Instruction: Generate impression based on findings.

Input: Clinical question: Patient with history of non-Hodgkin's lymphoma in maxillary sinus. Signs and symptoms: Non-Hodgkin's lymphoma. Enhanced CT of maxillofacial:In comparison with the prior examination there is significant interval reduction in the amount of fluid/soft tissue density within bilateral maxillary sinuses and anterior ethmoids as well as left frontal sinus. There is suggestion of bilateral endoscopic functional sinus surgery of maxillary sinuses. On the current exam there is only very minimal mucosal thickening of the right maxillary sinus without any detectable tumor. There is mucosal thickening at the level of sinonasal window with occlusion.There is also significant improvement of the left maxillary sinus with residual mucoperiosteal thickening throughout the left maxillary sinus and it severely compromised sinonasal window. The frontal sinuses are well pneumatized and no evidence of residual disease. There is evidence of bilateral ethmoidectomy with some residual mucoperiosteal thickening however with interval improvement since prior exam.Images through the nasal cavity demonstrate postoperative changes and no detectable mass. This examination demonstrate no definitive evidence of lymphoma however this can be further evaluated with a dedicated MRI examination of maxillofacial region. Bony structures of the area of the study demonstrate no destructive changes.Few small nonpathologic and non-enhancing bilateral cervical nerve roots in this limited view of upper neck are again identified. Limited view of intracranial content and including cavernous sinuses demonstrate no definitive abnormality.Images through the orbits are unremarkable.40 cc of Omnipaque 350 was utilized for the above study.

Output: 1.Significant improvement of paranasal sinuses since prior study with better pneumatization as detailed above.2.Residual mucoperiosteal thickening in bilateral maxillary sinus and with occluded bilateral sinonasal windows as described.3.This examination demonstrates no definitive evidence of tumor however CT scan can miss small tumors as it can appear as mucosal thickening. This area can be better evaluated with a dedicated MRI for tumor.4.No evidence of bony destructive lesion and unremarkable limited view of intracranial content.


Instruction: Generate impression based on findings.

Input: Low back pain that has not responded to injections and conservative therapy, patient denies radiation down her legs Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Minimal degenerative changes are seen including mild multilevel disc desiccation; individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. There is mild facet arthropathy, relatively worse on the left.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. There is mild bilateral facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. There is mild to moderate degree of facet arthropathy bilaterallyParaspinous soft tissues are within normal limits.

Output: 1. No significant compromise to the lumbar spinal canal or neural foramina.2. Mild to moderate multilevel facet arthropathy, relatively worse at the L5-S1 level which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Evaluate ventricular size. Normal pressure hydrocephalus. VP shunt now with increasing headaches. Nonenhanced head CT:Images through posterior fossa are unremarkable and unchanged since prior MRI exam from 2004.Images two supratentorial space demonstrate enlargement of all supratentorial ventricular system. This exam is compared with prior MRI study from 2004. A the transverse axis of the third ventricle on the current head CT measures 16.3-mm compared to prior measurement of 20.7-mm.The transverse measurements of bilateral frontal horns measures 35mm compare to prior measurements of 43.3 mm.There is a BSO a right-sided ventricular catheter with the tip of the catheter in the right frontal horn at the level of foramina of Monroe.Examination also demonstrate small low-density bilateral subdural collections in the frontal and parietal regions. The size of right frontal subdural measures 3.4-mm in thickness and the left frontal subdural measures 4.4-mm in thickness. These subdurals were not present on prior MRI exam from 2004.There is no detectable intraparenchymal hemorrhage or edema. The gray -- white matter differentiation remains within normal.

Output: 1.Smaller size of supratentorial ventricular system since prior MRI examination from 2004. There is however persistent enlargement of all supratentorial ventricular system. Right-sided ventricular catheter with the tip in the right frontal horn.2.No detectable parenchymal abnormality.3.Since 2004 are small bilateral frontal and parietal low-density subdural collections which measure 3.4mm in thickness in the right frontal region and 4.4 mm in the left frontal region.


Instruction: Generate impression based on findings.

Input: Back pain. Evaluate for potential kyphoplasty. There is compression fracture of T10, with no significant retropulsion. The fracture involves primarily the anterior column. Posterior wall of the vertebral body and pedicles appear intact. Mild degenerative changes are seen in the rest of the thoracic spine. No additional fracture is seen. Please also refer to recent MRI of thoracic spine for additional findings suggesting multiple myeloma lesions.There is a left upper lobe mass, with central calcification, probably representing a calcified granuloma and measures 14 mm. Small pleural effusion is seen bilaterally.There is a large hiatal hernia. There is thickening of esophageal wall, of uncertain significance. This is prominent soft tissue density seen at the right lateral aspect of the esophagus, at T5 -- T6 level, of uncertain significance; this may represent a vascular structure, but an underlying mass cannot be excluded.

Output: 1. T10 compression fracture, with intact posterior wall of the vertebral body and pedicles.2. Please refer to recent MRI of thoracic spine for additional multiple myeloma lesions.3. Large hiatal hernia.4. Thickening of esophageal wall and prominent soft tissue density at the right lateral aspect of the esophagus, at T5 -- T6 level, of uncertain significance. Suggest correlation with contrast enhanced CT.5. Left upper lobe calcified granuloma.


Instruction: Generate impression based on findings.

Input: 36-year-old female with a strong family history of breast cancer in her mother, maternal aunt, maternal grandmother, and two maternal cousins. Known BRCA1 mutation carrier. History of left cyst aspiration in 2011. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 52-year-old woman with metastatic breast cancer. Restaging exam.. There is diffuse, heterogeneous, enhancing abnormal marrow signal within the calvarium with areas of expansion that correspond to the lytic lesions seen on recent CT. There are multifocal areas of dural enhancement adjacent to the calvarial lesions, however, there is no dural nodularity or mass effect on the underlying brain. There is also an enhancing lesion within the clivus. The visualized upper cervical spine vertebrae are unremarkable.There is no abnormal intraparenchymal mass, mass effect, or areas of abnormal parenchymal enhancement. There are a few small areas of abnormal T2/FLAIR signal in the subcortical white matter which are nonspecific and may be related to mild chronic small vessel changes. No evidence of acute infarct. The ventricles and basal cisterns are normal in configuration. There is no midline shift or herniation. There is no evidence of intracranial hemorrhage or abnormal extra-axial collection.The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses are grossly unremarkable.

Output: 1.Innumerable calvarial metastatic lesions.2.Multifocal nonspecific areas of dural enhancement adjacent to the calvarial lesions which are favored to be reactive in etiology; dural invasion is less likely but can not be entirely excluded. 3.No intraparenchymal metastatic lesions, edema or mass effect.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type I. Mid thoracic pain. Please assess for paraspinous humerus. There is a mild but focal leftward convex curvature centered at T2. Alignment is otherwise anatomic. There is a mild deformity of the T2 vertebral body, where it appears scalloped along its right lateral aspect with minimal asymmetric height loss. There is no soft tissue mass to explain the scalloping. The soft tissue along this region is, however, heterogeneously T2-hyperintense. A similar but more mild deformity also affects the T1 vertebral body.Otherwise, the vertebral body heights are preserved. The other thoracic vertebrae are of normal morphology. There is no suspicious marrow abnormality. The disks heights are preserved as well as their T2 signal.The spinal canal and the neural foramina are preserved.Thoracic spinal cord shows normal signal and shape. On the coronal images, there is mild thickening of the lower cervical nerve roots which is suggestive of small nerve root neurofibromas. T2-hyperintense small but elongated masses just posterior to the common carotid/internal jugular veins at the root of the neck may represent small neurofibromas (or less likely lymph nodes). A left paraspinal T2-hyperintense nodule that measures 5 mm anterior to the neural foramen at T2-T3 level may represent a dilated lymphatic channel or a small neurofibroma. There is no paraspinal mass. However, the study was performed without intravenous contrast and there was minimal motion.

Output: 1.Minimal T2 vertebral body deformity associated with mild but focal leftward convex curvature may relate to mesenchymal dysplasia of NF1 or resected paraspinal neurofibroma or lateral meningocele, if there is compatible clinical history.2.Mild thickening of the lower cervical nerve roots probably reflects nerve root neurofibromas. Other findings are also present including soft tissue nodules at the root of the neck as well as a 5 mm nodule anterior to the left T2-T3 neural foramen as described above. These may represent additional neurofibromas as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for worsening cerebral edema. Signs and symptoms: Mental status change. Non-enhanced CT brain:There is suggestion of possible cerebral edema in the supratentorial brain parenchyma. The paucity of cortical sulci is similar to prior examination from 4 -- 6 -- 2010. There is no evidence of hemorrhage, midline shift or hydrocephalus. Follow-up exam with an MRI is again recommended.

Output: Stable exam. Recommend MRI examination.


Instruction: Generate impression based on findings.

Input: Clinical question: Please compare to prior exam. Signs and symptoms: Patient with left thalamic IPH.. The status-post EVD placement. Nonenhanced brain MRI:Examination demonstrates restricted diffusion involving the cortex of left posterior frontal left parietal region and extending into the left basal ganglia. There is significant distortion of the images at the level of previously noted large hemorrhage in the left basal ganglia and thalamus.Restricted diffusion is also noted involving the cortex left mid to posterior temporal lobe. All regions of the above detailed restricted diffusion demonstrate increased flair signal intensity in with resultant thickening of the cortex and effacement of the adjacent cortical sulci.A large irregularly shaped a second hematoma measures at least at 15 9 x 51 mm in transaxial dimensions. The hematoma and surrounding vasogenic edema results in significant mass effect on the third ventricle which is deviated across the midline to the right of approximately 15 mm. The left lateral ventricle remains compressed and there is mild prominence right lateral ventricle. When compared with prior CT exam there may be slight interval increased size of right lateral ventricle. A right frontal approach ventricular catheter with the tip in the anterior body of right lateral ventricle is noted. On prior head CT study the tip of the catheter was in the third ventricle.Flair and T2 weighted images also demonstrate findings suggestive of mild to moderate chronic small vessel ischemic strokes. Tiny foci of flair hyperintensity in the pons are also believed to represent chronic small lacunar infarct. Susceptibility MRI sequence demonstrate several punctate size foci of susceptibility throughout bilateral cerebral hemispheres and pons.The signal void of major intracranial branches are identified.

Output: 1.Regions of restricted diffusion involving the cortex of mid to posterior left temporal lobe and extending superiorly into the left posterior frontal -- parietal region.2.Large acute hematoma in the left thalamus/basal ganglial without convincing evidence of interval increased size since prior head CT exam.3.Hematoma and surrounding edema results in mass effect and 15-mm with deviation of third ventricle across the midline to the right.4.Right frontal approach ventricular catheter with the tip now in the anterior body of right lateral ventricle as compared to prior head CT which showed the tip in the third ventricle. 5.There is suggestion of mild interval increased size of right lateral ventricle.6.Mild findings of chronic small vessel ischemic strokes. Multiple punctate foci of susceptibility in bilateral cerebellar hemispheres and pons.


Instruction: Generate impression based on findings.

Input: History of neurofibromatosis with pain and mass in the right forearm. The visualized osseous structures and musculature are unremarkable.On the volar aspect of the mid forearm subjacent to a skin marker, there is a subcutaneous nodule (series 3, image 26) measuring approximately 6 x 10 mm. The nodule demonstrates homogenous low T1 signal and intermediate T2 signal. The nodule is confined to the superficial soft tissues without invasion into the underlying musculature. No additional abnormal lesions are identified.

Output: Superficial soft tissue nodule as described above. The nodule lacks typical features of a neurofibroma and is nonspecific. Examination otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Diagnosis: Headache(784.0)Clinical question: pain behind right eyeSigns and Symptoms: pain behind right eye MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a cystic-appearing extra-axial mass present measuring 18 x 13 mm axial dimensions which is underneath and adjacent to the left inferior temporal gyrus and abuts the petrous portion of the temporal bone it is somewhat heterogeneous on T2 imaging but it is low signal on FLAIR imaging and low signal on T1-weighted imaging is suspected to be associated with the lumen of susceptibility effect. It appears to be covered by dura. There also appears to communicate with the left temporomandibular joint. Incidental note is made of some hypertrophic changes at the left temporomandibular jointThere is a 18 x 7 mm coronal dimension sessile extra-axial lesion present which is adjacent to the right parietal lobe. It is associated with diffusion restriction.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The patient is status post anterior fusion at C5-6.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level associated with some disc material and mild narrowing of the neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are uncovertebral osteophytes present on the right side at this level with some narrowing of the right neural foramen.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Small lesions are suspected present in the left upper mediastinum which are bright signal on T2 STIR imaging. The adjacent to each other one measures 10 x 14 mm sagittal dimensions and the other measures 9 x 12 mm sagittal dimensions. This is not completely imaged on this exam. It's possible that may represent lymph nodes at the upper limits of normal in size.

Output: 1.There is a small extra-axial mass present adjacent to the right parietal lobe. It most likely represents a meningioma. It does not compress the underlying brain.2.There is a small complex cystic extra-axial lesion adjacent to the left temporal lobe. If clinically appropriate MRI of the brain with gadolinium may be of further benefit in evaluating this since it does have a somewhat complex appearing component. Its proximity to the left TMJ may suggest a relationship with this such as a ganglion cyst or synovial chondromatosis. Another possibility is that it represents a cystic meningioma. It is atypical for an arachnoid cyst.3.There are multilevel degenerative changes present in the cervical spine but no significant compromise to spinal canal or exiting nerve roots. The patient is status post anterior fusion at C5-6.4.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.5.There are degenerative changes present in the left temporomandibular joint that are not completely imaged on this exam and appear to be adjacent to the cystic lesion identified next to the temporal lobe. If clinically appropriate CT or plain film imaging of the temporomandibular joint may be of benefit.6.Nodules in the left upper mediastinum are incompletely imaged on this exam and may represents lymph nodes but are not adequately imaged for a more conclusive interpretation. This would represent an incidental finding.7.Findings were discussed with Dr. HEKMATPANAH at 11:30 on 7/6/15.


Instruction: Generate impression based on findings.

Input: Right lower extremity weakness and hyperreflexia, assess for myelopathy. MR brain: Again seen are several foci of T2 hyperintensity in the periventricular and subcortical white matter, all of these similar to the previous exam with the exception of a new T2 hyperintense focus in the right middle cerebellar peduncle. There is no associated restricted diffusion or abnormal enhancement in any of these lesions. No definite acute lesions are seen.There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild opacification of the right mastoid air cells. MR cervical spine: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality seen. There is mild narrowing of the disc height at C5-C6. There is new T2 signal abnormality in the right dorsal cervicomedullary junction (image 9, series 1601). There is no associated pathological enhancement.There is a clear area of abnormal T2 signal along the right lateral cord at C4-C5 which is best seen on image 15, series 1801, which is unchanged. In addition, best seen on sagittal STIR sequences, long segment subtle T2 hyperintensity is suspected in the cord extending from C2 into the lower cervical region, which could be artifactual or may represent subtle disease. On close inspection of the previous exam it may have been perhaps.There is mild-to-moderate degenerative disease in the cervical spine.At C2-3, there is no significant compromise to the spinal canal or neural foramina.At C3-4, there is mild left neuroforaminal narrowing. There is no significant central canal stenosis. At C4-5, there is a right paracentral disc protrusion resulting in mild narrowing of the right neural foramen. There is no spinal canal stenosis.At C5-6, there is a disc osteophyte complex resulting in moderate, left more than the right, foraminal stenosis. There is no spinal canal stenosis. At C6-7, there is a disc protrusion without significant compromise to the spinal canal or neural foramina.At C7-T1, there is no significant compromise to the spinal canal or neural foramina.

Output: 1. Several small foci of signal abnormality are redemonstrated in the cerebral white matter. There may be a new lesion in the right middle cerebellar peduncle and at the right dorsal cervicomedullary junction.2. A lesion is noted in the right lateral cord at C4-C5. There is also subtle possible signal abnormality extending over a long segment of the cervical spinal cord, which may have been present on previous imaging. 3. Imaging features of both the intracranial and spinal cord lesions suggests a demyelinating process, post inflammatory sequelae or connective tissue disorders such as SLE.3. Stable multilevel degenerative disc changes of the cervical spine, worst at C5-C6 resulting in moderate bilateral neural foraminal narrowing. No spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Congenital lymphangioma status post sclerotherapy. Brain: 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 or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable.Face: There is a large multicystic trans-spatial right face mass with a hemorrhage level in a right parapharyngeal cystic compartment that measures up to 17 mm, increase in size of a dominant right oral cavity cystic component that measures up to 35 mm, but decrease in size of the nasopharyngeal cystic components, measuring up to 25 mm. The submental region cystic component are similar in size and there is an unchanged heterogeneously fatty component in the left nasal and oral cavity that measures up to approximately 25 mm. There is associated deformity of the mandible and a cleft palate. There is persistent effacement of the upper pharyngeal airway, which is otherwise intubated.Neck: There is no significant cervical lymphadenopathy. The salivary glands are unchanged. The thyroid gland is unremarkable. The cervical spine appears to be intact.

Output: 1. Multicystic trans-spatial right face lymphatic malformation with recent hemorrhage in a right parapharyngeal cystic compartment, increase in size of a dominant right oral cavity cystic component, but decrease in size of the nasopharyngeal cystic components.2. Cleft palate, which is better depicted on the prior CT.3. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 77-year-old male status post fall. Question bleed question fracture. Review of prior studies indicates the patient has metastatic melanoma. Numerous brain masses are present. A prominent high attenuation mass in the high convexity of the right frontal lobe (series 6900 image 30) measures 1.1 x 0.9 cm. This lesion was not visualized on the MRI dated 3/2/2009. A high attenuation lesion in the right parietal lobe (series 6900 image 22) is also not clearly visualized on the previous MRI. Two high attenuation lesions in the right cerebellar hemisphere are faintly visible on post contrast images of the the study dated 3/2/2009. The large lesion seen in the left temporal lobe on the previous MRI is not well visualized on today's study.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: 1. No CT evidence of traumatic hemorrhage or fracture.2. Numerous high attenuation lesions scattered throughout the cerebral hemispheres and cerebellum -- consistent with hemorrhagic metastases from the patient's known melanoma.


Instruction: Generate impression based on findings.

Input: Pain ACETABULAR LABRUM: There is a small tear of the anterior superior labrum with an associated small (1-2 mm) paralabral cyst. Posterior labrum is intact.ARTICULAR CARTILAGE AND BONE: No cartilage defects. Bone marrow signal is within normal limits.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Small tear of the anterior superior labrum with an associated small (1-2 mm) paralabral cyst.


Instruction: Generate impression based on findings.

Input: 54 year old man with history of SLE, non-ischemic cardiomyopathy, referred for evaluation of possible lupus related myocarditis. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 16%, the LV end diastolic volume index is 236 ml/m2 (normal range: 74+/-15), the LVEDV is 471 ml (normal range 142+/-34), the LV end systolic volume index is 199 ml/m2 (normal range 25+/-9), the LVESV is 397 ml (normal range 47+/-19), the LV mass index is 57 g/m2 (normal range 85+/-15), and the LV mass is 114 g (normal range 164+/-36). LV dysfunction is global. There is a small patch of subendocardial late gadolinium enhancement in the basal-mid inferior wall. This pattern may be due to a small RCA branch infarct (given history of non-ischemic cardiomyopathy possibly embolic vs native atherosclerosis) or a prior fibrosing, infiltrative, or inflammatory process. The remainder of the myocardium is viable. There are no findings indicative of an acute myocarditis (increased myocardial edema or acute inflammation).Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 22%, the RV end diastolic volume index is 160 ml/m2 (normal range 82+/-16), the RVEDV is 320 ml (normal range 142+/-31), the RV end systolic volume index is 125 ml/m2 (normal range 31+/-9), and the RVESV is 249 ml (normal range 54+/-17).Right AtriumThe right atrium size is difficult to determine due to defibrillator artifact, however it appears moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is apically displaced due to bi-leaflet tethering. There is moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root size is unable to be measured due to defibrillator artifact. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery size is unable to be measured due to defibrillator artifact.Venous AnatomyThe SVC and IVC drain normally into the right atrium. The IVC is dilated.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are moderate bilateral pleural effusions (R>L). Right chest ICD with defibrillator wire in the RV noted with associated artifact. Probable renal cysts. Calcified splenic granulomas likely explains focal areas of hypointensity within the splenic tissue. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No evidence of acute myocarditis.2. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 16%. LV dysfunction is global.3. There is a small patch of subendocardial late gadolinium enhancement in the basal-mid inferior wall. This pattern may be due to a small RCA branch infarct (given history of non-ischemic cardiomyopathy possibly embolic vs native atherosclerosis); less likely a prior fibrosing, infiltrative, or inflammatory process. The remainder of the myocardium is viable.4. The right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 22%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 53 years, Male, pleural mesothelioma with lung metastases. Presents with nasal field defect in the left eye. There is marked mucosal thickening within the left nasal cavity, with no underlying lesion identified. There is no restricted diffusion to suggest acute ischemia. There are multiple areas of periventricular and subcortical T2 hyperintensity. There is also T2 hyperintensity within the globus pallidi and pons. The globus pallidi are otherwise unremarkable. There is no intracranial hemorrhage. The ventricles are within normal limits in size and configuration. There is no abnormal meningeal enhancement. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Bone marrow signal and extracranial soft tissues are within normal limits. Incidental note is made of asymmetric mucosal swelling within the left nasal cavity.

Output: Nonspecific T2 hyperintense lesions within the periventricular and subcortical white matter, and pons most likely secondary to chronic microvascular ischemic disease. However there are additional areas of T2 hyperintensity within the globus pallidi bilaterally, which are atypical, and may be due to a combination of chronic microvascular ischemic disease and/or remote toxin exposure such as carbon monoxide.


Instruction: Generate impression based on findings.

Input: Reason: assess for MCL sprain and acute medial meniscal tear History: medial knee pain and 2/2 fall MENISCI: Note is made of increased signal abnormality within the body of the lateral meniscus indicating intrasubstance degeneration. There is blunting of the free edge of the body of the lateral meniscus indicating a small horizontal cleavage tear which extends to the femoral articular surface. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is focal full-thickness articular cartilage degeneration along the anterior aspect of the lateral femoral condyle with a 2.5 cm area completely devoid of articular cartilage. There is associated underlying subchondral signal abnormality. The medial tibiofemoral compartment appears relatively spared. There are near full-thickness to full-thickness articular cartilage fissures along the median eminence of the patella and femoral trochlea centrally. There is near full-thickness to full-thickness articular cartilage degeneration along the medial facet of the patella with articular cartilage delamination. There is also near full thickness to full thickness articular cartilage degeneration along the medial facet of the femoral trochlea, inferiorly.LIGAMENTS: The ACL and PCL appear intact. The LCL appears intact. There is thickening and intermediate signal intensity involving the superficial and deep fibers of the MCL indicating a sprain.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Findings indicating a sprain of the MCL as well as a mild strain injury of the biceps femoris muscle.2. Degeneration and tearing of the lateral meniscus as described above.3. Osteoarthritis of the knee including full-thickness articular cartilage degeneration most pronounced along the patellofemoral and lateral tibiofemoral articulations. 4. Moderate-sized joint effusion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: History of medullary thyroid cancer with liver metastases. ABDOMEN:LIVER, BILIARY TRACT: Again noted are multiple hepatic metastases. The following reference measurements were made:The right posterior segment peripheral lesion measures 6 mm(series 3/11) compared to 7 mm previously .The reference anterior segment lesion measures 1.0 cm (series 3/11), compared to 8 mm previously.The more inferior posterior segment lesion measures 6 mm (series 3/14), compared to 6 mm previously.The inferior posterior segment peripheral lesion measures 1.2 cm (series 3/18), compared to 1.1 cm previously.No new definite lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal superior pole simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Enhancing L2 vertebral body osseous lesions are unchanged. The sternal lesion is not adequately imaged.OTHER: No significant abnormality noted.

Output: Stable metastatic disease to the liver and lumbar spine.


Instruction: Generate impression based on findings.

Input: Disorientation, unspecified [R41.0], Reason for Study: ^Reason: presented with confusion and lethargy. S/p BMT on chronic steroids. rule out infection vs other etiology History: confusion, lethargy There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings of bilateral maxillary sinuses (right worse than left), ethmoid sinus and sphenoid sinus are seen indicating sinusitis.

Output: No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Paresthesias, evaluate for progression of demyelinating disease. Brain: Again seen are scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter not appreciably changed compared to 6/12/2015. No new lesions. There is subtle focus of enhancement in the right posterior frontal lobe, series 4 image 12 with enhancement not present on the 3-D SPGR sequences likely related to differences in technique and contrast timing. There is corresponding T2 FLAIR hyperintensity which was present on prior study from 6/12/2015 but did not demonstrate enhancement. As such this may represent new enhancement within pre-existing lesion versus chronic enhancement which was not appreciable previously due to technique. Subtle focus of enhancement is also suspected in the right ventral pons, series 3 image 130 also not appreciated on prior.Brain parenchymal volume is preserved. No evidence of intracranial mass or mass effect. No hydrocephalus or extra-axial collections. Evidence of prior left parietal burr hole placement for biopsy with gliosis involving the adjacent cortex again seen. Visualized extracranial soft tissues are unremarkable.Cervical spine: There is minimal patchy T2 signal abnormality throughout the cervical cord without findings to suggest a new discrete lesion. No discrete/large lesion with enhancement is appreciated. There are subtle foci of enhancement which are again questioned in the cervical cord, such as at the C1 level sagittal series 9 image 8 and at the left C4 level, sagittal series 9 image 9. Previously described foci of enhancement at the C2 level and right lateral C6 level are no longer appreciated.Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow signal abnormality or enhancement is seen. No significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are unremarkable.

Output: Compared to 6/12/2015, there are small scattered T2/FLAIR hyperintense lesions in the white matter which are not appreciably changed since 6/12/2015. There are tiny foci of enhancement, such as in the right posterior frontal lobe and right ventral pons which were not appreciated on prior. Similarly in the cervical cord, there are tiny T2 hyperintense lesions which overall are not appreciably changed. There are subtle foci of enhancement in the cervical cord which appear new, while subtle enhancing foci present on prior study which are no longer appreciated on the current study. Overall, these tiny areas of enhancement in the brain and cervical cord suggest ongoing inflammation/demyelination. Given their small size (1-3 mm) it is possible that they represent chronic subtle enhancing foci with apparent fluctuation possibly related to differences in technique/contrast timing.


Instruction: Generate impression based on findings.

Input: 17-year-old female patient with pain and swelling of the left knee. Evaluate for meniscal tear. MENISCI: There is no evidence of meniscal injury.ARTICULAR CARTILAGE AND BONE: No focal articular defects.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament, medial collateral abdomen complex, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: No acute abnormalities in the left knee.


Instruction: Generate impression based on findings.

Input: 58-year-old female with history of a pancreatic lesion. ABDOMEN:LIVER, BILIARY TRACT: There T2 hyperintense lesions with peripheral discontiguous persistent enhancement within left and right hepatic lobes. The right hepatic lobe lesion measures 2.2 x 1.7 cm (series 1303, image 29). Findings consistent with hemangiomas. SPLEEN: No significant abnormality noted.PANCREAS: There is a lobulated T2 hyperintense pancreatic tail lesion measuring 2.0 x 1.6 cm (series 5, image 28). This lesion does not demonstrate contrast enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cystic lesion within the pancreatic tail. This may represent a mucinous cystic neoplasm.2.Right and left hepatic hemangiomas.


Instruction: Generate impression based on findings.

Input: History of right lumpectomy for breast cancer. Also, BRCA 1 positive. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Normal size and morphology lymph node in the left outer breast at posterior depth. Post-surgical changes of the right breast, including an outer breast seroma and volume loss are again noted. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: 52 yo M w/ pancreatic ductal dilation and fluid collection on CT scan. ERCP 5/26 w/ pancreatic duct stricture unable to be bypassed. MRI/MRCP w/ secretin to assess pancreatic duct History: pancreatic duct stricture, pancreatic fluid collection ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensities, likely cysts.SPLEEN: The splenic vein is narrowed but appears patent. There are multiple perisplenic collateral vessels.PANCREAS: Peripancreatic fluid collection in the region of the pancreatic neck is slightly decreased in size measuring 3.3 x 2.1 cm (501/22), previously 3.6 x 2.1 cm. An adjacent collection more distal adjacent to the lesser curvature of the stomach has nearly resolved (501/24), previously measuring 3.4 x 3.4 cm.There is main pancreatic duct throughout the tail of the pancreas with stricturing within the pancreatic body. The distal pancreas is atrophic and has low T2 signal with diffusion restriction and hyperenhancement, suggesting chronic pancreatitis. A blunted response to seek attention is also observed, also supporting findings of chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 4.6 cm left midpole cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Peripancreatic fluid collections have decreased in size since the prior exam.2.Stricturing of the main pancreatic duct within the pancreatic body and associated dilatation within the pancreatic tail.3.Findings of chronic pancreatitis of the pancreatic tail with a blunted response to secretin.


Instruction: Generate impression based on findings.

Input: 9 year-old female with rhabdomyosarcoma of the nasal cavity now with METs to brain to evaluate for further METs This is a suboptimal study for soft tissue lesion due to no contrast media is used.Limited view of the brain demonstrate right frontal lobe soft tissue mass with vasogenic edema, midline shift to the left and hydrocephalus. Please refer to the dedicated MRI examination for more details.Non-enhancing CT demonstrates a soft tissue mass in superior nasal cavity and ethmoid sinus with possible extension to the right orbital cavity. The ethmoid bone, fovea ethmoidalis, cribriform plates, right lamina papyracea and anterior clinoid process show erosion and loss of continuity. Mucosal thickening is seen in the right maxillary sinus, opacification of the left maxillary sinus, sphenoid sinuses and frontal sinuses are seen.Views of soft tissue neck shows numerous lymph nodes in bilateral posterior triangle, jugular chain, submandibular and submental regions. One in the left jugulodigastric lymph nodes measures 17.3-mm. it is hard to differentiate all those lymph nodes due to lack of contrast. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent.

Output: Soft tissue mass in superior nasal cavity and ethmoid sinuses with multiple bony destruction and occlusive paranasal sinuses inflammatory change as detailed above.Intracranial extension better seen on MR and CT. Neck lymphadenopathy as detailed above.


Instruction: Generate impression based on findings.

Input: 42 year old man with history of heart failure with reduced ejection fraction, hypertension who presents with new drop in ejection fraction. Cardiac MRI done to evaluate for structure, function, and etiology of cardiomyopathy Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 15%, the LV end diastolic volume index is 222 ml/m2 (normal range: 74+/-15), the LVEDV is 542 ml (normal range 142+/-34), the LV end systolic volume index is 189 ml/m2 (normal range 25+/-9), the LVESV is 462 ml (normal range 47+/-19), the LV mass index is 117 g/m2 (normal range 85+/-15), and the LV mass is 285 g (normal range 164+/-36). There is global hypokinesis. There is a small area of near transmural late gadolinium enhancement in the apical lateral wall in a pattern most consistent with prior myocardial infarction due to an embolic event. No evidence of myocardial iron overload, cardiac amyloidosis, or other infiltrative process.No LV apical thrombus present.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 25 %, the RV end diastolic volume index is 125 ml/m2 (normal range 82+/-16), the RVEDV is 305 ml (normal range 142+/-31), the RV end systolic volume index is 93 ml/m2 (normal range 31+/-9), and the RVESV is 227 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is restricted opening of the mitral valve with moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderate dilated and measures 35 mmVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a small right pleural effusion. Evidence of increased interstitial lung markings at bilateral lung bases. 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 severely dilated with severely reduced systolic function (LVEF 15%)2. The right ventricle is mildly dilated with severely reduced systolic function (RVEF 25%)3. There is a small area of near transmural late gadolinium enhancement in the apical lateral wall in a pattern most consistent with myocardial infarction from an embolic event. No evidence of infiltrative myocardial process such as iron overload, sarcoidosis, or amyloidosis. The extent of LV dysfunction is out of proportion to the size of her myocardial infarction suggesting a predominantly non-ischemic etiology.4. Severe left atrial dilation5. Main pulmonary artery dilation.6. Moderate mitral regurgitation.7. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Six rule female with history of intracranial METs, now with right-sided headache. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse periventricular and subcortical white matter hypodensity consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Noncontrast evaluation is limited for evaluation of tumor.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute change.


Instruction: Generate impression based on findings.

Input: 74 year old woman with history of HTN, COPD and multiple myeloma, with SCT, referred for evaluation of possible cardiac amyloid. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 70 ml/m2 (normal range: 65+/-11), the LVEDV is 125 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 47 ml (normal range 31+/-10). There is severe LVH. There are no regional wall motion abnormalities present. . There is patchy late gadolinium enhancement in multiple segments of the myocardium, consistent with infiltrative diseases such as cardiac amyloid.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 66 ml/m2 (normal range 69+/-14), the RVEDV is 117 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 46 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%2. There is patchy late gadolinium enhancement in multiple segments of the myocardium, consistent with infiltrative diseases such as cardiac amyloid.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%


Instruction: Generate impression based on findings.

Input: 20-year-old female with a history of sickle cell disease, pain in her arm. Assess for avascular necrosis. ROTATOR CUFF: There is mild increased signal intensity within the supraspinatus tendon suggesting mild tendinosis and mild bursal surface fraying, but we see no discrete tear. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. There is a small cyst in the underlying humeral head which may not be of any clinical significance. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: Although we see no frank fluid within the subacromial/subdeltoid bursa, there is increased signal intensity on fluid sensitive sequences that may reflect minimal inflammation. There is a slight downsloping of the distal clavicle, which is associated with mild impression of the superior fibers of the supraspinatus. GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of a non arthrogram study. There is a small cyst in the humeral head which may not be of any clinical significance. There is a small amount of fluid within the joint without evidence of a large effusion.BICEPS TENDON: The tendon of the long head biceps appears intact. A small amount of fluid within the tendon sheath of long of the biceps likely represents fluid extension from the joint. ADDITIONAL

Output: 1. Mild supraspinatus tendinosis and possible bursal surface fraying. There is also mild impression of the superior fibers of the supraspinatus by the distal clavicle with questionable mild inflammation of the subacromial subdeltoid bursa.2. Bony stigmata of sickle cell disease, but no specific features of avascular necrosis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of unspecified nature of brainClinical question: s/p crani for tumor resectionSigns and Symptoms: s/p crani for tumor resection Since the prior exam the patient is undergone left-sided parietal craniotomy for a left precuneus mass. Associated vasogenic edema has not changed. There are blood products present at the surgical site which have bright signal on T1 as well as susceptibility effect.There is a scalp soft tissue swelling associated with the patient's surgical siteNormal 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 maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Status post recent left parietal lobe surgery. A ring-enhancing lesion is no longer present in the left precuneus. There are blood products present at the surgical site


Instruction: Generate impression based on findings.

Input: Female 55 years old Reason: History of right forearm AVM, tx with laser therapy, now with pain and decreased strength to area History: Pain and muscle weakness to right forearm Within the subcutaneous tissues along the lateral aspect of the proximal forearm at the level of the radial head/neck is a vascular malformation. A questionable feeding vessel appears to arise from the proximal radial artery immediately distal to the bifurcation of the brachial artery. The venous drainage follows deep perforators which eventually drain into the cephalic vein. There is no adjacent edema. The visualized muscles and bones are unremarkable. No mass lesions are identified.

Output: Vascular malformation in the superficial proximal lateral forearm as described. It is uncertain whether this is arterial or venous in etiology, however there is a possible feeding artery arising proximal radial artery. A diagnostic angiogram can be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Severe positional headaches with visual disturbances and vomiting. Chiari suggested on outside MRI dated 2/15. MRI BRAIN: There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The cerebellar tonsils are low-lying, measuring approximately 4 mm below the level of the foramen magnum. The brain parenchyma appears otherwise unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. MRV BRAIN: There is diminished signal and associated T2/FLAIR signal abnormality involving the left transverse sinus highly suspicious for thrombosis. The left internal jugular vein also appears to be thrombosed. The remainder of the venous sinuses appear patent.

Output: 1. MR venogram without contrast is suboptimal but demonstrates findings highly suspicious for thrombosis involving the left transverse sinus and the left internal jugular vein. Remainder of the dural venous sinuses appear patent. No evidence of parenchymal edema or hemorrhage.2. Low-lying cerebellar tonsils without clear evidence of Chiari malformation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Prostate cancer status post focal laser ablation. 3 month follow-up PELVIS:PROSTATE:Prostate Size: 5.1 x 4.1 x 4.1 cmPeripheral Zone: The right peripheral zone is slightly atrophic in the region of the prior tumor, compatible with expected post-ablation changes. Slightly asymmetrically increased T1 signal throughout the right peripheral zone is compatible with prior hemorrhage. No suspicious T2 hypointense, enhancing, or diffusion restricting lesions are identified.Central Gland: Heterogeneous without suspicious nodule evident.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. No lymphadenopathy by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Post-ablative changes in the right peripheral zone, without suspicious lesion identified.


Instruction: Generate impression based on findings.

Input: Bell's palsy [351.0] / Acute lymphoid leukemia, without mention of having achieved remission(204.00) [204.00], Reason for Study: ^Reason: 56 y/o male with ?Bell's Palsy dx at OSH, h/o ALL with CNS relapse 3/2015; still with facial droop History: 56 y/o m Due to patient complained of his pain during the scan, the scan was of limited immaturity. On this limited exam, there is no evidence of acute ischemic lesion on the scan.On FLAIR imaging, patchy high signal intensities on bilateral deep white matter likely represent nonspecific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Limited exam.No evidence of acute ischemic lesion.Regarding the clinical symptom of Bell's palsy, the exam should be repeated with the gadolinium-enhanced T1-weighted images for precise imaging evaluation.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Numbness, chest tightness. Please do Dr Javed MS protocol, and compare to uploaded MRI from outside MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical white matter lesions which are bright on T2 and FLAIR MRINo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma which are mostly unchanged since the prior exam. A lesion adjacent to the temporal horn of the right lateral ventricle which enhances following contrast administration is new since the prior exam. A small lesion in the right pons now enhances following contrast administration.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.The patient has multiple periventricular white matter and subcortical white matter lesions as well as a couple brainstem lesions which were also present on the prior exam and are mostly unchanged, however, there is a new lesion adjacent ot the temporal horn and a previously present lesion in the right pons which display contrast enhancement suggesting that they are active.2.No cervical spinal cord lesions are identified to suggest cervical spinal cord involvement.


Instruction: Generate impression based on findings.

Input: 71-year-old male patient with history of severe diarrhea, prior abnormality on upper GI series showing flocculation on small bowel. Evaluate for small bowel inflammatory process. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: There is nodularity of the left adrenal gland.KIDNEYS, URETERS: There are bilateral renal cysts. RETROPERITONEUM, LYMPH NODES: There is retroperitoneal lymphadenopathy as noted on prior studies. The infrarenal abdominal aorta is ectatic.BOWEL, MESENTERY: Within significant limitations as described in the technique section, there is no gross abnormality of the small bowel or large bowel on non-contrast imaging. No evidence of small bowel obstruction. There are small mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited and essentially non-contrast examination as described in the technique section. Within this limitation, there is no gross abnormality within the small or large bowel on non-contrast images. If clinical concern for small bowel pathology continues, CT enterography may be of more value.2.Retroperitoneal and external iliac lymphadenopathy.3.Cholelithiasis without evidence of acute cholecystitis.


Instruction: Generate impression based on findings.

Input: 33-year-old female with heavy, frequent menses. Evaluate for adenomyosis. PELVIS:UTERUS, ADNEXA: The uterus measures up to 7.8 cm in transverse, 6 cm in AP, and 12.8 cm in length. Demarcation of the junctional zone is difficult to visualize, and indistinct margins are suggestive adenomyosis. No suspicious lesions are identified on the postcontrast series.Bilateral normal-appearing ovaries containing small follicles. Incidental noted is made of a small nabothian cyst.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: 1.Demarcation of the junctional zone difficult to visualize; the indistinct margins suggestive of adenomyosis. Ultrasound may be useful for further clarification.2.With respect to myometrial heterogeneity seen, underlying neoplastic process felt to be less likely; no suspicious lesions identified on the postcontrast series, progressive enhancement of myometrium noted.


Instruction: Generate impression based on findings.

Input: Male 27 years old Reason: Assess for resolution of previous intra-abdominal infections History: hx of Crohn's disease and intra-abdominal infections in 2015 ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent.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 retroperitoneal lymphadenopathy.BOWEL, MESENTERY: There is a 10 cm segment of bowel wall thickening, hyperenhancement and wall edema involving the terminal ileum including involving the ileocecal valve. No bowel obstruction at this level.There are 2 other areas of mild bowel wall thickening involving the mid ileum with mild bowel hyperenhancement which is suggestive of active disease the segments measure 6cm and 7 cm. These areas is suboptimally evaluated due to suboptimal bowel distention.No intra-abdominal abscess is evident. Suboptimal evaluation of the jejunum due to under distention.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of active disease involving the 10 cm segment of terminal ileum.2.Other areas of mild bowel wall hyperenhancement involving the mid ileum h are equivocal for active disease given the segments are underdistended.


Instruction: Generate impression based on findings.

Input: 70 old male with NSCLC status post RT to the right lung, assess for response, has history of rheumatoid pulmonary nodules CHEST:LUNGS AND PLEURA: Previously noted spiculated mass in the posterior segment of the right upper lobe is less well delineated on the current exam due increased atelectasis involving its segment as well as an increasing right loculated pleural effusion.Noted are multiple pulmonary nodules, some demonstrating cavitation that are stable and may be related to rheumatoid nodules or secondary to chronic infection.Marked changes of centrilobular emphysema with scarring and areas of bronchiectasis noted particularly at the lung basesMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable small hypodense lesions, most likely representing hepatic cystsSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Extrarenal pelvis bilaterally and/or peripelvic cysts, with punctate, nonobstructing calculus in the right kidneyPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Compression fractures of T7, T8, 6 vertebrae are stable. However new fracturesare noted at T4 and T5. At T4 there is extension posteriorly into the spinal canal. MRI of the thoracic spine is recommended to evaluate for stenosis/cord compressionOTHER: Atherosclerotic changes of the aorta

Output: 1. Increased atelectasis in associated pleural reaction is identified in the posterior segment right upper lobe.2. Multiple pulmonary nodules, some cavitating are stable and again consistent with rheumatoid nodules and/or chronic infection.3. Extensive centrilobular emphysema, as well as scarring and bronchiectatic changes, more pronounced in the lower lobes unchanged4. New compression fractures at T4 and T5 with extension of the T4 fracture into the spinal canal. Correlation with previous MRI (12/10/09) to evaluate for stenosis/cord compression


Instruction: Generate impression based on findings.

Input: Low back pain Five lumbar type vertebral bodies are presumed to be present. There is approximately 25% loss of height involving the L5, approximately 20% loss of height involving the L2 vertebral body, and minimal loss of height involving the L1 and L3 vertebral bodies. No edema within the vertebral bodies and no significant change since 10/19/2012. Small Schmorl nodes at multiple levels again seen. There is grade 1 retrolisthesis of L2 on L3 and slightly greater at L3 on L4. There is grade 1 anterolisthesis of L4 on L5 and L5 on S1. There is slight worsening of the retrolisthesis of L3 on L4 compared to prior. Alignment is otherwise unchanged since 10/19/2012. Bone marrow signal is benign. The conus medullaris is normal in position at the mid L2 level. Again seen are postsurgical changes of laminectomy at L4-L5, medial facetectomy, and posterior interspinous fixation.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal retrolisthesis and mild disk bulge. No spinal canal or neural foraminal stenosis.L3-L4: There is grade 1 retrolisthesis (which is slightly worse since MRI from 2012), disk uncovering, and mild disk bulge. There is mild bilateral facet arthropathy. There is prominence of the epidural fat, similar to prior with mild spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis relatively worse since 2012. There is central clumping of the cauda equina nerve roots. L4-L5: Spinal canal is surgically decompressed with mild narrowing of the spinal canal related to calcifications along the lamina, better seen on the CT. Anterolisthesis is similar to prior. There is bilateral facet arthropathy. There is mild to moderate right and mild left neural foramina stenosis. There is central clumping of the cauda equina nerve roots. L5-S1: There is grade 1 anterolisthesis with disc uncovering and mild bulge which is eccentric to the right involving the right neural foramen. No spinal canal stenosis. There is moderate bilateral neural foraminal stenosis, worse on the left. Paraspinous soft tissues are unremarkable aside from postsurgical changes and mild paraspinous muscle atrophy.

Output: 1. Compared to MRI 10/19/2012, there are post surgical changes of interval spinal canal decompression at L4-5 and interspinous fixation.2. Central clumping of the cauda equina nerve roots from L3-4 to L4-5 suggestive of arachnoiditis.3. Mild spinal canal narrowing at L3-L4 and L4-5.4. Moderate bilateral L5-S1 neural foraminal stenosis and to a lesser degree at L3-4 and L4-5 as detailed above.5. Spondylolisthesis from L2-3 to L5-S1 largely similar to 2012; mild L3-4 retrolisthesis is slightly worse however. 6. Advanced facet arthropathy at L4-5 and L5-S1 and to a lesser degree at L3-4. 7. Unchanged mild chronic compression deformities and Schmorl nodes.


Instruction: Generate impression based on findings.

Input: Perirectal abscess ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Left perirectal abscess measuring 2.6 x 2.5 cm. The abscess extends into the left ischiorectal fossae no fistula is to the skin intergluteal region. The size of the abscess in the is pararectal fossa is 4.5 x 2 cm. Inflammatory changes and possible fistulous tracts is also likely present on the right side. Further evaluation with pelvic MRI may be helpful for better depiction of the abscess and fistula tracts.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Left pararectal and ischiorectal abscess and fistula. Right perirectal inflammation. Further evaluation with a pelvic MR is recommended for better depiction of the fistula tracts.


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.he patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 3 ml Omnipaque 240 (to confirm the intra-articular position of the needle) was injected into the joint. Contrast opacified the joint in the expected manner. 1 cc of Aristospan and 4 cc of Bupivacaine was then injected into the joint. 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: 25 seconds

Output: Successful left hip injection.


Instruction: Generate impression based on findings.

Input: Headache. Evaluate for pituitary mass. There is a punctate non-enhancing focus interposed between the anterior hypophysis and posterior pituitary. The pituitary gland is not enlarged and otherwise enhances homogeneously. The infundibulum, optic apparatus, and cavernous sinuses are intact. There are mild nonspecific scattered T2 hyperintense foci in the cerebral white matter. There is a cystic pineal gland that measures up to 15 mm, without associated nodular enhancement. There is no evidence of intracranial hemorrhage 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: 1. Punctate pars intermedia cyst, but no evidence of pituitary adenoma.2. Nonspecific cystic pineal gland that measures up to 15 mm, but no ventriculomegaly.3. Mild nonspecific scattered T2 hyperintense foci in the cerebral white matter.


Instruction: Generate impression based on findings.

Input: 46 year old woman with history of heart failure, CVA referred for CMRI for further evaluation of cardiac function and viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 12%, the LV end diastolic volume index is 235 ml/m2 (normal range: 65+/-11), the LVEDV is 415 ml (normal range 109+/-23), the LV end systolic volume index is 206 ml/m2 (normal range 18+/-5), the LVESV is 364 ml (normal range 31+/-10), the LV mass index is 86 g/m2 (normal range 67+/-11), and the LV mass is 152 g (normal range 114+/-24). There is akinesis of the apical two thirds of the anterior wall, apical one half of the inferior wall, apical one half of the lateral wall and apical two thirds of the septum. The segments are thinned. The remaining basal segments are severely hypokinetic. Limited post contrast assessment was obtained on this study, which limits full viability evaluation; however, overall appearance is of a proximal wrap-around LAD infarct that is considered to likely be nonviable due to the degree of thinning. There is no LV thrombus.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mild to moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 135 ml/m2 (normal range 69+/-14), the RVEDV is 197 ml (normal range 110+/-24), the RV end systolic volume index is 111 ml/m2 (normal range 22+/-8), and the RVESV is 197 ml (normal range 35+/-13). Right AtriumThe right atrium is mild to moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is MR in the setting of LV dilation with at least moderate, if not severe MR. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is estimated 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 normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a large left pleural effusion with compression of the entire left lung and rightward shift of the mediastinum. The pleural effusion is increased since prior CT thorax. The previous right pleural effusion is resolved. There are small axillary lymph nodes which may be reactive in nature.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 12%. There is akinesis of the basal, mid and apical anterior, septal and infero-septal walls. The myocardium is thinned and dilated. Limited post contrast assessment was obtained on this study which limits full viability evaluation, however overall appearance is of a proximal wrap-around LAD infarct that is less likely to be viable. 2. There is no evidence of an LV thrombus.3. The right ventricle is mild to moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 17%4. Large left pleural effusion, as described above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 41-year-old male. Pain. Evaluate left shoulder/Dr Shi protocol. Four views of the left shoulder show moderate to severe osteoarthritis of the glenohumeral joint. There is slight posterior subluxation of the humeral head relative to the glenoid on the axillary view. Of note, the posterior glenoid appeared hypoplastic on the prior MRI. Mild to moderate osteoarthritis affects the acromioclavicular joint.

Output: Osteoarthritis, as above.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass or edema. Periventricular small vessel disease of indeterminate age. A poorly defined focus of hypoattenuation in the left pons may represent artifact, however, pontine CVA cannot be excluded. MRI may be helpful for further evaluation if clinically indicated.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: 1.Small vessel disease of indeterminate age. 2.Poorly defined focus of hypoattenuation in the left pons may represent artifact, however, pontine CVA cannot be excluded. MRI may be helpful for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: History of tuberous sclerosis, SEGA, and seizure on Everolimus. Evaluate SEGA, and cortical tubers for interval change. Redemonstrated are extensive cortical and subcortical foci of increased T2 signal in the bilateral cerebral hemispheres, which are similar to prior study. There is a subtle ill-defined focus of low signal intensity on FLAIR and high T2 signal intensity on T2-weighted images in the inferior posterior aspect of the left cerebellar hemisphere without significant interval change, likely an additional stable parenchymal tuber. There is associated susceptibility artifact/calcifation and very subtle enhancement. Multiple subependymal enhancing nodules of varying size are again identified. An enhancing nodule/SEGA in the right frontal horn measures 11x9x10 mm, previously 13x8x9 similar to prior study. An enhancing nodule at the level of the trigone of the right lateral ventricle and along the ependymal lining of the posterior body of the left lateral ventricle are also similar in size allowing for differences in technique. These nodules are calcified as seen on prior CT.There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a mucous retention cyst in the right maxillary sinus. The skull and extracranial soft tissues are unremarkable.

Output: 1. Overall, stable stigmata of tuberous sclerosis including dominant enhancing nodule at the right frontal horn/foramen of Monro. This lesion may represent a subpendymal giant cell tumor but has not enlarged in the interval.2. No hydrocephalus.


Instruction: Generate impression based on findings.

Input: 61-year-old female with history of IO placement within the right tibia now with concern for cellulitis and osteomyelitis. There is branching signal abnormality and enhancement within the proximal tibia extending from the tibial plateau into the proximal diaphysis over a craniocaudal distance of approximately 11 cm compatible with osteomyelitis. There is less well-defined signal abnormality which is appreciated within the distal tibia along with small round foci of enhancement which may also represent infection.There is a large knee joint effusion with mild synovial enhancement. Please note that we cannot exclude the possibility of a septic joint. There is a small Baker cyst.There is edema and enhancement of the soft tissues of the upper leg appearing similar to the prior MRI exam. A small fluid collection is present within the subcutaneous fat adjacent to the tibial tuberosity measuring approximately 1.5 x 0.7 cm in the transverse dimension and 2.5 cm craniocaudally which may represent a small abscess. There is also edema within the soft tissues of the distal thigh particularly between the vastus lateralis and biceps femoris.

Output: 1.New signal abnormality within the bone marrow of the tibia compatible with osteomyelitis.2.Soft tissue inflammatory changes as described above including a small abscess along the medial aspect of the tibial tuberosity.Findings discussed with Dr. Davey at 0930 on 1/13/15.


Instruction: Generate impression based on findings.

Input: Right upper quadrant pain. History of a benign liver cyst status post unroofing. Pathology showed a simple biliary cyst. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. No biliary ductal dilatation. Normal gallbladder.The patient is status post unroofing of the large right hepatic dome cystic mass. In this region there is a 2.3 x 1.4 cm predominantly T2-weighted hyperintense nonenhancing focus and post-surgical changes. Similarly the caudate/segment 4A lesion has been resected.Several additional subcentimeter nonenhancing T2-weighted hyperintensity lesions in the liver, compatible with simple cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts. No 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: Post-surgical changes from unroofing of the right hepatic dome lesion and the caudate/segmenta IVa cystic lesion. No specific findings to account for the patient's current abdominal pain.


Instruction: Generate impression based on findings.

Input: 46 sure old female with low back pain Minimal chronic anterior wedging at L1. Mild multilevel disk desiccation including L1-L2, L3-L4, L4-L5 and L5-S1. Alignment is anatomic. Signal within the distal cord and conus is within normal limits.T12-L1: No significant central canal stenosis or neural foraminal narrowing.L1-L2: No significant central canal stenosis or neuroforaminal narrowing.L2-L3: No significant central canal stenosis or neuroforaminal narrowing.L3-L4: Asymmetric disk bulge to the right. No significant central canal stenosis. Mild right neuroforaminal stenosis.L4-L5: Asymmetric disk bulge to the right. No significant central canal stenosis. Mild right-sided neuroforaminal stenosis. Bilateral facet arthropathy.L5-S1: Broad based disk bulge with a small central protrusion producing mild central canal narrowing. Minimal right-sided neuroforaminal stenosis. Mild left-sided neural frontal stenosis.

Output: Central disk protrusion that L5-S1 producing mild central canal stenosis.


Instruction: Generate impression based on findings.

Input: Prior intrathecal MTX: gait difficulty and cognitive symptoms. There appears to be mild disproportionate enlargement of the lateral and third ventricles, as well as a prominent cerebrospinal fluid flow jet in the third ventricle. There is diffuse patchy cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. Findings suggestive of normal pressure hydrocephalus.2. Diffuse white matter abnormality may represent sequela of chemotherapy versus chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Syncopal episode. There is a punctate focus of subcortical white matter T2 hyperintensity in the right superior frontal gyrus. The hippocampi are unremarkable. There is no evidence of heterotopia, 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: No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: MS, eval for progression History: gait problems Multifocal bihemispheric FLAIR high signal intensity lesions are again seen.Overall the number and size of lesions do not show any significant interval change since prior scan. However, there are a couple of lesions appear to be more conspicuous on this scan than prior which include left superior temporal gyrus anterior aspect lesion and the lesion just below the left Heschl's gyrus, right mesial temporal lobe. On the other hand, the FLAIR high signal intensity lesion at the right periventricular white matter lesion at anterior aspect of the external capsule especially around the frontal horn appears to be slightly smaller in its extent than prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Overall stable FLAIR high signal intensity lesions consistent with Multiple Sclerosis.2. Some lesions are more conspicuous on today's scan and another appears to be slightly decreased in its extent since prior scan as described above.


Instruction: Generate impression based on findings.

Input: There is no acute cord compression. Degenerative changes are predominantly seen in the cervical spine with areas of mild to moderate central canal stenosis, most significantly at C3-C4. Increased signal within the cervical spinal cord seen on STIR images may be artifactual. Dedicated cervical spine imaging can be considered if further evaluation is clinically warranted. Scattered areas of ligamentum flavum hypertrophy are seen throughout the thoracic spine.

Output: No acute cord compression. Dedicated segment-specific MRI is recommended if symptomology localizes and/or if chronic pathology is identified requiring subsequent therapies which has not been imaged previously.


Instruction: Generate impression based on findings.

Input: Pseudotumor cerebri with headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are bifrontal tracts related to prior ventricular catheterization. There is flattening of the pituitary gland, but no frank partially empty sella. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: No evidence of ventriculomegaly, ventricular effacement, or herniation. Flattening of the pituitary gland, but no frank partially empty sella, may nevertheless be a manifestation of pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: 16 week old male with swelling and pain and elevated inflammatory markers. Evaluate for myositis versus osteomyelitis. Again the proximal femoral metaphysis is noted to be displaced laterally from the acetabulum. This is moderate-sized intermediate T1 and T2 signal left hip joint effusion measuring at least 2.2 x 1.7 cm (series 1001, image 11) with synovial enhancement.Mildly increased focal T2 signal involving the distal left femoral metaphysis as noted on coronal STIR series 401, image 23; this region does not demonstrate abnormal enhancement and the overlying cortex is intact. There is extensive T2/STIR signal within the left gluteal and left thigh musculature compatible with inflammation/edema. The left thigh musculature and the left gluteal musculature demonstrates extensive enhancement compatible with myositis. In addition, there are multiple T1 hypointense and T2 hyperintense collections throughout the inferior gluteus medius, gluteus minimus, proximal hamstrings, and proximal anterior thigh musculature which demonstrate peripheral enhancement compatible with abscesses. The largest of these is in the gluteus medius and measures approximately 1.4 x 1.1 cm (cranial caudal and AP dimension as seen on series 1001, image 12).

Output: 1.Extensive left gluteal and thigh musculature myositis. No definite evidence of osteomyelitis. 2.Findings compatible with multiple abscesses in the left gluteal and proximal thigh musculature as detailed.3.Moderate sized complex appearing left hip joint effusion concerning for septic arthritis.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to partial glossectomy and neck dissection, as well as effect of radiation therapy. There is no measurable residual tongue mass. The mandible appears to be intact. There is no significant cervical lymphadenopathy. The remaining salivary glands and thyroid are unchanged. There is mild degenerative spondylosis involving the lower cervical spine. The orbits and imaged intracranial structures are unremarkable. There is fluid in the left mastoid air cells.

Output: 1. No definite evidence of measurable locoregional tumor or significant cervical lymphadenopathy.2. The mandible appears to be intact. 3. Persistent left mastoid effusion.


Instruction: Generate impression based on findings.

Input: Seizures. Evaluation is limited by motion artifact, lack of intravenous contrast and early termination of the study due to patient intolerance. There is no evidence of acute intracranial hemorrhage, mass effect, or acute infarct. There is encephalomalacia involving the left anterior inferior frontal lobe and left anterior temporal lobe. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific, but most consistent with moderate chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. Incidentally noted is a partially empty sella.

Output: 1.No obvious lesion to correlate with CT findings. Motion artifact and lack of intravenous contrast limits evaluation. Additionally, the patient was unable to tolerate completion of the study.2.No evidence of acute intracranial hemorrhage, mass effect, or acute infarct.3.Encephalomalacia involving the left anterior inferior frontal lobe and left anterior temporal lobe, likely related to chronic infarcts.4.Moderate chronic white matter small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Syncope and collapse [R55], Reason for Study: ^Reason: Transient right side weakness with right arm tremor question TIA vs seizure History: Above Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is no evidence of abnormal enhancement.There is tubular susceptibility lesion about 7.4mm in length on the left caudate head which may indicate prior hemorrhagic foci or partially visualized venous structure, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA:3D TOF MRA of neck and 3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Tubular susceptibility lesion on the left caudate head likely represent either old hemorrhagic foci or partially visualized venous structure, no change since prior scan.3. Normal Brain MRA and Neck MRA


Instruction: Generate impression based on findings.

Input: 52 years Female (DOB:8/14/1963)Reason: Eval meningioma. S/p fractionated SRS in 7/2014. Please compare to older OSH MRIs. History: probable meningioma.PROVIDER/ATTENDING NAME: RIMAS V LUKAS RIMAS V LUKAS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 13 x 11 mm axial dimension and 13 x 15 mm sagittal dimension extra-axial mass adjacent to the left cuneus and also adjacent to the superior sagittal sinus. Superior sagittal sinus appears to be patent.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There appears be large arachnoid granulation within the left transverse sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a small meningioma adjacent to the left cuneus and adjacent to the superior sagittal sinus. The superior sagittal sinus appears to be patent.


Instruction: Generate impression based on findings.

Input: History of pancreatic mass, please evaluate. Per Epic notes, prior outside imaging showed splenic lesion and incidental 3 mm uncinate process mass.. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal signal intensity without focal lesions. No biliary ductal dilatation. SPLEEN: There is a 2.8 x 3.3 x 3.1 cm mass within the spleen (series 7, image 11). The mass demonstrates peripheral low signal rim, increased T2 signal centrally, decreased T1 signal centrally, and does not enhance. These features are most consistent with a cyst from prior trauma.PANCREAS: The pancreas demonstrates normal signal intensity and enhancement. The pancreatic duct is normal in caliber. There is a 3 mm cystic focus within the pancreatic head which is nonspecific and too small to characterize.ADRENAL GLANDS: There is a 5 mm nodule within the left adrenal gland which demonstrates loss of signal on T1 out of phase images compatible with a benign adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Nonspecific 3 mm cystic focus in the pancreatic head, too small to characterize. Normal-appearing pancreatic duct and biliary system.2.Cyst in the spleen measuring 3.3 cm, likely post traumatic.3.5 mm left adrenal adenoma.


Instruction: Generate impression based on findings.

Input: Redemonstrated are changes from left temporal craniectomy with interval increase in extent of transcranial herniation associated with an increase of left occipital horn ex vacuo dilatation. Gliosis and susceptibility from hemosiderin staining is again noted along the operative approach. Dural thickening and enhancement is noted at the craniectomy site, however without an associated fluid collection. There remains smooth dural thickening and enhancement involving the left tentorium, above that normally expected. Additionally, there remains enhancement along the superior aspect of the operative approach. Previously demonstrated scalp enhancement has nearly resolved.There is new T2 hyperintensity associated with new mild mass effect involving the expected locations of the inferior olivary nuclei (best seen series 1801, image 5/30).The most recently documented CT hyperdense lesion, corresponding with cerebral cavernous malformation on comparison MRI, is again noted within the left posterolateral pons, without residual perilesional edema. When compared to the comparison MRI, there has been a change in character of the intrinsic components. Specifically, there has been an interval increase in septation and components demonstrating a more cystic fluid-like appearance,.There is no midline shift. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Left mastoid fluid signal has resolved.

Output: 1.The patient was nonverbal and moving throughout the exam, necessitating protocol modifications including some fast-scanning techniques.2.Redemonstrated are changes from left temporal craniectomy with interval increase in extent of transcranial herniation associated with an increase of left occipital horn ex vacuo dilatation. 3.There is new T2 hyperintensity associated with new mild mass effect involving the expected locations of the inferior olivary nuclei, most likely secondary to hypertrophic olivary degeneration.4.Left pontine cerebral cavernous malformation without residual perilesional edema.