Instruction: Generate impression based on findings.

Input: 58 years Male (DOB:7/26/1957)Reason: Evaluate for steno-occlusive disease, etiology of RUE weakness History: RUE weaknessPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER MRI of the brainThere is a focus of diffusion restriction present involving the posterior aspect of the left putamen and extending into the left centrum semiovale measuring approximately 25 x 9 mm in axial dimensions. Another focus of diffusion restriction is present in the left centrum semiovale more anterior measuring approximately 9 x 9 mm axial dimensions. These are also high signal on T2 MRI imaging sequences.The appears to be a small focus of encephalomalacia in the right medial occipital lobe which although has some high signal on diffusion-weighted imaging and is high signal is also present on the ADC maps indicating that it may very well represent T2 shine through rather than diffusion restriction..Punctate T2 signal hyperintense foci are present in the brainstem.Please note that T2 imaging is markedly compromised due to patient motion artifact.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the left maxillary sinus and left anterior ethmoid air cells as well as part of the left frontal sinus. This would indicate nonocclusive pattern in the left hiatus semilunaris potentially.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left vertebral artery smaller than the right vertebral artery. There is extracranial origin of the left posterior inferior cerebellar artery. The posterior communicating arteries are small. The anterior communicating artery is small.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified.

Output: 1.No evidence for cerebrovascular occlusive disease.2.Findings are compatible with a small foci of infarction in the left centrum semiovale and basal ganglia3.Findings suggest old focus of encephalomalacia in the right occipital lobe possibly related to prior infarction.4.Findings are compatible with the paranasal sinuses obstructive pattern centered in the left hiatus semilunaris.5.Examination is compromised due to patient motion artifact. Additionally, the patient refused to complete the exam due to claustrophobia. This may compromise both interpretation and identification of additional lesions.


Instruction: Generate impression based on findings.

Input: New left middle cerebral artery infarct. In the recently demonstrated areas of loss of gray-white matter differentiation in the left parietal lobe, including the inferior precentral gyrus, there is diffusion restriction and high T2 signal. There are additional small areas of diffusion restriction in the posterior left temporal lobe and left insula. There is a background of extensive high T2 signal in the periventricular and subcortical white matter. There is encephalomalacia in the bilateral corona radiata and basal ganglia with unchanged areas of susceptibility effect. There is diffuse prominence of the ventricles and sulci due to cerebral volume loss. There is no evidence of acute intracranial hemorrhage or mass. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Acute to early subacute infarcts in the left middle cerebral artery territory involving the left parietal lobe, posterior temporal lobe, and insula, but no evidence of acute intracranial hemorrhage or midline shift.2. Extensive chronic small vessel ischemic disease and chronic infarcts in the bilateral corona radiata and basal ganglia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: 60-year-old female with history of MM, pathologic fracture. Signs and symptoms: Pain, with old L2 compression fracture, now new T12 and L1 acute fractures. Pre-and post-enhanced thoracic MRI:The examination demonstrates a well-demarcated focus of increased T2 and T2 stir signal intensity in the vertebral body of T12 measuring at 17-mm AP and 9-mm cc in size on sagittal T2 stir series. This finding demonstrate T1 hyperintense signal pattern and the cuneiform enhancement. Finding is suggestive of a metastatic multiple myeloma. The marrow signal intensity of T12 vertebrae is otherwise unremarkable and without abnormal enhancement or bone marrow edema to suggest acute fracture, there is however more than 50% compression deformity of T12 vertebrae on the left which is suggestive of a chronic compression fracture. The maximum height of T12 vertebra measures at 21-mm and 7-mm on the left at the level of maximum compression deformity. The alignment of the vertebral column remains within normal at this level and without compromise of canal. Mild left neural foraminal compromise at T12 -- L1 is detected.There is no evidence of any additional compression deformity of the thoracic vertebral column. The no evidence of spinal stenosis or compromise at any level. No significant neural foraminal compromise is detected.There is uniformly abnormal signal intensity of vertebral column and with multiple small foci of enhancement within the vertebral bodies and posterior elements suggestive of multiple myeloma.Compared to prior examination there is no significant change in the extent of above detailed findings. Slightly less conspicuous patchy marrow signal abnormality of vertebral column on the current exam could be result of treatment or technique related.The signal intensity and caliber of cord remains within normal and without abnormal enhancement.Pre-and post-enhanced lumbosacral spine:This examination demonstrate significant compression fracture of L1 vertebrae with mild bulge of compressed vertebra into the spinal canal however without central spinal stenosis or significant neural foraminal compromise. This appearance remains identical to prior exam from 10 -- 27 -- 2014. The alignment of vertebral column remains anatomical otherwise and without evidence of central spinal stenosis or compression fracture.Diffuse patchy marrow signal changes of the vertebral column consistent the patient's history of multiple myeloma is less conspicuous on current exam compared to prior.The signal intensity of the conus and cauda equina is within normal and without abnormal enhancement.

Output: 1.Pre-and post-enhanced MRI of thoracic spine demonstrate a well-demarcated enhancing mass in the vertebral body of T12 consistent with a multiple myeloma. There is more than 50% compression deformity of the left side of T12 vertebrae without associated marrow signal changes or enhancement and suggestive of a chronic fracture. No interval change since prior exam. Multiple additional small foci of marrow signal change and enhancement involving vertebral bodies and the posterior elements of thoracic spine consistent with metastatic disease without appreciable change since prior study. There is no evidence of spinal canal or significant neural foraminal compromise at any level. Normal signal intensity and caliber of the cord without abnormal enhancement. 2.Pre-and post enhanced lumbar MRI demonstrate no areas of any acute or definitive new findings since prior study from 2014. Stable significant chronic compression fracture of L1 with mild expansion into the spinal canal and without spinal stenosis. Diffuse marrow signal changes of vertebral column consistent with patient's known multiple myeloma is a slightly less conspicuous on current exam. No evidence of spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: 86-year-old female with right hip pain and tenderness. ACETABULAR LABRUM: There is heterogeneity and increased signal abnormality within the anterior superior labrum indicating degeneration. There is linear increased signal abnormality within the anterior superior labrum consistent with degenerative tearing.ARTICULAR CARTILAGE AND BONE: Moderate osteoarthritis affects the right hip. No acute fracture is evident.SOFT TISSUES: There is diffuse marked fatty atrophy of the imaged musculature of the right hip. There is nonspecific subcutaneous edema along the lateral aspect of the greater trochanter.ADDITIONAL

Output: 1. Diffuse marked fatty atrophy of the imaged musculature of the right hip.2. Moderate osteoarthritis of the right hip with degeneration/degenerative tearing of the acetabular labrum.3. Degenerative disc disease of the lower lumbar spine.


Instruction: Generate impression based on findings.

Input: 11 year old female with dilated common bile duct on serial ultrasound, no elevation of LFTs ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology. There is mild fusiform dilatation of the mid common bile duct measuring up to 8 mm in diameter over a length of approximately 2 cm. No intrahepatic or ductal dilatation. The gallbladder appears moderately distended and otherwise otherwise normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal enhancement without hydronephrosis.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: Mild fusiform dilatation of the mid common bile duct, which may represent a normal variant or type I choledochal cyst.


Instruction: Generate impression based on findings.

Input: Patient status post fall after syncopal episode. Was down on the floor for 4 hours. Presents with right hip pain. The study is mildly limited in evaluation of the upper pelvis due to extensive peristalsis of the bowel.ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is uniform diffuse fatty marrow signal without evidence of fracture or underlying moderate osteoarthritis of the right hip.SOFT TISSUES: There is no extrapelvic lymphadenopathy. We see no gross intrapelvic mass on this limited exam. ADDITIONAL

Output: No acute fracture of the right hip.


Instruction: Generate impression based on findings.

Input: Reason: Rule out tear, eval for osteoarthritis History: chronic L shoulder pain ROTATOR CUFF: Heterogeneous signal within the supraspinatus and infraspinatus tendons indicates mild tendinopathy. The subscapularis and teres minor tendons are intact and demonstrate normal signal intensity.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum appears grossly intact. Moderate osteoarthritis affects the acromioclavicular joint.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild tendinopathy of the supraspinatus and infraspinatus tendons.


Instruction: Generate impression based on findings.

Input: 25-year-old male. Weakness with flexion and knee pain with running. Evaluate for ACL or meniscal tear. MENISCI: The medial and lateral menisci are intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: The patellofemoral and tibiofemoral compartment cartilage are intact. Bone marrow signal intensity is normal without evidence of contusion or fracture. The patella appears slightly large, but this is not necessarily of clinical significance.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: No meniscal tear, ligament tear, or other specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 15-year-old male with knee pain and swelling and joint pain for 3 months after fall, injury in basketball. Evaluate for medial meniscal tear. MENISCI: There is a complex tear of the anterior horn of the lateral meniscus with a horizontal and vertical component. There is an adjacent parameniscal cyst anteriorly measuring 6 mm (series 401, image 26). Horizontally oriented intermediate signal intensity within the posterior horn of the lateral meniscus which does not extend to the articular surfaces. Similar horizontally oriented intermediate signal intensity pattern is present within the posterior horn of the medial meniscus although to a lesser extent. The anterior horn of the medial meniscus is normal.ARTICULAR CARTILAGE AND BONE: Irregularity of the articular cartilage of the lateral femoral condyle and lateral tibial plateau with intermediate signal intensity clefts visualized, however no full-thickness defects are evident. The articular cartilage elsewhere about the knee is normal. There is bone marrow edema within the lateral tibial plateau and lateral femoral condyle. Bone marrow signal intensity elsewhere is normal.LIGAMENTS: There is high T2 signal intensity along the course of the ligament fibers of the anterior cruciate ligament distally near its insertion on the tibial plateau. The posterior cruciate ligament is normal. There is mild thickening of the lateral collateral ligament. The medial collateral ligament is normal.EXTENSOR MECHANISM: The extensor mechanism is intact and normal.ADDITIONAL

Output: 1. Complex tear of the anterior horn of the lateral meniscus with adjacent parameniscal cyst. Likely degeneration of the posterior horn of the lateral and medial menisci, more prominent within the lateral meniscus. 2. Nonspecific signal changes within the distal anterior cruciate ligament which may represent partial tear.3. Articular cartilage defect/degeneration within the lateral femoral condyle and lateral tibial plateau with associated subchondral bone marrow edema.4. Moderate knee joint effusion.


Instruction: Generate impression based on findings.

Input: 17-year-old male with left knee pain, evaluate for possible patellar dislocation MENISCI: We see no meniscal tears. Globular increased signal within the posterior horn of the medial meniscus likely represents artifact or perhaps a meniscal contusion.ARTICULAR CARTILAGE AND BONE: Marrow edema is seen within the anterolateral aspect of the lateral femoral condyle. This may reflect prior dislocation, although we see no corresponding kissing contusion in the medial aspect of the patella. There is also edema within the anterior aspect of the lateral tibial plateau with an associated subchondral focus of curvilinear T1 signal intensity which may represent a nondisplaced subchondral fracture. The femoral trochlea is abnormally shallow, indicating dysplasia. The tibial tubercle to trochlear groove distance is 19 mm which is borderline abnormal. The Insalata-Salvati ratio is 1.35 suggesting mild patella alta.LIGAMENTS: The medial and lateral collateral ligament complexes are intact. The ACL and PCL are intact. There is mild edema along the abductor tubercle, and the medial patellofemoral ligament is not well visualized at its femoral attachment, perhaps representing a tear.EXTENSOR MECHANISM: The extensor mechanism is intact. ADDITIONAL

Output: 1.Edema within the anterolateral femoral condyle suggests prior lateral dislocation of the patella. Although we see no edema within the medial patella, there is edema along the abductor tubercle and incomplete visualization of the medial patellofemoral ligament at its femoral attachment as well as morphologic abnormalities which may predispose to patellofemoral instability as described above.2.Additional edema as well as a probable nondisplaced subchondral fracture along the anterior tibial plateau suggesting a hyperextension/valgus component to the mechanism of injury.


Instruction: Generate impression based on findings.

Input: 59 years, Female, grade 2 oligodendroglioma. Status post RT and now receiving PCV. Again seen is expansile T2 hyperintensity involving the left temporal lobe including the left middle and inferior temporal gyri as well as the fusiform gyrus consistent with known tumor. There is focal area of enhancement within this region which remains unchanged since 11/25/2015. Extent of FLAIR hyperintensity is also not significantly changed since 11/25/2015 but clearly decreased when compared to remote study from 5/9/2015, presumably related to decrease in the vasogenic edema component of the signal abnormality. There is mild serpiginous T1 hyperintensity and extensive susceptibility effect related to calcifications associated with the tumor. There is unchanged minimal local mass effect. No midline shift or herniation. No hydrocephalus. No evidence of acute ischemia or hemorrhage. Evidence of prior biopsy is noted via left temporal burr hole.There is unchanged subcentimeter focus of T2 hyperintensity involving the right cerebellum which is nonspecific and possibly related to prior infarct, although can be further assessed with future follow-up studies.There is partial opacification of the left mastoid air cells, similar to prior. There is trace mucosal thickening involving the paranasal sinuses. Remainder of the calvarium and extra cranial soft tissues are unremarkable.

Output: 1. No evidence of progression of left temporal oligodendroglioma compared to 11/25/2015. Compared to earliest available comparison study from 5/9/2015, there is decrease in extent of FLAIR signal abnormality in the left temporal lobe, presumably related to decrease in vasogenic edema.2. Subcentimeter focus of T2 hyperintensity involving the right cerebellum remains unchanged since 5/9/2015. This lesion is nonspecific and may represent prior infarct, although can be further assessed on future follow-up studies.


Instruction: Generate impression based on findings.

Input: 62-year-old female with a history of metastatic lung adenocarcinoma status post chemoradiation (8/11/2016- completed whole brain radiation, 8/25/2016- started on Erlotinib 100 mg). There is a rim-enhancing mass in the anterior right superior frontal gyrus with surrounding vasogenic edema. The lesion measures up to 20 mm, previously also 20 mm. There is also enhancement superficially along the right postcentral gyrus, which measures up to 12 mm in length, which appears similar is size. There are additional subcentimeter enhancing lesions in the left cerebellar hemisphere, which appear slightly smaller. There is no evidence of intracranial hemorrhage or acute infarct. There is mild scattered cerebral white matter and brainstem T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild mucosal thickening in the paranasal sinuses. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. No significant change in size of multiple intracranial metastases.2. Mild scattered cerebral white matter and brainstem T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemia.


Instruction: Generate impression based on findings.

Input: Right face weakness and slurred speech. Brain MRI: There is a 25 mm wide area of predominantly gyriform high T2 signal and restricted diffusion involving the left posterior cingulate gyrus and adjacent parietal lobe superimposed upon a background of otherwise unchanged diffuse cerebral and pontine white matter T2 hyperintensity without restricted diffusion. There is also a punctate focus of restricted diffusion and high T2 signal in the left thalamus. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The right vertebral artery flow void is deficient. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal mucosal thickening in the right maxillary sinus.Brain MRA: There is paucity of flow-related enhancement of the C3 and C4 segments of the right vertebral artery. There is reconstitution of flow-related enhancement at the proximal basilar artery via the left vertebral artery. The proximal portions of the anterior cerebral circulation appear to be intact. There is no evidence of saccular aneurysms.Neck MRA: There is lack of opacification of the majority of the right vertebral artery beyond a short V1 segment. There is enhancement of the distal portion of the V2, as well as the V3 and V4 segments of the right vertebral artery. There is no evidence of significant steno-occlusive lesions in the other major cervical arteries. There is a three vessel arch.

Output: 1. Small area of acute infarction involving the left posterior cingulate gyrus and adjacent parietal lobe and punctate acute infarct in the left thalamus superimposed upon a background of chronic white matter small vessel ischemic disease, but no evidence of hemorrhagic transformation.2. Significant steno-occlusive disease involving the proximal right vertebral artery with distant hemodynamic impact.Discussed with Dr. Burns at 11:10 AM on 1/24/15.


Instruction: Generate impression based on findings.

Input: 70-year-old female with history of SRS for arteriovenous malformation in January 2015: one year follow-up. There is an enhancing arteriovenous malformation in the left superior frontal gyrus, which has decreased in size measuring 11 mm x 9 mm x 14 mm, previously 13 mm x 13 mm x 11 mm. There is no associated residual surrounding edema. There is a mildly prominent draining vein extending to the superior sagittal sinus. The left anterior cerebral artery is larger in caliber in comparison with the right, which is unchanged. There is no evidence of flow limiting stenosis. There is a 1 mm wide outpouching along the origin of an anterior temporal branch of the left posterior cerebral artery. There is an unchanged 2 mm thick area of extra-axial enhancement along the left parietal convexity, which may represent a prominent venous complex or meningioma. There are scattered foci of T2 hyperintensity within the subcortical and periventricular cerebral white matter without restricted diffusion. There is no evidence of acute intracranial hemorrhage. The ventricles and sulci are unchanged in appearance and there is no midline shift. There is a small right ethmoid sinus retention cyst. The orbits appear unremarkable.

Output: 1. Interval decrease in size of the left superior frontal gyrus arteriovenous malformation, along with interval resolution of the associated surrounding vasogenic edema. 2. A 1 mm wide outpouching along the origin of an anterior temporal branch of the left posterior cerebral artery may represent an aneurysm or prominent infundibulum.3. Chronic small vessel ischemic disease, without evidence of acute infarction.


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. Localizing CT examination demonstrated the lucent lesion within the proximal femoral diaphysis with a central nidus corresponding to the findings seen on recent MRI examination. Using CT guidance, a 13 gauge OnControl core biopsy needle was advanced into the lesion. One 13-gauge core biopsy specimen was obtained and placed in formalin. Subsequently, a RFA trocar and probe were advanced into the lesion using CT guidance. Radiofrequency ablation was performed at 90 degrees centigrade for approximately 4 minutes. The RFA probe and trocar were removed.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 and patient's mother.ESTIMATED BLOOD LOSS: Less than 5cc. Dermabond and a Tegaderm were placed on the patient's skin.

Output: CT-guided core needle biopsy and radiofrequency ablation of a left femur lesion/osteoid osteoma.


Instruction: Generate impression based on findings.

Input: There is no suspicious intracranial enhancement, acute infarct, mass, or cerebral edema. There are nonspecific periventricular and subcortical T2 hyperintense foci which are likely related to ischemic degenerative disease. There is mild diffuse volume loss which is felt to be advanced for patient age. There is minimal prominence of the left lateral ventricle as compared to the right. There is no midline shift or herniation. There is a mucus retention cyst in the right maxillary sinus. There is diffuse low T1 signal of the calvarial marrow without focal lesion.

Output: 1.Mild diffuse volume loss with no acute infarct.2.Diffuse low T1 signal of the calvarial marrow without focal lesion, nonspecific and could be related to anemia of any etiology or other marrow replacing process. Please correlate clinically and bone scan can be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: 51 years Female (DOB:8/8/1965)Reason: lower back pain with LLE radiculopathy History: abovePROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is mild disc desiccation at L3-4, L4-5 and L5-S1.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There is only minor degenerative disc disease present.


Instruction: Generate impression based on findings.

Input: 64 year old male with COPD, presented with shortness of breath, HFrEF, triple vessel disease and LV thrombus. Referred for MRI evaluation prior to possible CABG. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 14%. The LVEDV is 243 ml (normal range 142+/-34), the LV end diastolic volume index is 141 ml/m2 (normal range: 74+/-15), the LVESV is 209 ml (normal range 47+/-19) and the LV end systolic volume index is 121 ml/m2 (normal range 25+/-9). The LV mass is 111 g (normal range 164+/-36) and the LV mass index is 64 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is transmural late gadolinium enhancement involving the entire apex, mid-apical inferior and inferoseptal walls. This area is non-viable. There is subendocardial late gadolinium enhancement involving >50% of the anteroseptal and anterior walls. These territories are of intermediate viability. The remaining myocardium is viable. The pattern on late gadolinium enhancement is consistent with prior myocardial infarction.There is no myocardial iron overload. There is a small thrombus noted in the LV apex. Left AtriumThe left atrium is moderately dilated. There is no obvious LAA thrombus noted.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 30%. The RVEDV is 177 ml (normal range 142+/-31), RV end diastolic volume index is 103 ml/m2 (normal range 82+/-16), the RVESV is 125 ml (normal range 54+/-17), and the RV end systolic volume index is 72 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a mild-moderate sized right and a trivial left pleural effusion. 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 moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 14%. 2.The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 30%.3.There is transmural late gadolinium enhancement involving the entire apex, mid-apical inferior and inferoseptal walls. This area is non-viable. There is subendocardial late gadolinium enhancement involving >50% of the anteroseptal and anterior walls. These territories are of intermediate viability. The remaining myocardium is viable. The pattern on late gadolinium enhancement is consistent with prior myocardial infarction.4.There is a small apical LV thrombus noted.5.There is at least moderate mitral regurgitation.6.There is at least mild tricuspid regurgitation.7.See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Low back pain. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.The signal intensity of the vertebral column demonstrate changes secondary to degenerative disease.Examination from T10-T11 through L2-L3 levels demonstrate no spinal stenosis or neural foraminal compromise and no significant degenerative disease.L3-L4 demonstrate advanced disc disease with significant loss of disc height, shallow broad-based bulging disc, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis. Moderate to significant right neural foraminal compromise compromise secondary to hypertrophic changes of posterior elements as well as a small right lateral and far lateral disc protrusion. Patent left neural foramina.L4-L5 demonstrate advanced disc disease with significant loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis. Bilateral moderate to severe neural foraminal compromise (left greater than right).L5-S1 demonstrate moderate disc disease and loss of disc height moderate bilateral ligamentum flavum hypertrophy as well as moderate left facet hypertrophy changes. Constellation of changes results in significant bilateral ( left greater than right) neural foraminal compromise. Unremarkable perispinal soft tissues. Unremarkable partially visualized SI joints.

Output: 1.Extensive degenerative changes primarily at L3-L4 through L5-S1 levels as detailed.2.No evidence of spinal stenosis.3.There are multilevel neural foraminal compromise (some significantly) in lower lumbar levels as detailed per level.


Instruction: Generate impression based on findings.

Input: Hepatitis C and cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Left hepatic and caudate lobe hypertrophy with fissural widening and nodular contour compatible with cirrhosis.No intra or extrahepatic biliary ductal dilatation. No focal liver lesion.Cholelithiasis within a normally distended gallbladder.Patent hepatic vasculature.SPLEEN: The spleen measures 13 cm in craniocaudal dimension without a focal lesion. Small splenule adjacent to the hilum and anterior aspect of the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia. Endplate degenerative changes of the lumbar spine.OTHER: No significant abnormality noted.

Output: Cirrhosis without a suspicious lesion. Cholelithiasis without cholecystitis.


Instruction: Generate impression based on findings.

Input: Female 58 years old Reason: Gall stones, CBD stones, Sphincter of Oddi dysfunction. PERFORM with SECRETIN STIMULATION History: pain with eating ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter cyst in the right hepatic dome. An enhancing focus with no washout in the right hepatic dome may represent a venovenous shunt. No suspicious liver lesion. There is diffuse loss of signal within the liver parenchyma out of phase imaging indicating hepatic steatosis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances homogeneously. The pancreatic duct is diffusely dilated up to 5 mm to the level of the ampulla. There is no significant change in post secretin images.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts and a minimally complex right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Diffuse pancreatic ductal dilatation to the level of the ampulla with no change on post secretin images. No pancreatic mass is seen. Dilatation may be due to a stricture at the level of the ampulla or sphincter of Oddi dysfunction although this is less likely given the normal caliber common duct. A main duct IPMN is not excluded.2.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: 68-year-old female with SLE, HTN, CAD with episodes of hallucination with facial weakness and limited upgaze. A moderate or vasculitis or vascular pathology. CT of brain without infusion.No evidence of hemorrhage, cortical stroke, mass effect, edema or midline shift is detected. Previously reported small muscle disease on MRI examination is not visible on this study.The bony density of calvarium, pneumatization of paranasal sinuses and mastoid air cells are also unremarkable.CTA of intracranial circulation.CTA of the carotid system demonstrates patent bilateral intracranial portions of the carotid arteries with no abnormality in particular no evidence of vasculitis. There is also good visualization of bilateral anterior and middle cerebral arteries and all of their branches. Within the limitation of CTA no evidence of vasculitis of the left middle or anterior cerebral arteries or their branches is detected.CTA of vertebral basilar system demonstrates patent bilateral intracranial components of the vertebral arteries with no pathology. There is good visualization of bilateral PICAs. The basilar artery is also well visualized and demonstrates no pathology. There is normal visualization of bilateral posterior cerebral arteries and superior cerebellar arteries with no evidence of pathology in particular no evidence of vasculitis.Within the limitation of CTA no evidence of vasculitis of the branches of the posterior cerebral arteries or superior cerebellar arteries is detected.

Output: Unremarkable CTA of intracranial circulation.Within the limitation of CTA for detection of small vessel vasculitis this is study is unremarkable.


Instruction: Generate impression based on findings.

Input: Male 13 years old Reason: Marfan syndrome Left VentricleThe left ventricle is normal in size. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation. Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch. Sinus of Valsalva is 34 mm in diameter (significant dilation). The mitral valve annulus is 21 mm. The descending aorta is 15.5 mm. The aortic arch is 16 mm. The descending aorta is 12.7 mm and the descending aorta at the level of the diaphragm is 15.7 mm in diameter.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.

Output: 1. Marfan's syndrome with significant dilation of the sinus of Valsalva (34 millimeters)2. No evidence of aortic aneurysms.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: History of focal nodular hyperplasia of the liver, 6 month follow-up to evaluate for change in size. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity. There is once again a mass in the right hepatic lobe near the dome (series 901, image 31) measuring 2.7 x 2.8 cm, unchanged. The lesion demonstrates mild T2 hyperintensity with a small central T2 hyperintense component, mild T1 hypointensity with a central T1 hypointense component, homogeneous arterial enhancement, and retention of contrast on the hepatobiliary phase compatible with focal nodular hyperplasia with central scar. There are numerous additional small T2 hyperintense foci throughout the liver without significant enhancement most compatible with benign biliary hamartomas. No biliary ductal dilatation. The gallbladder appears unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Previously seen prominent nonspecific left anterior juxtaphrenic lymph node is not clearly visualized.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right hepatic lobe mass consistent with focal nodular hyperplasia unchanged in size.2.Please note that the pelvis is not included on this examination, and the previously described and subsequently resected pelvic tumor is not assessed.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left knee was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using a 25-gauge needle.Under fluoroscopic guidance, a 22-gauge needle was advanced into the joint. Attempted aspiration yielded 10 cc's of translucent viscous blood tinged fluid. Next, 20 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 32 seconds.

Output: Successful fluoroscopic guided injection of dilute gadolinium into the left knee for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: Thigh pain. Look for narrow for impingement. There is a mild, broad-based leftward convex lumbar curvature. Alignment is also notable for minimal anterior subluxation of L4 relative to L5 associated with facet proliferative disease. The intervening disc shows moderate loss of height and decreased T2 signal. In addition to uncovering, there is right paracentral disc protrusion. The marrow adjacent to the endplates show degenerative signal. The canal is moderately narrowed. Marrow signal is notable for fat-containing foci in the T11, T12, L3 and S1 bodies. It homogeneously suppresses on the STIR imaging.T12-L1 and L1-L2: There is no central or foraminal stenosis.L2-L3: Facet proliferative change is present but no central or foraminal stenosis.L3-L4: Disc bulge is associated with left paracentral sequestration and left foraminal protrusion. The sequestered fragment cranially migrates resulting in severe left subarticular recess stenosis while the protrusion causes severe left foraminal stenosis. Facet proliferative change and ligamenta flava buckling result in mild to moderate central canal narrowing as well.L4-L5: The subluxation is associated with disc uncovering and a cranially migrating central/right paracentral extrusion that results in severe right subarticular recess and right foraminal stenoses. There is mild left foraminal narrowing. Facet proliferative changes are slightly more pronounced on the left with excess joint fluid. Ligamenta flava thickening is also moderate to severe. Central narrowing is moderate.L5-S1: Severe bilateral facet productive changes result in severe bilateral foraminal stenosis. Ligamenta flava thickening mild. There is no central narrowing.

Output: 1.Multilevel degenerative disc disease and posterior element hypertrophy in the lower lumbar spine is most significant at L3-L4 (left sequestered paracentral disc fragment and left foraminal protrusion) and L4-L5 (central/right paracentral disc extrusion) and L5-S1 (foraminal stenoses) as described above.2.There is also multilevel spinal canal narrowing moderate at the L4-L5 and mild to moderate at L3-L4.


Instruction: Generate impression based on findings.

Input: Brisker reflexes on right side Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild straightening of the cervical spine and minimal anterolisthesis of C2 on C3. Alignment of the cervical spine is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina. Small left perineural cyst incidentally noted.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Visualized brain parenchyma demonstrates diffuse cerebellar atrophy. There is a heterogeneous cystic and solid mass at the level of the bilateral thyroid lobes, which is obscured by the saturation band. The enlarged thyroid gland measures up to 7 cm in the craniocaudal dimension.

Output: 1. No abnormal cord signal or evidence of significant spinal canal stenosis at any level in the cervical spine. 2. Partially imaged brain demonstrates diffuse cerebellar atrophy, as seen on recent head CT.3. Enlarged thyroid gland with multiple large cystic and solid nodules, findings better assessed on recent ultrasound from 7/13/2015.


Instruction: Generate impression based on findings.

Input: History of invasive ductal carcinoma grade 3 in the left breast and a metastatic left axillary lymph node. Outside study performed at Advocate Christ Center for breast care dated 9/16/2015. There are two standard views of both breasts which were performed digitally with tomosynthesis. Only the C view portion of tomosynthesis can be reviewed. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. There is an enlarged left axillary lymph node with a biopsy clip within it. Given the extremely dense nature of the breast tissue, there is no evidence of the malignant mass as revealed on subsequent MRI. Scattered bilateral calcifications are noted. Suggestion of underlying right breast cysts on the MLO view, as seen on MRI.

Output: Known left breast cancer. Limited mammogram due to breast density. Please refer to subsequent breast MRI dated 9/18/2015 for additional details and recommendations.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 58 year old male patient with prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.4 x 3.4 x 3.7 cm.Peripheral Zone: There is diffuse T2 hypointensity within the peripheral zone which may be related to prostatitis or scarring which makes evaluation of underlying lesions difficult. Within this diffuse abnormality, there are more focal areas of signal abnormality suspicious for tumor as follows:Region of T2 hypointensity with ADC hypointensity within the right mid-gland of the peripheral zone measuring 10 x 5 mm (image 13, series 301). Region of ADC hypointensity with vague T2 hypointensity within the right apex measuring 7 x 7 mm (image 184, series 605).Region of T2 hypointensity with ADC hypointensity within the left mid-gland measuring 10 x 5 mm (image 14, series 301). Central Gland: BPH nodules.Seminal Vesicles: No definite involvement.Extracapsular Extension: No definite extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple lesions within the right and left peripheral zone which are suspicious of tumor on a background of signal abnormality possibly related to prostatitis/scarring. 2.No extraprostatic extension.


Instruction: Generate impression based on findings.

Input: 62 year old female patient with recent abnormal CT showing biliary ductal dilatation to the ampulla. Evaluate for any discrete mass or abnormalities. ABDOMEN:LIVER, BILIARY TRACT: There is cholelithiasis without evidence of acute cholecystitis. There is mild intra and extrahepatic biliary ductal dilatation. The common bile duct measures up to 9 mm in diameter, which is decreased from the prior exam. There is no obstructing lesion.There is a right hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic ductal diameter is within normal limits.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a left renal cyst and left renal cortical scarring.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a subcentimeter enhancing focus in the right breast.OTHER: Post-surgical changes of an aorto-bifemoral bypass with a surrounding collection, which is better visualized on prior CT.

Output: 1.Interval decreased intra- and extrahepatic biliary ductal dilatation without evidence of obstruction or mass lesion. 2.Cholelithiasis without evidence of acute cholecystitis. 3.Enhancing focus in the right breast; correlate with mammography.


Instruction: Generate impression based on findings.

Input: 77-year-old female with hepatitis C cirrhosis. HCC, status post TACE RFA x2, follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Cholelithiasis without evidence for acute cholecystitis. No intra or extrahepatic biliary ductal dilatation. Patent vasculature. The segment 2/3 ablation cavity (series 11 image 125) has slightly decreased in size measuring 2.8 x 2.1 cm (prior 3 x 2.6 cm). No residual or recurrent enhancing lesion is identified. No new suspicious lesions with washout are seen.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Stable small nonenhancing right lower pole renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastroesophageal varices again noted. Artifact related to air within a known duodenal diverticulum is unchanged (series 11 image 67). No ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slightly decreased size of segment 2/3 ablation cavity without evidence for residual or recurrent disease.2.Cirrhotic morphology with stable gastroesophageal varices. No ascites.3.Status post splenectomy and distal pancreatectomy.


Instruction: Generate impression based on findings.

Input: 14-year-old female with a history of bilateral hip pain and limited range of motion, right greater than left. Evaluate for sacroiliitis, joint space narrowing, or erosions. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The sacroiliac joints are normal in appearance. Sclerotic changes of both femoral heads. There is high T2 signal in the femoral trochanters which may represent trochanteritis. Punctate low T1, intermediate T2 focus along the lateral aspect of the right femoral head may represent a subchondral cyst or erosion (best seen on coronal projection, series 301, image 16). There is a moderate-sized right hip joint effusion with debris present. On post-contrast images, the joint effusion demonstrates enhancement. Small focus in the right posterior acetabulum (series 901, image 22) is low signal on T1, intermediate to high on T2, and demonstrates enhancement. OTHER: No significant abnormality noted.

Output: 1. Right hip deformity with a moderate-sized joint effusion. Enhancement of the synovium is suggestive of synovitis. Enhancing focus in the right posterior acetabulum may represent an erosion. 2. No evidence of sacroiliitis as clinically questioned.


Instruction: Generate impression based on findings.

Input: Cystic subdiaphragmatic retroperitoneal mass ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter hepatic cysts. The hepatic and portal veins are patent. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonenhancing cystic subdiaphragmatic mass in the left upper quadrant measures 3.6 x 2.4 cm (series 3, image 11). No focal wall thickening or nodular components with thin wall. The mass is separate from the adrenal gland and does not abut the neural foramina. BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cystic subdiaphragmatic mass in the left upper quadrant is most consistent with a enteric duplication cyst. Neurogenic tumor and lymphangioma are considered much less likely given the location and signal characteristics.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with right hand pain. Evaluate for neurofibromas. The cervical lordosis is slightly reversed which may be positional. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or abnormal marrow enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic cord enhancement is detected. However, thickening and enhancement of the extraforaminal nerve roots is seen at multiple levels, most conspicuously from C5-6 through T1-T2 bilaterally. Innumerable cutaneous and subcutaneous nodules are also seen. Small enhancing nodules are evident within the paraspinal fat just above the lung apices.C2-3: Minimal posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C3-4: Posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C4-5: Posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C5-6: Posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild right foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation with a small right paracentral protrusion. No spinal canal stenosis. Mild left foraminal narrowing. C7-T1: Left uncovertebral hypertrophy. No spinal canal stenosis. Mild left foraminal narrowing.

Output: 1.Extraforaminal nerve root thickening and enhancement is seen bilaterally at lower cervical and upper thoracic levels suggestive of multiple neurofibromas.2.Numerous additional cutaneous, subcutaneous and deep space nodules are seen compatible with neurofibromas.3.No high-grade spinal canal or neuroforaminal compromise.


Instruction: Generate impression based on findings.

Input: Status post prior removal of an intrathecal pain pump and catheter system and T11 level abscess. Postoperative changes are again seen from previous bilateral T11 laminectomy with partial resection of the T10 spinous process. There is an interval decreased thickness of the residual extradural collection within the laminectomy bed, now measuring 32 mm CC, compared to previous 41 mm CC. On axial images, the most confluent area of fluid signal now measures 16 x 5 mm on 8/47, compared to previous 14 x 12 mm at the mid T11 level. Additional fluid is identified again extending posteriorly with surrounding likely granulation tissue related enhancement along the prior surgical tract, into the deep subcutaneous fat, although overall decreased in extent. There is slight decreased ventral convexity of the collection, although there remains effacement of the CSF within the thecal sac at this level without significant mass effect upon the cord.There is decreased degree of enhancement of the dura along the surgical bed, with significant increased confluence of enhancement within the posterior subcutaneous and paraspinal soft tissues. There is persistent focal cord enhancement measuring up to 6 x 4 mm in greatest axial dimensions. Associated T2 hyperintense cord signal abnormality has significantly improved with perhaps subtle abnormality extending from upper T10 to mid T12 levels, with more conspicuous residual T2 hyperintensity seen at this level on the sagittal images which may relate to myelomalacia versus residual cord edema. Cord caliber has mildly diminished at the affected levels.A prominent T1/T2 hyperintense hemangioma is present in the left T2 vertebral body. Incidental note is made of a stable oval nonenhancing T2 hyperintense structure associated with the right T7 rib posteriorly which could relate to a cystic schwannoma or other cystic lesion measuring 6 x 17 mm.

Output: 1. Interval expected evolution of previously seen postoperative changes. Minimal residual extradural fluid collection seen along the laminectomy bed at the T11 level with resolved mass effect upon the cord at this level although there remains CSF effacement.2. Persistent intramedullary cord enhancement at the T11 level, with significant further reduction in associated cord signal abnormality likely relating to resolving cord edema with possible development of myelomalacia.


Instruction: Generate impression based on findings.

Input: Images are motion degraded. Fast imaging techniques were attempted. Given this caveat:Previously demonstrated restricted diffusion involving the left cerebral peduncle and midbrain has slightly diminished, with a small subtle focus of enhancement now notable involving the left cerebral peduncle, findings consistent with evolution. There is a small collection of new restricted diffusion involving the posterior left frontal lobe (best demonstrated series 501 images 259-260). All these foci are associated with T2 hyperintensity, however without susceptibility abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Previously demonstrated restricted diffusion involving the left cerebral peduncle and midbrain has slightly diminished, with a small subtle focus of enhancement now notable involving the left cerebral peduncle, findings consistent with evolution. There is a small collection of new restricted diffusion involving the posterior left frontal lobe (best demonstrated series 501 images 259-260). All these foci are associated with T2 hyperintensity, however without susceptibility abnormality.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, abnormal intracranial enhancement, mass, or cerebral edema. There are no gray matter heterotopias, discrete cortical dysplasias or evidence for mesial temporal sclerosis. The ventricles and basal cisterns are within normal limits. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: 4 4 year-old male with history of intraventricular hemorrhage with hydrocephalus, status post shunt placement, ex-28 week premature gestation, experiencing new seizure As before, several sequences are degraded secondary to artifact induced by the patient's ventricular shunt reservoir. Given this caveat:Redemonstrated is a right parietal approach ventriculostomy catheter which crosses the midline with its tip terminating at the lateral aspect of the left lateral ventricle, unchanged in position. There has been no interval change in size of the dysmorphic lateral ventricles when compared to the most recent CT. The third and the fourth ventricles remain unchanged in size. Left hemispheric dysmorphism is unchanged.A previously demonstrated prominent left extra-axial fluid space redemonstrates mid intensity on T1, hyperintensity on T2, with diffuse enhancement. This extends to also involve the tentorium and falx, as well as to a lesser extent the right hemispheric dura. Overlying this is a second area of crescentic abnormality measuring up to 6 mm in maximal depth over the parietal-occipital region which is nonenhancing, lower intensity on T1and T2 when compared to the overlying process, yet appearing hyperintense on T1 and T2 compared to CSF. These sizes, morphologies, and characteristics are stable.Hemosiderin staining along the epididymal surface of the lateral ventricles is unchanged. Redemonstrated is residua from germinal matrix hemorrhage. There is no midline shift or basal cistern effacement. Myelination within the uninvolved brain appears mature. Redemonstrated is thinning of the corpus callosum and volume loss in the white matter.Major intracranial flow voids appear present. Previously demonstrated complete opacification of the paranasal sinuses has nearly resolved. Mastoid air cells and middle ear cavities are clear. Orbital contents are unremarkable.

Output: 1.Redemonstrated is a right parietal approach ventriculostomy catheter which crosses the midline with its tip terminating at the lateral aspect of the left lateral ventricle, unchanged in position. 2.There has been no interval change in size of the dysmorphic lateral ventricles when compared to the most recent CT.3.Stable multiple intracranial abnormalities as described in detail above.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis patient started on tecfidera: fatigue. There are multiple supratentorial and infratentorial T2 hyperintense white matter lesions, many of which have decreased in size. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval decrease in size of many of the intracranial demyelinating lesions.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with back ache. Straightening of the lumbar lordosis is seen. Sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable.The visualized spinal cord, conus and cauda equina are within normal limits.As visualized on the sagittal images only, thickening of the right ligamentum flavum at T10-11 is seen which may cause some mild canal narrowing.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L4-5: Advanced facet degeneration bilaterally with effusions, right side greater than left. There is also a posteriorly directed extracanalicular synovial cyst on the right. Mild bulging disc. Narrowing of the lateral recesses. Moderate to severe bilateral foraminal narrowing. L5-S1: Advanced facet degeneration bilaterally. Mild bulging disc slightly asymmetric to the right. No significant spinal canal stenosis. Severe right and moderate to severe left foraminal narrowing.

Output: Relatively mild degenerative disc disease is seen without high-grade spinal canal stenosis.More notable is the presence of advanced facet degeneration at L4-5 and L5-S1. These changes contribute to significant neuroforaminal narrowing at these levels.


Instruction: Generate impression based on findings.

Input: Neck and right upper extremity pain. Evaluate for stenosis. Redemonstrated are postsurgical findings related to an anterior cervical discectomy and fusion from the C5-6 through C6-7 levels. The craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord demonstrates right coronary atrophy with associated T2 hyperintensity posterior to the C6 vertebral body which is unchanged compared to previous MRI indicating myelomalacia.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: A disc osteophyte complex is noted with uncovertebral hypertrophy and ligamentum flavum thickening. There is resultant mild to moderate right and mild left neuroforaminal stenosis. No central spinal canal stenosis.C4-5: Again seen is a disc osteophyte complex, facet and uncovertebral hypertrophy as well as ligamentum flavum thickening. This results in moderate to severe bilateral neural foraminal stenosis and moderate central spinal canal stenosis.C5-6: Status post discectomy and fusion. Mild to moderate bilateral neural foraminal stenosis is visualized but there is no central spinal canal stenosis.C6-7: Status post discectomy and fusion. No significant neuroforaminal or central canal stenosis.C7-T1: Small disc osteophyte complex is seen with left greater than right facet hypertrophy. However there is no neural foraminal or central canal stenosis.At the T2-T3 level seen on sagittal imaging is a disc protrusion which abuts the cord and encroaches on the right neural foramen. No significant central spinal canal stenosis at this level.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1.Postsurgical changes from a C5-C7 anterior cervical discectomy and fusion.2.Multilevel degenerative changes most severe at C4-5 where there is moderate to severe bilateral neuroforaminal stenosis and moderate central spinal canal stenosis.3.The cervical spinal cord demonstrates right coronary atrophy with associated T2 hyperintensity posterior to the C6 vertebral body which is unchanged compared to previous MRI indicating myelomalacia.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with history of multiple myeloma status post stem cell transplant presenting with diffuse weakness. Evaluate for new spinal lesions. Cervical:Grade 1 retrolisthesis of C3 relative to C4 is unchanged. Vertebral body height and morphology are within normal limits. No concerning marrow replacement is seen. No pathologic marrow enhancement is evident.The spinal cord demonstrates normal signal intensity throughout. No abnormal intramedullary or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Moderate spinal canal stenosis with slight flattening of the ventral cord. Moderate left foraminal narrowing. No interval changes.C4-5: Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. No significant foraminal narrowing. No interval changes.C5-6: No spinal canal stenosis or neuroforaminal narrowing. C6-7: Posterior disc-osteophyte complex formation. Mild spinal canal stenosis. No significant foraminal stenosis. No interval changes.C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Thoracic:Alignment is anatomic. Vertebral body heights are preserved. T1 isointense and T2 hyperintense signal within the left T3 vertebral body is unchanged and probably represents an atypical hemangioma.The spinal cord demonstrates normal signal intensity throughout. No pathologic intramedullary or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.Scattered facet arthropathy and minimal disc degeneration is seen through the thoracic spine. No areas of high-grade spinal canal or foraminal stenosis are detected.An enhancing mass in the right retrocrural space at T12 is unchanged in size measuring up to 28 x 11 mm in the axial plane. Small T2 hyperintense lesions are demonstrated in the liver, likely cysts.Lumbar:A transitional L5 vertebral body is seen. Vertebral body morphology is otherwise unremarkable. Marrow signal is somewhat heterogeneous but there are no suspicious areas of marrow replacement or enhancement. Endplate degeneration with associated marrow signal changes seen at L3-4. Mild edema and enhancement in the left iliac crest is seen, potentially related to recent bone marrow biopsy.The distal spinal cord, conus and cauda equina are unremarkable except as discussed below. No epidural abnormalities are suspected. No leptomeningeal enhancement is seen.L1-2: Facet arthropathy. Minimal disc bulging. Mild generalized spinal canal stenosis with slight crowding of the cauda equina. No significant foraminal narrowing. No interval changes. L2-3: Facet arthropathy. Mild disc bulging. Moderate generalized spinal canal stenosis with crowding of the cauda equina. Mild bilateral foraminal narrowing. No interval changes. L3-4: Facet arthropathy. Minimal bulging disc. Moderate generalized spinal canal stenosis with crowding of the cauda equina. Moderate bilateral foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Minimal bulging disc. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No interval changes. L5-S1: A conjoined L5-S1 nerve root is seen on the left. No significant spinal canal stenosis or neuroforaminal narrowing.

Output: 1.No clear evidence of osseous myelomatous disease.2.Stable mass in the right retrocrural space at T12.3.Degenerative findings are redemonstrated without significant interval change.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:3/28/1961)Reason: Preop planning for brain tumor resection History: preop planningPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI There is an extra-axial mass present adjacent the right frontal lobe measuring 30 x 34 mm axial dimensions. There are associated flow voids at its base from the dura suggesting fairly vascular. There is associated mass effect. There is a small amount of T2 signal hyperintensity in the adjacent right frontal lobe white matter. Most likely this would represent a small amount of edema.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 mucous retention cysts in the left maxillary sinus and some mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells demonstrate partial opacification of the right mastoid air cells The visualized portions of the orbits are intact.

Output: 1.A vascular extra-axial mass adjacent to the right frontal lobe and associated with mass effect most likely represents meningioma. There is small amount of edema in the adjacent right frontal lobe. There is also mass effect.2.Please note that this examination was performed for the purpose of stereotactic guidance for surgery.


Instruction: Generate impression based on findings.

Input: Tumor on tip of tongue, possibly vascular in origin. There is a well-defined, T2 hyperintense, enhancing lesion along the right anterior aspect of the oral tongue, which measures up to 15 mm. There is a similarly well-defined, T2 hyperintense, enhancing nodular lesion in the right parotid gland, just lateral to the retromandibular vein, which also measures up to 15 mm. There is otherwise no evidence of significant lymphadenopathy in the neck. The thyroid, orbits, and imaged intracranial structures are unremarkable. There is mild multilevel degenerative cervical spondylosis.

Output: 1. A well-defined, T2 hyperintense, enhancing lesion along the right anterior aspect of the oral tongue, which measures up to 15 mm, may represent a vascular tumor or malformation.2. A similarly well-defined, T2 hyperintense, enhancing nodular lesion in the right parotid gland, which also measures up to 15 mm, may also represent a vascular tumor or malformation.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with profound lower extremity weakness, hypotension without etiology, prior MRI with notable diskitis. Severe endplate irregularity, loss of disk height and some loss of vertebral body height is evident at T11-12. These findings are similar to those noted on the prior body CT but are new when compared to an older lumber spine MRI from 2012. The degenerated disk space, and likely the right anterior projecting disk osteophyte complex, demonstrate elevated STIR signal, but the remainder of the vertebral body marrow space does not. Please note that these findings are only assessed on sagittal images as the axial field of view does not extend to this level.Spinal alignment is grossly anatomic. Except as above, vertebral body heights are preserved. A Schmorl's node has progressed along the inferior L3 endplate. Marrow signal characteristics are heterogeneous but benign. The visualized spinal cord and conus demonstrate normal signal intensity. Additional level specific findings are as follows:T11-12: Facet hypertrophy and ligamentum flavum thickening. Progressive loss of disk height and disk bulging. Prominence of the dorsal epidural fat. Findings contributes to produce a moderate generalized spinal canal stenosis with possible slight impingement on the conus. Severe right and moderate left neuroforaminal narrowing. Findings are new relative to prior. T12-L1: No significant spinal canal stenosis or neuroforaminal narrowing. L1-2: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. No interval changes.L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes.L3-4: Moderate facet hypertrophy with a left facet effusion and ligamentum flavum thickening, progressed. Moderate bulging disk with a superimposed right paracentral protrusion. Moderate to severe generalized spinal canal stenosis with crowding of the cauda equina, unchanged. Moderate left and mild right foraminal narrowing, unchanged. L4-5: Marked facet hypertrophy with bilateral facet effusions and ligamentum flavum thickening. Moderate to severe generalized spinal canal stenosis with crowding of the cauda equina, unchanged. Moderate bilateral foraminal narrowing, unchanged. L5-S1: Marked facet hypertrophy with bilateral facet effusions and ligamentum flavum thickening. Moderate bulging disk, progressed. Moderate to severe generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing, unchanged. The kidneys are atrophic.

Output: 1. Severe deformity involving the disk space and endplates at T11-12 is similar to that seen on a recent body CT but new when compared to a prior MRI from 2012. Findings are only partially images on the present exam. Abnormal signal is evident within the severely deformed disk space and perhaps also the associated disk osteophyte complex, but not necessarily within the adjacent vertebral body marrow. Differential diagnosis would include severe disk degeneration, sequela of prior trauma or sequela of prior infection. Ongoing active infection is considered a less likely possibility, but correlation with clinical and laboratory parameters should be made.2. Along with disk space deformity, there is a new bulging disk at T11-12 which results in a moderate generalized canal stenosis and perhaps slight impingement of the conus.3. Moderate to severe degenerative findings are seen at additional levels in the lumbar spine with areas of slight progression as indicated above. L3-4 through L5-S1 are the most severely affected levels where disk disease and posterior element hypertrophy contribute to causing moderate to severe spinal canal stenoses.


Instruction: Generate impression based on findings.

Input: 67 year old with BRCA2 mutation and personal history of breast and ovarian cancer. Prior left lumpectomy, radiation therapy and chemotherapy in 2002. Family history of breast cancer in her sister and maternal aunt. Mild parenchymal enhancement is noted bilaterally. Asymmetric breast size left smaller than right, compatible with prior surgery. Mild postsurgical scarring in the left medial breast and left axilla again noted.No suspicious enhancement is seen in either breast. Intramammary lymph node in the posterior left breast near 3:00 again seen.No abnormal axillary lymph nodes are identified in either axillary region.High T2 liver lesions again noted, likely benign cysts.

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


Instruction: Generate impression based on findings.

Input: Male, 10 years old, status post craniotomy for tumor resection to 3 month follow-up exam. A small left parietal lobe resection cavity is seen status post resection of a small tumor from this location. Edema surrounding the cavity seen on the prior examination has resolved. Prior gyriform enhancement at the operative site has resolved, and there is now only a small area of curvilinear enhancement extending into the cavity from the dura which is likely postoperative in nature. No definite evidence of residual tumor is seen.Elsewhere brain morphology and signal characteristics are within normal limits. No abnormal extra-axial collections are seen. No parenchymal edema or mass effect is detected. The ventricles are normal in size and morphology.

Output: Expected evolution of postoperative findings status post resection of a small tumor from the left parietal lobe.No definite evidence to suggest residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: 53-year-old male with history of CVA presents with dizziness, upward deviation of the left eye and dizziness. Please evaluate for intracranial hemorrhage, CVA. There is no evidence of intracranial hemorrhage, mass or edema. Loculated lacunar infarct within the left basal ganglia and head of the caudate with adjacent ex vacuo dilatation of the frontal horn. Multiple scattered low densities noted with the bilateral cerebellar hemispheres. There is a small focus of encephalomalacia within the posterior aspect of the right occipital lobe which is too small to determine age. If there is clinical concern for acute ischemia, an MRI may be considered.Multiple is areas of intracranial vascular calcifications. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Multiple hypodensities in the distribution of the bilateral superior cerebellar arteries are suspicious for small strokes which are too small to determine age. MRI is recommended for further evaluation, if clinically warranted.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal MRI of the knee with no specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic lung cancer to brain. Evaluate for change. Signs and symptoms: None. Pre- and post enhanced brain MRI: A small mildly enhancing metastatic lesion in the left inferior cerebellum measuring at 11 x 10 mm in transaxial dimensions compared to prior study measurements of 9 x 9 mm. No surrounding edema or mass effect.A right posterior occipital peripheral small enhancing metastatic lesion measuring at 4.6 x 5.7 mm compared to prior study measurement of 3 x 4.6 mm. No surrounding edema or mass effect.A right high convexity posterior parietal enhancing metastatic lesion measuring 4.2 x 3 mm on sagittal post enhanced images compared to prior study measurement of 2.5 mm in transaxial dimensions. There is no surrounding edema or mass effect.There is no evidence of any new parenchymal metastatic lesion and no detectable that the meningeal enhancement.Calvarium demonstrates normal signal intensity and without metastatic lesions.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.Examination demonstrate multiple previously noted metastatic lesions in supra and infratentorial brain parenchyma with evidence of minimal interval increased size as detailed/measured above. None of the lesions demonstrate any surrounding edema or mass effect.2.No evidence of any new parenchymal metastatic lesions and no detectable leptomeningeal enhancement.3.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Male, 9 years old, with left scapular winging and palpable mass in the superior medial angle of the scapula. The left trapezius muscle is atrophic relative to the right. However, the left sternocleidomastoid muscle demonstrates normal caliber. The scapulae are only partially visualized on this examination, but the left scapula was fully visualized on the accompanying shoulder MRI. Elsewhere in the neck, no obvious masslike lesion is seen. Scattered cervical lymph nodes are within normal limits for age. The aerodigestive mucosa is unremarkable as are the salivary glands and the thyroid. The visualized osseous structures of the cervical spine are within normal limits. No significant compromise of the spinal canal or neural foramina is suspected. The spinal cord demonstrates normal signal characteristics. No enhancing lesions are seen.

Output: Atrophy of the left trapezius muscle is demonstrated, implying dysfunction of the left spinal accessory nerve. Sparing of the sternocleidomastoid muscle would imply that the affected segment is relatively more distal along the course of the nerve. No obvious mass or impinging lesion is identified on this examination to account for the findings. In general, dysfunction of the spinal accessory nerve can result from prior trauma, though it can also be idiopathic.


Instruction: Generate impression based on findings.

Input: Cavernous malformation status post recent resection. There are recent postoperative findings related to left temporal craniotomy and transtentorial presigmoid resection of a left pontine cavernous malformation. There is an expected amount of extra-axial fluid in the surgical bed and diffuse dural enhancement. There is circumferential susceptibility effect along the margins of the left pons resection cavity. There is decreased mass effect upon the fourth ventricle and cerebral aqueduct, with resultant decreased dilatation of third and lateral ventricles. There is vasogenic edema in the posterior pons and superior left cerebellar hemisphere, but no evidence of territorial infarct. There is fluid and mucosal thickening in the right sphenoid sinus.

Output: Recent postoperative findings related to left pontine cavernous malformation with interval resolution of the obstructive hydrocephalus.


Instruction: Generate impression based on findings.

Input: 47-year-old man with history of partial kidney and renal clear cell carcinoma status post resection 4/2015. ABDOMEN:LIVER, BILIARY TRACT: An approximately 1 cm T2 hyperintense, peripherally enhancing focus is noted in segment 7 of the liver, likely a small hemangioma. The gallbladder is normal. There is no intra or extra hepatic biliary duct dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The patient has a history of horseshoe kidney, status post partial resection of right moiety and left nephrectomy. There is a 55 x 31 mm T2 isointense, enhancing mass arising from the mid/inferior pole (series 10, image 27), corresponding restricted diffusion noted. There is tumor invasion of the right renal vein and IVC (series 8, image 27). Additionally, the right renal artery branches appear to be encased by tumor (series 8, image 29). RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The previously described mass abuts the third portion of the duodenum, however the fat plane between the 2 appears intact. The small bowel and colon are otherwise normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE: No significant abnormality noted.BLADDER: No significant abnormality noted.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: Recurrent/residual tumor involving the right kidney and vasculature as described above.


Instruction: Generate impression based on findings.

Input: Male, 30 years old, history of Ewing's sarcoma. Prior cryoablation resulting in paralysis. Evaluate for progression. Compared to 4/9/2015, there is slight decrease in enhancement associated with lesion involving the dorsal and superior aspect of the T12 vertebral body. The area of enhancement measures approximately 17 x 13 mm in the sagittal plane compared to 21 x 14 mm measured similarly; component of enhancement (which is favored to represent the edema component) is decreased, with the lesion itself measuring approximately 11 mm and not significantly changed. Small enhancing lesion involving posterior superior aspect of the T3 vertebral bodies is not significantly changed, measuring approximately 11 x 8 mm and previously also 11 x 8 mm. Again seen is the sequelae of prior ablation and cement placement within the T10 vertebral body. This includes bilateral transpedicular access tracts and low signal centrally within the vertebral body related to the presence of cement. There is abnormal STIR signal and enhancement involving this vertebral body extending into the pedicles similar to prior. Again seen is atrophy of the spinal cord at the T10 level. The cord seems to be retracted anteriorly towards the vertebral body as seen before. Again seen is nodular enhancement along the anterior aspect of the cord at this level. Abnormal T2 signal involves the central cord bilaterally as well as ventrally slightly more inferiorly at T10.No new enhancing lesions are appreciated. No evidence of epidural tumor. There is minimal depression involving the superior endplate of the T10 vertebral body similar to prior. Vertebral body heights are otherwise maintained. Alignment is maintained. No significant spinal canal stenosis or neural foraminal narrowing is detected.

Output: 1. Compared to 4/9/2015, there is no evidence of metastatic disease progression. Previously treated enhancing T10 vertebral lesion is not significantly changed. Enhancing T3 lesion is not significantly changed. T12 vertebral body lesion demonstrates slight decrease in surrounding edema and enhancement which may suggest treatment response. No new lesions.2. Sequela of prior cryoablation related injury to the thoracic cord with mild cord atrophy and ventral cord enhancement at T10.


Instruction: Generate impression based on findings.

Input: History of pituitary macroadenoma resection, now with secondary adrenal insufficiency. There are postoperative findings related to transsphenoidal surgery. There is no significant interval change in size of the pituitary mass, which now measures 16 AP x 29 RL x 25 SI mm, previously 16 AP x 30 RL x 24 SI mm. The mass protrudes into the bilateral cavernous sinuses. However, there is no mass effect upon the optic apparatus. The pituitary infundibulum remains shifted to the left. The internal carotid artery flow voids are intact.

Output: No significant interval change in size of the pituitary macroadenoma.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for vascular dementia. Signs and symptoms: Sudden onset of confusion. Nonenhanced brain MRI:No evidence of acute intracranial process and in particular no evidence of acute ischemic stroke.Examination demonstrate mild patchy periventricular and to a lesser degree subcortical foci of flair hyperintensity bilateral cerebral hemispheres. Minimal similar signal changes are also noted in the pons. Although nonspecific considering patient's stated age of 87 this appearance is often result of chronic small vessel ischemic strokes. The cortical sulci and ventricular system as well as the CSF spaces remain within normal for age.The signal void of major intracranial arterial branches are identified.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits.Mild chronic sinus disease is noted.

Output: 1.No acute intracranial process.2.Periventricular, subcortical and pontine foci of flair hyperintensity suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.3.Unremarkable nonenhanced brain MRI otherwise


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: r/o acute ischemia History: vertigo, nystagmus Linear restricted diffusion lesion on the left frontal lobe deep white matter indicating acute/subacute ischemic infarct. Subtle high signal intensities on DWI on the right thalamus are more likely represent T2 shine through.There is no evidence of acute hemorrhagic lesion on the scan.There are FLAIR/T2 high signal intensity lesions involving bilateral centrum semiovale and periventricular white matter indicating non specific small vessel ischemic disease, unchanged.Multifocal tissue losses involving bilateral basal ganglia, thalamus, right side corpus callosum genu and left external capsule indicating chronic lacunar infarctions, unchanged. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Linear ischemic infarction on the left frontal lobe deep white matter as described above.2. Unchanged non specific small vessel ischemic disease and multiple lacunar infarctions since prior scan.


Instruction: Generate impression based on findings.

Input: Post contrast images are somewhat limited by patient motion. There are prominent areas of susceptibility, intrinsic T1 hyperintensity, and central diffusion restriction corresponding to areas of recently identified parenchymal hemorrhage, along the anterolateral aspect of the cranial margin of the left posterior parietal resection cavity. Previous blood products within the resection cavity have resolved, with residual rim of hemosiderin staining. The area of the hemorrhage measures 1.2 x 1.8 cm in greatest axial dimensions, and appears to demonstrate a dependent blood level.Compared to the prior MRI, there are multiple areas of increasingly confluent but slightly heterogeneous enhancement along the margins of the resection cavity. Direct comparison is somewhat limited due to lack of 3-D T1 post contrast images on the current exam. Overall, the cavity itself is expanded and now FLAIR hyperintense concerning for tumor involvement. Overall extent of prominent left cerebral FLAIR hyperintensity appears similar within the white matter, with extension into the left external and internal capsules. There is progressive extension of abnormal signal into the corpus callosum across midline, as well as mild medial expansion of the abnormal signal along the posterior body of the left lateral ventricle. There is increased midline shift to the right now measuring 8 mm and localized mass effect upon the near completely effaced posterior left lateral ventricle.One of the more confluent areas is identified along the medial aspect of the left ventricular atrium, now measuring 2.3 x 1.9 cm on 1101/14, previously 1.8 x 1.5 cm. There is also a new 1.3 x 1.1 cm area of enhancement along the anterior aspect of the left temporal horn which is now near completely effaced. The previously identified intraventricular nodule along the anterior body of the left lateral ventricle has increased in size now measuring 6 x 7 mm, previously 4 x 5 mm. Overall craniocaudal extent of the area of abnormal enhancement now measures 5.7 cm on 1201/10, compared to previous 3.9 cm.There is stable focal prominence of CSF space along the anterior aspect of the left temporal pole which may represent a small arachnoid cyst, as it is present on the baseline exam from 2009. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.Redemonstration of small area of hemorrhage along the superior margin of the previous left parietal resection cavity, with overall progression of tumor within and surrounding the prior resection cavity. Similar degree of associated white matter abnormality to correspond to recent CT, as well as localized mass effect and midline shift with near complete effacement of the posterior left lateral ventricle.2.Further increased size of tumor nodule within the anterior body of the left lateral ventricle.3.New left temporal periventricular tumor involvement.4.Gradual progressive extension of abnormal signal across midline along the corpus callosum increased medial extension of abnormal white matter signal within the adjacent expanded left frontal lobe gyri.


Instruction: Generate impression based on findings.

Input: Chiari malformation, no decompression or surgery, worsening headaches. Brain: The cerebellar tonsils extend up to approximately 5 mm inferior to the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal and morphology. There is lack of cervical lordosis, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. The cerebellar tonsils extend up to approximately 5 mm inferior to the foramen magnum. 2. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Epilepsy; planning for laser fiber placement. There has been interval removal of several transoccipital and transtemporal depth electrodes positioned from the right temporal lobe region with patchy enhancement along portions of the surgical tracks. There is also interval laser ablation of the right medial temporal lobe. There is no evidence of any substantial intracranial hemorrhage. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There are postoperative changes in the skull and scalp.

Output: Operative-guidance MRI shows expected interval laser ablation effects in the medial right temporal lobe region.


Instruction: Generate impression based on findings.

Input: 17 year-old male with hydrocephalus, status post ventriculoperitoneal shunt Stable in size of the ventricles is observed when compared to the prior examinations on coronal view images. The slightly increased in size represent on axial view may be secondary to acquisition position difference between the studies. Right frontal ventriculostomy catheter is unchanged in position, with distal tip at the level of the third ventricle. The fourth ventricle remains dilated, with bilateral cerebellar encephalomalacia, which is stable. Suboccipital craniotomy, with adjacent dystrophic calcifications is also stable. Redemonstration of the encephalomalacia in left frontal periventricular white matter, consistent with previous instrumentation change. No evidence of acute intracranial hemorrhage, midline shift or hydrocephalus. Gray-white matter differentiation is preserved. The visualized paranasal sinuses and mastoid air cells are well-pneumatized. There is redemonstration of C1 congenital platybasia.

Output: 1. Interval stable in size of the supratentorial ventricular system, as described above. The slightly increased in size represent on axial view may be secondary to acquisition position difference between the studies. 2. Stable in position of the right ventriculostomy catheter. Postsurgical changes, and stable encephalomalacia in the posterior fossa.