BOWEL, MESENTERY: No evidence of abnormal soft tissue thickening in the rectum, perirectal or perianal tissues to suggest tumor recurrence. Persistent intersphincteric perianal fistula at 6:00 position extending to the perineum. No loculated fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of tumor recurrence. 2.Unchanged intersphincteric perianal fistula in the 6:00 position.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no acute infarct, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The extracranial soft tissues are grossly unremarkable. Osseous marrow signal is mildly heterogeneous with no detectable discrete lesion, although CT is more sensitive for lucent myelomatous osseous lesions.ORBITS: There is asymmetric right lateral periorbital soft tissue thickening including the skin surface with associated enhancement posterior hyperintensity. In addition, there is slight asymmetric thickening and enhancement of the right eyelid. The findings are seen in the right superolateral extraconal space which appears to relate to the lacrimal gland, again with asymmetric enhancement. The adjacent bone is unremarkable.The globes and extraocular muscles are intact with normal signal intensity and caliber. The lens are not dislocated. The optic sheaths and optic nerves are within normal limits in caliber and signal intensity. There is no proptosis. There is an incidental partially empty sella. There is no mass effect on the optic chiasm. The pituitary stalk is midline. The cavernous sinuses are symmetric in enhance normally. There is no enlargement of the superior ophthalmic veins.

Output: 1. Asymmetric enhancement, abnormal signal, with soft tissue prominence involving the right lacrimal gland and right periorbital soft tissues including the skin surface as well as superolateral extraconal space . This is nonspecific, although the differential diagnosis includes infectious/inflammatory etiologies such as sarcoid or Sjogren's, orbital pseudotumor, with malignancy felt to be less likely but not excluded including lymphoma or primary glandular tumor. Myelomatous involvement of the lacrimal gland is rare although has been reported.2. No intracranial abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 67 years old Reason: rule out prostate cancer History: elevated PSA, rising, previous negative prostate biopsy PELVIS:PROSTATE:Prostate Size: 5.2 x 3.5 x 4.8 cmPeripheral Zone: The bilateral posterior peripheral zones demonstrate hazy T2 hypointense signal at the mid gland/base. This demonstrates diffusion restriction and hyperenhancement on postcontrast images. This is somewhat wedge-shaped in configuration and due to the diffuse nature the appearance favors prostatitis.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Diffuse T2 hypointense signal within the posterior peripheral zone as described above. The appearance favors prostatitis. It is conceivable that a small focus of prostatic adenocarcinoma could be concealed within this diffuse signal hypointensity.


Instruction: Generate impression based on findings.

Input: Male 51 years old with severe left shoulder pain and decreased mobility following fall down flight of stairs, evaluate for rotator cuff injury. ROTATOR CUFF: There is perhaps mild bursal surface fraying along the supraspinatus tendon at the 12:00 position as well as perhaps mild thinning of the tendon anteriorly but we see no rotator cuff tear. There is a small cyst in the top of the humeral head with mild signal abnormality in the adjacent marrow which is likely degenerative in etiology.SUPRASPINATUS OUTLET: Mild to moderate acromioclavicular joint osteoarthritis. No fluid is seen in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment is normal. There is no joint effusion. Minimal osteoarthritis affects the glenohumeral joint. Intermediate signal intensity within the superior labrum posteriorly may represent a degenerative tear.BICEPS TENDON: The long head of the biceps tendon appears normal. ADDITIONAL

Output: 1.Equivocal bursal surface fraying of the supraspinatus. No evidence of acute rotator cuff injury.2.Osteoarthritis and other findings as above.


Instruction: Generate impression based on findings.

Input: The procedure, indications, benefits, risks/complications and alternatives were described to the patient and informed consent was obtained. The patient was placed in the prone position and the inferior back was prepped with Betadine, draped and anesthetized with 1% lidocaine subcutaneously into the deeper soft tissues. Using fluoroscopic guidance, a 22 gauge x 3-1/2 inch spinal needle was localized into the thecal sac at the L4-5 vertebral level. Care was taken to avoid the nearby catheter from the pain pump which was visualized the entire time by fluoroscopy by undergoing a right paramedian approach inferior to the catheter. Approximately 15 cc of clear CSF was obtained and separated into 3 vials. The sample was given to the primary team for further analysis. The patient tolerated the procedure well with no immediate complications.TOTAL FLUOROSCOPY TIME: 0 minutes and 30 seconds

Output: Successful fluoroscopic guide lumbar puncture.


Instruction: Generate impression based on findings.

Input: Reason: History of Right Rotator cuff repair 2/29/16, reinjury 5/9 lifting weight-evaluate rotator cuff History: right shoulder pain Exam is limited due to extensive metallic artifact.ROTATOR CUFF: There is a massive tear of the rotator cuff with full-thickness tear and marked retraction of the supraspinatus and infraspinatus tendons. Additionally, there is marked atrophy of the supraspinatus and infraspinatus muscles. The subscapularis and teres minor muscles and tendons appear to be intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is irregularity of the lateral aspect of the humeral head, which is most likely posttraumatic. The glenoid labrum appears to be intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Massive tear of the rotator cuff as above.


Instruction: Generate impression based on findings.

Input: New mental status changes. History of metastatic small cell lung cancer. There are multiple bilateral supratentorial and infratentorial enhancing lesions with extensive surrounding vasogenic edema, which are unchanged in size accounting for differences in technique. For example, the largest lesion is located in the left frontal lobe and measures up to 35 mm. Many of the lesions demonstrate susceptibility effects and restricted diffusion. There is unchanged 3 mm of rightward midline shift and partial effacement of the 4th ventricle. There is a background of mild cerebral white matter AAT2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of acute cerebral infarction. There is minimal mucosal thickening of the left maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Multiple supratentorial and infratentorial metastatic disease associated with extensive associated vasogenic edema and mild rightward midline shift. Many of the lesions contain hemorrhagic components, but have not significantly changed in size since the prior CT, accounting for differences in technique.


Instruction: Generate impression based on findings.

Input: Pain the flexion, positive McMurray's. Evaluate for loose body and medial meniscus tear. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is mild bone marrow edema along the anterior aspect of the medial femoral condyle. The articular cartilage of the medial and lateral compartments is intact. There is thinning of the articular cartilage of the medial femoral trochlea and partial thickness fissuring of the articular cartilage of the patellar apex.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Small intraarticular loose body.2. Medial femoral condyle bone contusion3. Intact menisci and ligaments.


Instruction: Generate impression based on findings.

Input: Indeterminate renal mass seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe is hypertrophied with displacement of the gallbladder towards the midline, unchanged. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The left renal interpolar 1.4 cm intrinsically T2 hyperintense lesion demonstrates no postcontrast enhancement and is compatible with a benign cyst. There is mild left renal cortical thinning. No suspicious renal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: At the level of L2-3 between the left psoas muscle and the body wall there is a nonspecific focus of postcontrast enhancement measuring 2.3 cm. This may represent a lymph node or neurogenic origin tumor.OTHER: Postsurgical changes of the partially imaged left hemithorax with volume loss and pleural fluid. The reference inferior mediastinal soft tissue mass is unchanged from the same day CT.

Output: 1.The left renal lesion corresponds to a benign simple cyst.2.Nonspecific 2.3 cm enhancing lesion at L2-3 between the left psoas muscle and the body wall may represent a lymph node or neurogenic origin tumor (e.g. nerve sheath tumor).3.Please refer to the separately dictated report of the dedicated CT of the chest.


Instruction: Generate impression based on findings.

Input: No intracranial mass or mass effect. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. No evidence of ischemia. There is a punctate focus of susceptibility in the left posterior parietal lobe compatible with chronic microhemorrhage versus mineralization and nonspecific. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Pituitary gland is within normal limits for age. There is mild scattered mucosal thickening in the paranasal sinuses. Mastoid air cells are clear. Calvarium and extracranial soft tissues are grossly unremarkable.CERVICAL SPINE

Output: 1. There is a punctate focus of susceptibility effect in the left parietal lobe which may represent a chronic microhemorrhage versus calcification and nonspecific. Brain MRI is otherwise unremarkable.2. There is trace prominence of the central canal in the mid to lower thoracic cord which can be normal variant. No discrete syrinx is evident. Minimal disc protrusions at the C4-C5 and C5-C6 levels are also seen without associated spinal canal or neural foraminal stenosis. MRI complete spine is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: History of discectomy in 2014, progressive numbness Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. No suspicious enhancement. The conus medullaris is normal in position.Multilevel degenerative changes are seen with significant disc height loss at the L3-L4 and L4-L5 levels, interval worse at L4-L5 when compared to prior. Associated endplate marrow signal changes are also evident at these levels and slightly progressed at L4-L5. Individual levels as below:L1-L2: Small Schmorl's node as before. Otherwise no significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is a disc bulge with small central disc extrusion which has progressed since prior but is not associated with spinal canal or neural foraminal stenosis.L3-L4: Tiny central disc protrusion is similar to prior and is not associated with significant spinal canal or neural foraminal stenosis. Mild facet arthropathy and ligamentum flavum thickening also again noted at this level.L4-L5: There is disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening, which appear similar to prior. There is mild left neural foraminal narrowing without clear nerve root impingement and similar to prior. No significant spinal canal or right neural foraminal narrowing.L5-S1: There is evidence of interval right-sided laminotomy at the L5-S1 level and discectomy involving the previously seen sequestered disc fragment in the right lateral recess at the right L5-S1 level. There is no evidence of reherniation at this level. There is enhancement involving the right lateral epidural space as well as surrounding the right S1 nerve root most compatible with granulation tissue. There is no significant spinal canal stenosis. Neural foramina are also patent. Mild facet arthropathy again seen.

Output: 1. Postsurgical changes of right-sided laminotomy and discectomy at the L5-S1 level. Previously seen sequestered disc fragment in the right lateral recess has been removed. No evidence of disc reherniation. Enhancement involving the right lateral epidural space and surrounding the right S1 nerve root is most compatible with scar tissue. 2. Neural foramina and spinal canal in the lumbar spine are grossly patent. Please see additional details above including slight progression of degenerative changes compared to 7/28/2014.


Instruction: Generate impression based on findings.

Input: 29 year old with history of hypertension and peripartum cardiomyopathy presenting for cardiac evaluation. MEDICATIONS: Amlodipine, aspirin, atorvastatin, furosemide, metoprolol, spironolactone, valsartan First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is noted.Viability/ Myocardial ScarThere is no late gadolinium enhancement to suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is severely enlarged with moderately reduced systolic function. There is mild circumferential left ventricular hypertrophy (IVSd=10mm). The overall LV ejection fraction is 38%, the LV end diastolic volume index is 153 ml/m2 (normal range: 65+/-11), the LVEDV is 287 ml (normal range 109+/-23), the LV end systolic volume index is 95 ml/m2 (normal range 18+/-5), the LVESV is 179 ml (normal range 31+/-10), the LV mass index is 65 g/m2, and the LV mass is 121 g. The left ventricular systolic dysfunction is global. Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is severely enlarged with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 146 ml/m2 (normal range 69+/-14), the RVEDV is 274 ml (normal range 110+/-24), the RV end systolic volume index is 72 ml/m2 (normal range 22+/-8), and the RVESV is 136 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately enlarged. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a pseudo-bovine brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated 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 FindingsA large left axillary lymph node (15mm) is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. LV is severely dilated with moderately reduced systolic function (LVEF 38%).4. RV is severely dilated with normal systolic function (RVEF 51%).5. Significant biatrial dilation. 6. Large left axillary lymph node noted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is of a right frontal approach deep brain stimulator with the electrode tip terminating in the region of the right inferior thalamus. There are no masses, mass effect or midline shift. Mild T2/FLAIR signal abnormality in the periventricular and subcortical white matter as well as pons consistent with chronic small vessel ischemic disease. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.Right-sided deep brain stimulator with tip terminating in the region of the right inferior thalamus. 2.No acute intracranial abnormalities.


Instruction: Generate impression based on findings.

Input: Reason: 50M h/o ETOH induced chronic pancreatitis c/b pseudocyst formation s/p EUS aspiration of fluid 3/30/16, eval for response s/p aspiration History: pancreatic pseudocyst ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. The main portal vein and SMV are compressed but patent.SPLEEN: No significant abnormality noted.PANCREAS: There is been interval placement of an AXIOS stent along the lesser curvature. No residual peripancreatic collections are appreciated.There is diffusion restriction throughout the pancreas. There is low T1 signal within the body and tail on precontrast sequences with delayed hyperenhancement. The main pancreatic duct is dilated within the body and tail with multiple dilated side branches, findings likely reflecting chronic pancreatitis. Main pancreatic ductal dilatation is abrupt and it is likely structured at the junction of the pancreatic body and neck (601/25) representing a stricture.Small peripancreatic nodes are present.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.Abrupt dilatation of the main pancreatic duct at the junction of the pancreatic body and neck likely represents a stricture.2.Findings suggesting associated chronic pancreatitis of the pancreatic body and tail.3.Resolution of peripancreatic fluid collections.


Instruction: Generate impression based on findings.

Input: Evaluate for tethered cord. History of rectourethral fistula, status post repair in infancy now with chronic fecal incontinence. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is unremarkable. The conus medullaris is normal in position at the mid L2 level. No abnormal signal within the visualized distal cord. No evidence of lipoma or other lesions involving the lumbar spinal canal. Prone images demonstrate appropriate ventral motion of the conus and cauda equina. There is no significant spinal canal or neural foraminal stenosis at any level. Paraspinous soft tissues are within normal limits.

Output: 1. No evidence of tethered cord.2.Please refer to separate report for findings in the pelvis


Instruction: Generate impression based on findings.

Input: Sickle-cell disease without crisis [D57.1], Reason for Study: ^Reason: 12 y/o with Hg SS, history of headaches History: headaches Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal enhancement.There is non expansile intra osseous T1 high signal intensity, T2 mixed but mainly high signal intensity without evidence of enhancement at the left sphenoid bone just lateral aspect of the sphenoid sinus and extends toward left side pterygoid plate. Comparing with prior CT scan obtained in 2013, there is no evidence of interval change since prior scan. Constellation of this lesion indicate benign bony lesion and the differential diagnosis include arrested pneumatization of the sphenoid sinus and benign bony lesions such as bone infarctions and non ossifying fibroma. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Mucosal thickenings and retention cysts. Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No evidence of intracranial arterial luminal stenosis. No intracranial arterial aneurysm.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement. No mass.3. Normal brain MRA4. Left sphenoid benign bone lesion, likely indicate arrested pneumatization differential diagnosis include bone infarction and non ossifying fibroma.


Instruction: Generate impression based on findings.

Input: Severe pancreatitis with transaminitis, evaluate for biliary stone or obstruction ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. The hepatic and portal veins are patent.No intra or extrahepatic biliary ductal dilation. The common bile duct is normal in caliber and morphology without evidence of choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Moderate to severe peripancreatic edema consistent with acute pancreatitis. The main pancreatic duct is normal in caliber morphology.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a focus of fat signal intensity with peripheral rim enhancement abutting the anterior margin of the left hepatic lobe most compatible with fat necrosis (series 1301, image 243).BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Normal caliber and morphology of the common bile duct without evidence of choledocholithiasis.2.Moderate to severe acute pancreatitis without evidence of complications.


Instruction: Generate impression based on findings.

Input: DBS lead with possible lead breakage. Preoperative planning for possible replacement. Limited examination for operative planning demonstrates bilateral transfrontal DBS lead placment with tips near the level of the subthalamic nuclei. No obvious lead discontinuity intracranially is appreciated. The right lead is minimall inferior as compared to the left. There is T2 hyperintensity surrounding the leads bilaterally.No intracranial mass or mass-effect. No hydrocephalus or extra-axial fluid collections.

Output: 1. Bilateral DBS leads with tips near the level of the subthalamic nuclei with the right lead slightly more inferior than the left. No obvious intracranial lead discontinuity is appreciated.2. T2 hyperintensity surrounding bilateral leads is of uncertain significance and may represent edema related to inflammatory response (Englot DJ, et al. Stereotact Funct Neurosurg. 2011;89(5):311-7).


Instruction: Generate impression based on findings.

Input: 50 year-old male for pre-surgical planning of lumbar fusion There is a normal lumbar lordosis. The lumbar alignment and the vertebral body heights appear normal. Spinal canal appears uniformly narrowed from congenitally short pedicles. The pedicles show no bony abnormality. Bilateral spondylolyses of L5 is again noted with grade 1 anterolisthesis of L5 on S1 and pseudo-bulge of the L5/S1 disk. Hypoattenuating lesion at the L2 vertebral body corresponding meningioma as seen on prior MRI.Degenerative changes as described below:T12/L1: No central spinal stenosis or neuroforaminal compromise.L1/L2: No central spinal stenosis or neuroforaminal compromise.L2/L3: Minimal left neuroforaminal narrowing. No central spinal stenosis or right neuroforaminal compromise.L3/L4: No central spinal stenosis or neuroforaminal compromise.L4/L5: Moderate disk bulge and facet joint/ligamentum flavum hypertrophy showing some compromise in the transverse dimension of the spinal canal. No compromise of the spinal canal in the AP direction. No detectable neuroforaminal compromise. Anterior osteophyte formation is also noted.L5/S1: Pseudo-bulge of the disk. Facet joint/ligamentum flavum hypertrophy causing bilateral neuroforaminal compromise. No central canal stenosis.

Output: 1. Bilateral spondylolyses of L5 with grade 1 anterolisthesis of L5 on S1. 2. Congenitally shortened pedicles without bony abnormality. 3. Multilevel degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: There are new areas of restricted diffusion along the right superior frontal sulcus and more inferiorly white matter of the right frontal lobe. There are also multiple new punctate foci of restricted diffusion in the white matter of the left frontal lobe. Restricted diffusion in the right occipital and parietal lobes is less conspicuous compared to the prior MRI. However, restricted diffusion in the superior cortex of the left parietal lobe has increased in size now extending more anteriorly along the cingulate gyrus. There is associated T2/FLAIR hyperintensity in these regions of ischemia. There is no evidence of hemorrhagic conversion.The midline structures and craniocervical junction are within normal limits. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. No abnormal extra-axial fluid collection is identified. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA HEAD

Output: 1.New areas of acute ischemia in the white matter of the left frontal lobe, left superior frontal sulcus and along the cingulate gyrus. Additional areas of subacute supratentorial ischemia are unchanged with no evidence of hemorrhagic conversion.2.Multifocal intracranial arterial luminal stenoses involving the bilateral MCAs, ACAs, and potentially the left vertebral artery. Please also refer to the report for the conventional angiogram from 9/1/2016, a more sensitive exam for evaluation of the vasculature.


Instruction: Generate impression based on findings.

Input: Spinal cord hematoma of unknown etiology. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is a subcentimeter retention cyst in the right maxillary sinus.

Output: No evidence of intracranial hemorrhage or mass.


Instruction: Generate impression based on findings.

Input: Male 63 years old Reason: slurred speech, AMS, eval for mass or CVA History: slurred speech, AMS. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There has been mild increase in the periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely from sequela of small vessel ischemic changes. Motion limits full evaluation of the post-contrast images, but there does not appear to be abnormal enhancement of evidence of a mass. 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 and scalp soft tissues are grossly unremarkable. There is minimal maxillary mucosal thickening.

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


Instruction: Generate impression based on findings.

Input: History of choroid plexus papilloma resection, with left subdural fluid collection. There are postoperative findings related to left left lateral ventricle tumor resection, without evidence of recurrent tumor. The ventricular system appears unchanged. There is a persistent left cerebral convexity fluid collection that measures up to 10 mm in thickness. There is unchanged mild midline shift to the right. Multiple foci of susceptibility effect in the parenchyma along the surgical approach are unchanged and likely represent chronic blood products. There is no evidence of acute infarct. The skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Postoperative findings related to left left lateral ventricle tumor resection, without evidence of recurrent tumor. A persistent left cerebral convexity fluid collection that measures up to 10 mm in thickness.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Research protocol. PELVIS:PROSTATE:Prostate Size: 5.1 x 4.1 x 3.3 cm (transverse by CC by AP)Peripheral Zone: Again seen is a dominant lesion in the right peripheral zone extending from the mid gland to the apex with decreased T2 signal, restricted diffusion, and early arterial enhancement. The lesion measures 11 x 8 mm in maximum axial dimension.Central Gland: Mild changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle in vision.Extracapsular Extension: Along the posterolateral aspect of the mass, there is extensive abutment of the prostate capsule with apparent thickening of the capsule and indistinct margins suspicious for extracapsular extension (series 401 image 12). This approaches but does not definitively involve the right neurovascular bundle which runs immediately superior to the tumor in this region.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: Redemonstration of an ovoid mass extending from the obturator foramen into the proximal thigh between the pectineus and adductor brevis muscles which measures 2.6 x 2.0 x 4.3 cm. The lesion is isointense to muscle on T1, T2 hyperintense, and a heterogeneously enhancing on the postcontrast images.There is incompletely evaluated peripherally enhancing focus within the right femoral neck seen on the large field-of-view images.OTHER: No significant abnormality noted.

Output: 1.Stable appearance of 1.1 cm lesion in the right peripheral zone mid gland and apex compatible with tumor. There is suspected extra prostatic extension posterolaterally.2.Incidental note of a enhancing heterogeneous mass in the proximal right thigh as described above possibly representing a peripheral nerve sheath tumor.3.Indeterminate enhancing focus in the right femoral neck. Consider dedicated imaging as clinically warranted.


Instruction: Generate impression based on findings.

Input: Neutropenic fever. History of leukemia.IMAGE ACQUISITIONS: 1.5-mm contiguous axial images of the brain without contrast infusion.2.Thin section axial and reformatted coronal images of paranasal sinuses without contrast infusion. Low-attenuation in involving right internal capsule and periatrial white matter and small portion of right medial temporal lobe is consistent with infarct, likely in the right anterior choroidal artery territory, as previously described on MRI. There is no acute intracranial hemorrhage, mass effect or shift of midline structures. Small white matter infarcts over the cerebral convexities that were present on the previous MRI are not as well demonstrated on CT due to decreased sensitivity CT compared MRI.On previous CT of sinuses the March 11, 2009, there was mild mucosal thickening in the right side of the sphenoid sinus. On the current scan, there is some frothy or bubbly secretion in the right side of the sphenoid sinus, which is new compared with the previous scan. Minimal mucosal thickening is again noted in the right maxillary antrum. There are no other areas of mucosal thickening. There are no fluid levels. There is no bone obstruction or sinus expansion.. Ostiomeatal complexes are structurally normal. Mastoids are mostly included in the field of view and are well aerated.Bilateral proptosis is again noted.

Output: 1.Chronic right anterior choroidal artery infarct is again noted. CT of the brain is otherwise negative.2.There is some frothy secretion in the sphenoid sinus on the right. This has developed since the previous scan and could indicate early acute inflammation.


Instruction: Generate impression based on findings.

Input: Diagnosis: Paresthesia of skinClinical question: MSSigns and Symptoms: memory, patchy signal abnormalities in the cervical spine The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple periventricular and subcortical white matter lesions which are hyperintense on T2 imaging and hypointense on T1 imaging present. Some of these are perpendicularly oriented to the lateral ventricles. Some extend to the colossal cingulate junction. Also appears to be a T2 hyperintense lesion in the posterior and peripheral aspect of the upper cervical spinal cord located midline and eccentric to the left at the C1 vertebral level which is incompletely assessed on this study.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are periventricular and subcortical white matter lesions present as well as a lesion suspected to be present in the upper spinal cord which are suspicious for demyelinating disorder which is compatible with the patient's known diagnosis of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: 31-year-old male with lymphadenopathy and brain lesion status post biopsy. Rule-out primary malignancy, calcifications or lymph nodes in the neck. Postoperative changes from a right frontal craniotomy are noted. Peripherally enhancing lesion in the right frontal lobe with associated extra-axial CSF fluid collection are again seen and are also likely secondary to postoperative changes. Ill-defined hypodensities are seen in the bilateral basal ganglia which correlate with the basal ganglia abnormalities seen on prior MRI examination. No new CT findings are seen within the brain.NECK CT

Output: Stable postoperative changes in the brain. No abnormal enhancing lesions or lymphadenopathy within the neck.


Instruction: Generate impression based on findings.

Input: Word finding difficulty. Evaluate for acute ischemia. There is a punctate focus of restricted diffusion within the left superior parietal lobule. There is no mass effect, midline shift or herniation. There are multiple punctate foci of susceptibility abnormality predominantly involving the basal ganglia, claustrum, thalami, and inferior cerebellum bilaterally, as well as the right centrum semiovale, right occipital lobe and left medial frontal lobe compatible with blood product from microhemorrhage. There is encephalomalacia likely in the right frontal lobe including the centrum semiovale, corona radiata, insula, and subinsular white matter with ex vacuo dilatation of the right lateral ventricle. There is also encephalomalacia in the right cerebellar hemisphere. There are additional scattered areas of T2 hyperintensity in the periventricular and subcortical white matter. There is diffuse cerebral volume loss with superimposed Wallerian degenerative of the right brainstem. There is minimal mucosal thickening involving the right anterior ethmoid air cells. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a punctate focus of T1 and T2 hyperintensity in the right parietal calvarium, which likely represents a hemangioma.

Output: 1.Punctate acute infarct in the left parietal lobe without hemorrhagic transformation.2.Multiple punctate foci of susceptibility likely represent chronic microhemorrhages related to hypertensive.3.Chronic infarcts involving the right frontal lobe, insula, and right cerebellar hemisphere.4.Chronic patchy periventricular and subcortical small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 21 months old, with leg weakness, thoracolumbar syrinx on the prior examination, assess for mass lesion, follow-up with infusion. The present examination consists of postcontrast images only as a complete precontrast spine MRI was obtained on 2/10/2016.A syrinx cavity is redemonstrated within the spinal cord beginning at T8-9 and continuing down to T12-L1. As before, the cavity measures up to 7 mm in diameter. No pathologic enhancement is seen within or adjacent to the syrinx, or at any other point along the spinal cord or cauda equina. No pathologic vertebral body or epidural enhancement is seen.

Output: 1.No evidence of any enhancing lesion is seen.2.The thoracolumbar spinal cord syrinx shows no significant interval change.


Instruction: Generate impression based on findings.

Input: Male 58 years old Reason: HCC screening History: cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology as evidenced by right hepatic lobe atrophy, caudate lobe enlargement and widening of the intrahepatic fissures. No suspicious mass is identified. Patent hepatic vasculature.SPLEEN: Splenomegaly measuring 15.3 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left upper pole renal scarring is unchanged. The non obstructing left upper pole calculus is not clearly identified on today's study.RETROPERITONEUM, LYMPH NODES: Stable mild enlargement of hepatoduodenal ligament lymph nodes, commonly seen in the setting of chronic liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Liver cirrhosis without suspicious intrahepatic mass.


Instruction: Generate impression based on findings.

Input: C5-C6 radiculopathy. At C5-6, there is a large eccentric left posterior disc-osteophyte complex that indents the spinal cord and substantially narrows the bilateral neural foramina. There is no discernible signal abnormality in the spinal cord. At C3-4 and C4-5, there is minimal posterior disc-osteophyte complex formation, without significant spinal canal or neural foraminal stenosis. At C2-3, C6-7 and C7-T1, there is also no significant spinal canal or neural foraminal stenosis. There is lack of the usual cervical lordosis, but there is no spondylolisthesis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: At C5-6, there is a large eccentric left posterior disc-osteophyte complex that indents the spinal cord and substantially narrows the bilateral neural foramina. There is no significant spinal canal or neural foraminal stenosis at the other cervical spine levels.


Instruction: Generate impression based on findings.

Input: 44-year-old female. Left breast cancer diagnosed in 2001 status post lumpectomy and RT. Follow-up. Dense breasts. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.A stable postsurgical scar is seen at the 12:00 position the left breast. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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