Instruction: Generate impression based on findings.

Input: There is a focus of multisequence hypointensity involving the lateral aspect of the right medulla measuring 6 mm AP x 5 mm transverse x 9 mm craniocaudal dimension (as measured via T2 technique). There is an associated parenchymal defect along its lateral most aspect, and there are postprocedural changes involving the occipital calvarium, consistent with the provided history of previous surgery. There is no perilesional edema or apparent associated developmental venous anomaly. There are no other foci of susceptibility abnormality.Incidental note is made of a development venous anomaly involving primarily the superior cerebellar vermis, without associated susceptibility abnormality.There are scattered foci of T2 hyperintensity primarily within the subcortical white matter without mass effect, restricted diffusion, susceptibility abnormality, or enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within the inferior right maxillary sinus. Otherwise the remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.There is a focus of multisequence hypointensity involving the lateral aspect of the right medulla measuring 6 mm AP x 5 mm transverse x 9 mm craniocaudal dimension (as measured via T2 technique). There is an associated parenchymal defect along its lateral most aspect, and there are postprocedural changes involving the occipital calvarium, consistent with the provided history of previous surgery of a cavernous malformation. There is no perilesional edema or apparent associated developmental venous anomaly. There are no other foci of susceptibility abnormality.2.There are scattered foci of T2 hyperintensity primarily within the subcortical white matter without mass effect, restricted diffusion, susceptibility abnormality, or enhancement. These are nonspecific in appearance, and statistically most likely secondary to chronic small vessel disease.


Instruction: Generate impression based on findings.

Input: History of craniopharyngioma and progressive cysts status post partial resection and cyst drainage done March 30, 2013 as well as receiving weekly interferon on EPIC note dated 1/30/2015. Surveillance examination. Allowing for differences in technique and slice thickness, there is overall slight interval decrease size of the mixed cystic and solid tumor centered in the suprasellar cistern, compared to recent prior study dated 4/3/2015. The left cerebellopontine angle cystic component appears less convex with AP dimension measuring 7 mm (series 1001, image 17), previously is 10 mm . The left prepontine cistern cystic component measures 11 mm in short axis (series 1001, image 15), previously 14 mm. The right ambient cistern cystic component measures 16 mm in short axis (series 1001, image 13), previously 15 mm.Compared to the remote prior study dated 1/30/2015, there is interval increase in size of the right ambient cistern cystic component measuring 16 mm in short axis, previously 11 mm. There is interval decrease in size of the left prepontine cistern cystic component measuring 11 mm in short axis, previously 13 mm.There continues to be involvement of the prepontine, cerebellopontine angle cistern, right ambient and right quadrigeminal cisterns, as well as the right middle cranial fossa, with associated mass effect upon the brainstem, right medial temporal lobe, and hypothalamus-optic apparatus complex. There is asymmetric volume loss of the left cerebellar hemisphere suggestive of mild encephalomalacia, without significant interval change compared to 4/21/2014, but not present on exams prior to this. The basilar artery is tortuous and appears to be encased by the mixed cystic and solid mass.There are postoperative findings related to right temporal craniotomy and stable position of right frontal approach drainage catheter with tip in the right prepontine cyst. The ventricular system also appears to be unchanged. There are foci of susceptibility artifact within the right temporal lobe and left cerebellar hemisphere, consistent with hemosiderin deposition.

Output: 1. Compared to recent study dated 4/3/2015, slight interval increase in size of right ambient cistern cystic component and interval decrease in size of several other cystic components as described. Compared to more remote study of 1/30/2015, slight interval increase in size of right ambient cystic component with decrease in size of left prepontine cistern cystic component. For future follow-up, full MRI may be obtained with additional 2 mm axial T2 signal sequence to provide for best direct comparison.2. Asymmetric volume loss of the left cerebellar hemisphere suggestive of mild encephalomalacia, unchanged from 4/21/2014. 3. Stable shunt in the right prepontine cistern cyst.


Instruction: Generate impression based on findings.

Input: Neck pain, evaluate for myelopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis with mild kyphosis at the C5-C6 level. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine with multilevel disc desiccation and significant disc height loss at the C5-C6 and C6-C7 levels. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is a disc osteophyte complex and ligamentum flavum flavum thickening resulting in mild to moderate spinal canal stenosis at this level. There is prominent uncovertebral hypertrophy at this level resulting in severe left and moderate to severe right neural foraminal stenosis.C6-7: There is a disc osteophyte complex which effaces the ventral thecal sac and results in mild spinal canal stenosis. There is severe left and moderate to severe right neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina. Bilateral facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Degenerative changes in the cervical spine particularly at the C5-C6 and C6-C7 levels. There is associated mild to moderate spinal canal stenosis. No cord signal abnormality. There is also prominent uncovertebral hypertrophy with significant neural foraminal stenoses bilaterally at these levels.


Instruction: Generate impression based on findings.

Input: Lupus cerebritis and altered mental status. There is a subcentimeter mildly T2 hyperintense lesion with restricted diffusion in the posterior left cerebellar hemisphere. Punctate foci of high T21 signal without restricted diffusion in the right thalamus and left basal ganglia and thalami. There is also trace bilateral periventricular white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or mass. There is no abnormal intracranial enhancement. There is perhaps mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small amount of secretions in the posterior right ethmoid sinus.

Output: 1. Acute infarct in the posterior left cerebellar hemisphere, which may be related to lupus vasculitis. 2. Punctate foci of high T21 signal without restricted diffusion in the right thalamus and left basal ganglia and thalami may represent prior lacunar infarcts related to lupus vasculitis.


Instruction: Generate impression based on findings.

Input: Sciatica, right side, with severe worsening pain, considering steroid injection Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is grossly normal limits with perhaps minimal L3-L4 anterolisthesis. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, with disc desiccation and height loss at L3-L4, L4-L5, and relatively worse at L5-S1. There is vacuum disc phenomenon at L5-S1. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.L2-L3: Small left foraminal disc protrusion with mild left neural foraminal stenosis. No spinal canal or right neural foraminal stenosis. Mild bilateral facet arthropathy, worse on the right.L3-L4: Mild disc bulge. Bilateral facet arthropathy. There is minimal narrowing of the thecal sac in the anterior-posterior dimension, otherwise no significant spinal canal stenosis. Mild right neural foraminal stenosis. No significant left neural foraminal narrowing.L4-L5: Mild disc height loss. No significant spinal canal stenosis. Minimal right neural foraminal narrowing. No significant spinal canal or left neural foraminal narrowing. Mild bilateral facet arthropathy.L5-S1: Disc height loss and vacuum phenomena. Minimal bulge. No spinal canal or left neural foraminal stenosis. There is minimal right neural foraminal narrowing. Mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Mild degenerative changes in the lumbar spine. No high-grade spinal canal or high-grade neural foraminal stenosis is seen at any level. There is minimal to mild neural foraminal stenosis as described above. Disc height loss and endplate changes are worst at L5-S1.2. Facet arthropathy is seen at multiple levels, relatively worse at L3-L4, with also minimal anterolisthesis at this level.


Instruction: Generate impression based on findings.

Input: Aneurysm of vertebral artery [I72.6], Reason for Study: ^Reason: eval vertebral artery aneurysm History: unsteady gait, Rt vert artery aneurysm 65 years Female (DOB:10/25/1951)Reason: eval vertebral artery aneurysm History: unsteady gait, Rt vert artery aneurysmPROVIDER/ATTENDING NAME: DOROTA K HAVLIN Brain MRIThere is about 19mm sized right distal vertebral artery aneurysm which shows T1 and T2 high signal intensity portion on the dome indicating possible partially thrombosed or flow related artifacts.There is also associated adjacent brain parenchyma T2/FLAIR high signal intensity lesions in particular on the right cerebellar hemisphere as well as right middle cerebellar peduncle indicating aneurysm related brain parenchymal edema.There is no evidence of acute ischemic or hemorrhagic lesion.There are multifocal lacunar infarcts involving bilateral basal ganglia left centrum semiovale.Patchy T2/FLAIR high signal intensity lesions on bilateral periventricular white matter are seen, indicate nonspecific small vessel ischemic disease.The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate dominant right vertebral artery with about 19mm sized distal right vertebral artery aneurysm. The right PICA arose at the level of C1 arch but likely intradural origin.No other aneurysm is seen.Bilateral Pcom arteries and Acom artery are patent.Ventricular system appears to be within normal limits.Multiple supra and infra tentorial susceptibility lesions are seen indicating either chronic petechial hemorrhage or parenchymal mineralizations.

Output: 1. About 19mm sized right distal vertebral artery aneurysm with adjacent brain parenchymal T11/FLAIR high signal intensity lesion indicating parenchymal edema.2. No evidence of acute ischemic or hemorrhagic lesion.3. Non specific small vessel ischemic disease.4. Multifocal parenchymal susceptibility lesions indicate either chronic petechial hemorrhage or mineralizations.


Instruction: Generate impression based on findings.

Input: 16 year old female patient with new onset difficulty with word retrieval. Evaluate for a brain lesion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There are terminal zones of myelination as manifested by bilateral T2 hyperintense areas in the periventricular regions of the parietal lobes. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: 53-year-old female with proximal muscle weakness. Clinical diagnosis of polymyositis. There is minimal increased signal abnormality on fluid sensitive sequences within the deltoid and biceps brachii muscle bellies proximal to the level of the myotendinous junction, which appear intact. There is no evidence of fatty atrophy of the imaged musculature of the right arm. The remainder of the visualized musculature is normal in appearance. No bone marrow signal abnormality is identified. The visualized tendons are grossly unremarkable. The glenohumeral joint alignment appears to be anatomic.

Output: Slight increased signal abnormality on fluid sensitive sequences within the biceps brachii and deltoid muscle bellies which is nonspecific but can be seen in subacute denervation injury, myositis, as well as in the brachial neuritis.


Instruction: Generate impression based on findings.

Input: Disorientation, unspecified [R41.0], Reason for Study: ^Reason: eval for structural lesions, vascular dementia History: cognitive decline, gait instability No evidence of acute ischemic or hemorrhagic lesion.Right frontal approach ventriculostomy tube is seen and the tip location is at the level of the right side foramen of Monro. There are susceptibility artifacts along the ventriculostomy tube tract indicating ventriculostomy track blood products. There is also susceptibility lesions on the right periventricular white matter with focal tissue loss indicating prior hemorrhagic infarction.Ventricle size appears to be slightly enlarged. Although different modality, comparing to prior head CT scan performed on Jul 30 2015, ventricle size does not show any significant interval change. Patchy scattered high signal intensities on periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease. The cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.The pituitary gland appears to be slightly bigger than usual (11mm x 10.4mm) size with slightly upward convexity. Thus, if clinically indicated, dedicated pituitary gland imaging and/or hormonal assay can be considered.

Output: 1. Right frontal approach ventriculostomy status, no significant interval change of ventricle size comparing to prior CT scan.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.3. Nonspecific small vessel ischemic disease with chronic hemorrhagic infarction on the right periventricular white matter as described above.


Instruction: Generate impression based on findings.

Input: 22 agenesis of the corpus callosum. Assess for septo-optic dysplasia. BRAIN:There is complete agenesis of the corpus callosum with the associated lateral ventricular colpocephaly and parallel orientation. The septum pellucidum is absent. There is no interhemispheric cyst or lipoma. There is a persistent falcine sinus. There is crowding in the posterior fossa which likely relates to low position of the tentorium cerebelli and perhaps also a rather large cerebellum. Despite the crowding, there is no significant downward extension of the cerebellar tonsils through foramen magnum. Otherwise, there is no focal brain abnormality. Myelination is appropriate for age. Major intracranial vascular flow voids are preserved.The extra-axial/subarachnoid spaces, especially bifrontally, are prominent but maintain normal CSF signal. Given given the provided history of large head, this likely represents benign expansion of the extra-axial spaces of infancy. Prominent adenoids and included upper cervical lymph nodes are nonspecific in this age group. There is also nonspecific mucosal thickening/fluid signal in the ethmoid sinuses and right mastoid air cells.PITUITARY:The posterior pituitary bright spot is preserved. The optic infundibulum is midline and not thickened. There is no gross pituitary abnormality but the study was performed without intravenous contrast.ORBITS:There is suggestion of the left optic nerve being very minimally smaller and more T2-hyperintense than the right. The remainder of the optic apparatus is unremarkable. There is no orbital abnormality. Olfactory nerves are present bilaterally.

Output: 1.Complete agenesis of corpus callosum with associated findings. 2.There is suggestion of very minimal asymmetry between the optic nerves, the left being smaller. Optic nerve atrophy, however, is probably better assessed clinically. There is no significant abnormality along the optic apparatus or in the orbits otherwise.3.The posterior pituitary bright spot is preserved and the pituitary gland is otherwise unremarkable.4.Bifrontal prominent extra-axial fluid is compatible with benign expansion of the extra-axial spaces of infancy, which is most commonly a self-limiting process resolving by the age of 2 years.5.Posterior fossa crowning is probably related to a low lying tentorium and perhaps also a prominent cerebellum.


Instruction: Generate impression based on findings.

Input: Male, 6 months old. Reason: Rickets, multiple fractures, sub dural , hydrocephalus, 2 month follow up MRI evaluate for changes History: 2 month follow up MRI evaluate for changes The previously seen numerous scattered foci of susceptibility are less conspicuous on this exam compared to the prior study dated 06/24/2015. Specifically, a focus in the left temporal lobe is decreased in size from prior, and additional foci in the left anterior frontal lobe, right anterior temporal lobe, bilateral occipital lobes, and along the left cerebellar vermis are no longer clearly seen. More tubular areas of susceptibility along the right parietal lobe are also significantly decreased in prominence from prior.The previously seen small bilateral frontal subdural hematomas are essentially resolved, with minimal residual prominence of the extra-axial spaces. There is no evidence of new intracranial hemorrhage and no new abnormal extra-axial fluid collection. The ventricles, cisterns, and sulci are normal in size and configuration. There is no midline shift or mass effect. There is no evidence of acute infarct. There is decreased opacification of the paranasal sinuses, bilateral mastoid air cells, and middle ears. The orbits are unremarkable.

Output: 1. The previously seen bilateral subdural hematomas are essentially resolved, with minimal residual prominence of the extra-axial spaces.2. Significant interval improvement in scattered areas of susceptibility without evidence of new intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Septic shock, ARDS, persistent altered mental status slight xanthochromia on lumbar puncture. There is a focal restricted diffusion on the left occipital lobe subcortical white matter indicating ischemic stroke.On gradient echo images, the lesion was associated with focal signal void which may suggest possibility of hemorrhagic conversion. However, precise evaluation of signal intensities on the left posterior temporal and occipital lobe area is not possible due to motion artifacts. Therefore, the diagnosis of possible hemorrhagic conversion the left occipital lobe may need to be followed to confirm the diagnosis.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. The midline structures and cranial-cervical junction are normal. Left frontal and bilateral ethmoid sinus show fluid collections and mucosal thickenings. Bilateral mastoid air cells show fluid collections. The MRA shows significant motion artifacts which prevents precise evaluation.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate no evidence of major arterial occlusion or significant luminal stenosis. Vertebrobasilar system appears to be normal. There is no evidence of intracranial arterial aneurysm.

Output: 1. Significant motion artifacts degraded image quality.2. Focal restricted diffusion lesion on the left occipital lobe. Suspicious hemorrhagic transformation of the lesion but cannot confirm due to artifacts.3. No definitive evidence of intracranial arterial aneurysm, no significant (more than 50%) arterial luminal stenosis on MRA.


Instruction: Generate impression based on findings.

Input: 41 year old with strong family history of breast cancer. Family history of breast carcinoma in her sister (diagnosed at age 36), two aunts (diagnosed at age 40), and a cousin. Family history of ovarian cancer diagnosed in two aunts. BRCA mutation. Mild parenchymal enhancement is noted bilaterally. Scattered fibroglandular tissue is seen.No suspicious enhancement is seen in either breast. No significant change in bilateral enhancing foci. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 59 years, Female, frozen shoulders and asymmetric arm reflexes, now arms very weak. There are multiple scattered foci and confluent areas of T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter. Many of these lesions demonstrate an ovoid morphology and periventricular distribution. Several infratentorial lesions are also noted including the pons, right cerebellar hemisphere, and right superior cerebellar peduncle There is moderate degree of global parenchymal volume loss including thinning of the corpus callosum. Many lesions with T1 hypointensity/black holes are also noted. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Major flow-voids are preserved. There is mild opacification of the left mastoid air cells as well as right posterior ethmoid air cells. Paranasal sinuses and mastoid air cells are otherwise clear. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: 1. Multiple supra- and infratentorial T2/FLAIR hyperintense lesions with morphology and distribution consistent with chronic demyelinating disease. 2. Moderate degree of global parenchymal volume loss including of the corpus callosum. Multiple T1 hypointense lesions/black holes.If comparison study becomes available, an addendum can be issued to evaluate for new lesions. Postcontrast sequence may also be considered if there is suspicion for active demyelination.


Instruction: Generate impression based on findings.

Input: Female, 43 years old, with history of a left cerebellopontine angle meningioma status post resection, surveillance imaging. Again seen are postsurgical changes of left retrosigmoid craniotomy for resection of a left cerebellopontine angle meningioma. Compared to multiple prior studies there appears to be mild gradual enlargement of the residual extra-axial enhancing tissue in the left prepontine cistern. For example enhancing tissue measures 8 x 20 mm, post gadolinium 3-D series 12 image 53, compared to 6 x 18 mm measured in a similar plane on study from 9/30/2015. Craniocaudally lesion measures approximately 18 mm, previously approximately 15 mm on 9/30/2015.There is focal mass effect upon the left aspect of the pons which is minimally worse. Mass is noted to contact the left trigeminal nerve in its cisternal segment which has slightly progressed since priors. There is minimal contact of the basilar artery which remains patent. Remainder of the brain parenchyma is unremarkable. Incidentally seen is linear enhancement within the central pons compatible with capillary telangiectasia. No evidence of ischemia or hemorrhage. Ventricles are normal in size. Small left paraclinoid internal carotid artery aneurysm is better appreciated on prior CTA.

Output: Postoperative findings related to prior left cerebellopontine angle meningioma resection. Residual meningioma centered in the left prepontine cistern demonstrates gradual enlargement across multiple prior studies.


Instruction: Generate impression based on findings.

Input: Reason: eval for stress fx History: pain over 5th metatarsal and anterior ankle Marker is noted dorsal to the base of the fifth metatarsal. We see no signal abnormality of the fifth metatarsal or other bones to indicate stress fracture. Increased signal intensity in the distal third, fourth, and fifth metatarsals on fat-suppressed proton-density sequences is likely incomplete fat suppression.Small amount of fluid adjacent to the peroneus longus tendon as it enters and courses through the cuboid tunnel, perhaps representing mild tenosynovitis. Peroneus brevis tendon appears normal. Achilles tendon and posterior ankle tendons are unremarkable. Lateral collateral ligament complex is intact. Distal tibiofibular syndesmotic complex is intact. Visualized deltoid ligament is intact. The musculature of the foot appears normal. Plantar fascia and sinus tarsi are normal. We see no osteochondral defect.

Output: Small amount of fluid along the peroneus longus tendon as it courses through the cuboid tunnel, which may represent mild tenosynovitis. We see no stress fracture or other findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: Female 40 years old Reason: uterine fibroids, s/p uterine artery embolization History: uterine fibroids PELVIS:UTERUS, ADNEXA: The uterus measures 15.8 x 9.3 x 13.2 cm (series 901, image 24; series 1001, image 29). Multiple submucosal, intramural and subserosal T2 hypointense lesions are identified throughout uterine body consistent with fibroids. The largest is in the uterine body and measures 10.9 x 7.9 x 8.8 cm. These are nonenhancing postcontrast. Unremarkable appearance of the ovaries. Small nabothian and Bartholin's cysts are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple nonenhancing fibroids throughout the enlarged uterus.


Instruction: Generate impression based on findings.

Input: 51-year-old male with pain and swelling. Evaluate for MCL or ACL injury. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is bone marrow reactive change along the lateral femoral condyle and posterior lateral tibial plateau consistent with pivot shift bone contusions. There is a full-thickness articular cartilage fissure along the lateral facet of the patella. There is underlying bone marrow reactive change within the patella. There is also a focal full-thickness articular cartilage defect and delamination along the lateral aspect of the medial femoral condyle.LIGAMENTS: There is increased signal within the proximal fibers of the superficial and deep bands of the MCL suggestive of partial thickness tearing of the MCL. There is a small amount of fluid within the MCL bursa. There is complete disruption of the proximal fibers of the ACL. The PCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Rupture of the proximal fibers of the ACL with partial thickness tearing of the MCL and full-thickness articular cartilage defects. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 38-year-old male with MRSA bacteremia, recurrent fever, MRI pelvis (4/20) noted 3.0 x 1.8 cm abscess in the right obturator internus muscle, and MRI LS-spine (4/20) without evidence of discitis or osteomyelitis. BONE MARROW: There is edema type signal with enhancement of the right iliac bone extending to the acetabulum.SOFT TISSUE: There is marked abnormal T2 hyperintense signal and T1 intermediate signal throughout the course of the right obturator internus muscle extending from its origin to the insertion about the greater trochanter of the femur with rim enhancement. This signal intensity pattern immediately abuts the right iliac bone throughout its course. The collection is difficult to measure in its entirety given the irregular contour however for reference the largest component measures 6.1 cm x 3.5 cm and spans approximately 10 cm in craniocaudal dimension. There is surrounding soft tissue edema in the right hemipelvis as well as stranding within the proximal musculature of the right thigh.JOINTS: The hip joints appear within normal limits bilaterally. The sacroiliac joints are unremarkable.ADDITIONAL

Output: Findings most compatible with an abscess within the right obturator internus muscle with high suspicion for osteomyelitis affecting the right iliac bone. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: lung cancer with h/o brain mets, compare to previous, measurements please History: n/a. There is redemonstration of innumerable foci of abnormal enhancement with associated susceptibility consistent with chronic hemosiderin deposition, due to scattered intracranial metastatic disease. The dominant right frontal lobe peripherally enhancing lesion has slightly decreased in size, now measuring 2.0 x 2.0 cm in greatest axial dimensions on 12/149 x 2.4 cm CC on 1200/141, compared to previous 2.2 x 2.0 x 2.6 cm, respectively. Reference right paramedian parietal lesion measures 1.4 x 1.5 x 1.4 cm, compared to previous reported 1.6 x 1.6 x 1.6 cm.On the left a bilobed heterogeneously enhancing lesion has significantly decreased in size, now only measuring approximately 0.9 cm AP x 1.5 cm CC, compared to previous 1.3 x 1.8 cm.The left cerebellar lesion appears slightly increased in on 12/60, more linear in appearance than on prior exam where it seemed more punctate. Other small scattered cerebral lesions appear stable. No definite new foci of enhancement are appreciated.The extent of associated FLAIR hyperintensity surrounding the treated lesions has decreased in all locations. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is complete opacification of the right sphenoid sinus with associated diffusion restriction which can relate to pus, new since prior exam. There is a mucosal retention cyst in the left maxillary. Small T2 hyperintense cyst along left aspect of the odontoid tip is likely degenerative.

Output: 1. Redemonstration of multiple intracranial metastatic lesions with the largest in the cerebral hemispheres, overall decreased in size with diminished surrounding vasogenic edema since prior exam consistent with favorable treatment response.2. Stable pattern of scattered foci of susceptibility without corresponding enhancement which may represent chronic hemosiderin and/or mineralization related to treated metastases.3. Complete opacification of right sphenoid sinus, with associated diffusion restriction. Please correlate for acute sinusitis.


Instruction: Generate impression based on findings.

Input: 44-year-old male with left lower calf pain and prior ultrasound showing "mass in left groin/calf."IMAGE ACQUISITIONS: Helical scanning through the left lower extremity performed after IV administration of 120 cc of Omnipaque 380 at a rate of 4 cc/sec. Although no discrete mass is seen, there is a poorly defined, tubular structure within the soleus musculature that is difficult to delineate as it is nearly isodense to muscle. On the transverse images (series 7, image 479/699), it is 1.5 cm in diameter and extends for a length of 7 cm as seen on the coronal images (series 80420, image 54/68). It does not have the typical appearance of a soft tissue tumor and may represent either an isolated bundle of muscle or perhaps a venous varix as it does appear to be slightly hyperintense to musculature on coronal images. The possibility of a deep venous thrombus cannot be excluded. Please correlate with ultrasound examination; MRI may be considered for further evaluation if clinically warranted.There is also a 2 cm x 1 cm collection of low density seen between the left femoral vein and the lateral aspect of the pubic bone (series 7, image 70/699), which based on location and density likely either represents a para-labral cyst or fluid within the iliopsoas bursa. No additional mass is evident.

Output: 1.Poorly defined, tubular structure in the calf as described above that may either represent a separate muscle bundle or possibly a venous varix. The possibility of a deep venous thrombus cannot be excluded. Correlation with ultrasound examination is recommended; MRI evaluation may be considered if clinically warranted.2.Left hip para-labral cyst versus fluid in the iliopsoas bursa as described above. Findings discussed with Dr. Druelinger of the emergency department at the time of dictation.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meninges [D32.0], Reason for Study: ^Reason: hx meningioma. eval change. History: surveillance No evidence of acute ischemic or hemorrhagic lesion.Extra axial mass lesions are seen one on the left convexity (10mm x 6.4mm), and another on the right convexity [43mm (AP) x 21.4mm(CC) x 35.7mm(RL)] parietal lobe area. There is no evidence of adjacent brain edema, nor evidence of mass effect. The masses do not show enhancement but show well circumscribed low signal intensity on T2 and high signal intensity on T1 with evidence of fat suppression. Differential diagnosis include meningioma with fatty degeneration.There are encephalomalacia on bilateral frontal operculum with evidence of gliotic changes indicating chronic ischemic infarctions (left more extensive than right).Several scattered lacunar infarctions are seen on bilateral cerebellar hemispheres, lower pons and bilateral basal ganglia.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Bilateral convexity extra axial masses likely represent meningiomas (left side bigger than right).2. Multifocal scattered lacunar infarctions as well as chronic ischemic infarctions with encephalomalacia involving bilateral frontal operculum.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 50-year-old male with right shoulder pain. Evaluate for bicipital tendinopathy. ROTATOR CUFF: Note is made of a partial-thickness undersurface tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity, involving greater than 50% of the tendon width, measuring approximately 2.1 cm in the AP dimension. There is associated delamination of the undersurface fibers with approximately 2 cm of retraction. The supraspinatus muscle appears intact. There is partial thickness undersurface tearing of the anterior fibers of the infraspinatus at the level of its insertion on the greater tuberosity. There is interstitial tearing of the infraspinatus tendon at the level of the myotendinous junction. There is thickening and intermediate signal abnormality within the infraspinatus indicating mild tendinosis. The teres minor and subscapularis tendons and muscles appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. Mild to moderate degenerative changes affect the acromioclavicular joint with inferior osteophyte formation.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal abnormality within the anterior inferior glenoid labrum indicating degenerative tearing within the limitations of a non arthrogram study. There is also increased signal abnormality traversing the superior glenoid labrum indicating degenerative tearing. There is no signal abnormality extending into the biceps anchor within the limitations of a non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is thickening and intermediate signal abnormality within the intra-articular portion of the long head of the biceps indicating mild to moderate tendinosis. There is fluid within the tendon sheath of the long head of the biceps which likely represents fluid extension from the glenohumeral joint versus a very mild tenosynovitis.ADDITIONAL

Output: 1. Near full-thickness undersurface tear of these rotator cuff with retraction as described above.2. Tendinosis of the long head of the biceps tendon.3. Degenerative tearing of the glenoid labrum.


Instruction: Generate impression based on findings.

Input: Follow-up of post treatment of posterior fossa tumor, Redemonstration of previously cerebellar resection cavity and diffuse for volume loss of the cerebellar hemisphere presented as confluent and patchy high signal intensities on FLAIR images. There is no evidence of abnormal enhancement on this scan, no change since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Right frontal lobe developmental venous anomaly is again shown. No change since prior scan.Again right mastoid air cell and ethmoid sinus fluid collections were seen, no significant interval 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.

Output: Postoperative status of cerebellar lesion, postop no unusual finding.Specifically, there is no evidence of acute ischemic or hemorrhagic lesion, no evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Premature infant with Dandy walker variant suggested on head ultrasound. There is hypoplasia of the right cerebellar hemisphere and inferior cerebellar vermis, with associated linear susceptibility effect, which likely represents a development venous anomaly. There is relatively deficient myelination in the bilateral peri-Rolandic regions. The brain parenchyma, brainstem, and pituitary gland otherwise appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Aside from deficiency of parenchymal along the right posterolateral aspect of the fourth ventricle, the ventricles 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. Hypoplasia of the right cerebellar hemisphere and inferior cerebellar vermis, with what may represent an associated developmental venous anomaly.2. Relatively deficient myelination in the bilateral peri-Rolandic regions may be commensurate with prematurity.


Instruction: Generate impression based on findings.

Input: 72 year old male with a history of coronary artery disease (s/p multiple PCI, last 3/1/16, DES to 2nd diag), Mobitz type I heart block, pulmonary fibrosis, and CKD presenting as a transfer from OSH for c/f in-stent thrombosis Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVEDV is 183 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 81 ml (normal range 47+/-19), the LV mass index is 56 g/m2 (normal range 85+/-15), and the LV mass is 119 g (normal range 164+/-36). There are wall motion abnormalities in the mid to apical anterior and anteroseptal walls. There is transmural late gadolinium enhancement in a pattern consistent with myocardial infarction in the apical to mid anterior, lateral, anterolateral walls. These areas are unlikely to be viable. The remaining myocardium is likely to be viable. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 129 ml (normal range 142+/-31), the RV end systolic volume index is 21 ml/m2 (normal range 31+/-9), and the RVESV is 46 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is 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 normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThe left left hemidiaphragm is elevated. Bilateral pulmonary fibrosis with upper lobe predominance.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%.There are wall motion abnormalities in the mid to apical anterior and anteroseptal walls. There is transmural late gadolinium enhancement in a pattern consistent with myocardial infarction in the apical to mid anterior, lateral, anterolateral walls. These areas are unlikely to be viable. The remaining myocardium is likely to be viable. 2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 65%


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with low back pain, and right leg pain. L5 radiculopathy. History of discitis. A grade 1 anterolisthesis of L5 relative to S1 is seen. Sagittal alignment is otherwise unremarkable.Vertebral body heights are preserved. Severe endplate degenerative signal alteration is seen at L5-S1, with moderate endplate signal alteration at L3-4. Edema is evident within the L5 pedicles and surrounding the right L4-5 facet joint. Apart from degenerative endplate enhancement, no concerning or worrisome marrow enhancement is seen.The visualized distal spinal cord, conus and nerve roots of cauda equina are unremarkable. No epidural abnormalities are suspected. No intradural or extradural enhancing lesions are seen.The left kidney is large and contains several cystic lesions. A normal right kidney is not visualized, though in the right renal bed there is an oval enhancing structure which may represent dysplastic somewhat featureless renal parenchyma. A subcentimeter liver cyst is incidentally noted. Mild enhancement is seen on the sacral side of the sacroiliac joints bilaterally.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. L3-4: Moderate facet arthropathy and ligamentum flavum thickening. Severe loss of disc height and endplate irregularity. Minimal disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Moderate facet arthropathy and ligament flavum thickening with a facet effusion on the right. Mild disc bulging. No significant spinal canal or foraminal stenosis. L5-S1: Marked facet arthropathy and ligamentum flavum thickening. Disc bulging and disc uncovering. No significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing.

Output: 1.Severe degenerative disc disease is seen at L3-4 and L5-S1 with complete or near complete loss of disc height and endplate irregularity at these levels. There is no significant spinal canal stenosis. However, the neural foramina at L5-S1 are significantly narrowed.2.Facet arthropathy is evident most notably at L4-5 and L5-S1.3.Enhancement along the sacral portion of the sacroiliac joints may represent sacroiliitis.4.It appears that the right kidney is dysmorphic and somewhat featureless. Dedicated abdominal imaging can be considered to further evaluate if clinically warranted.


Instruction: Generate impression based on findings.

Input: Again seen is an encephalomalacic cavity in the left frontal lobe with redemonstration of susceptibility signal consistent with hemosiderin deposition at the site of the previously known left anterior frontal hematoma. This is unchanged from the previous study and measures 27 x 9 mm.Multifocal punctate T2 high signal foci are seen in the periventricular white matter space consistent with mild nonspecific small vessel ischemic changes. Unchanged small right middle cranial fossa arachnoid cyst. No evidence of acute infarct. No new hemorrhage. No new mass or mass effect. No hydrocephalus. Major flow-voids are preserved. Trapped secretions again noted in the right petrous apex which is pneumatized. Left ethmoid sinus fluid noted.

Output: 1. Chronic hemorrhagic cavity in the left frontal lobe appears similar to prior. Mild chronic small vessel ischemic changes. No new infarct or hemorrhage. 2. If evaluation of the previously treated aneurysm is desired, an MRA or CTA can be considered.


Instruction: Generate impression based on findings.

Input: Fever. Evaluate for intracranial or ophthalmologic process. History of papilledema and tortuous ocular vessels with 19 days of fever. MRI 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. There is minimal fluid within the right anterior ethmoid sinus.MRV: The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. There is no evidence of venous thrombosis.MRI ORBITS: No abnormal mass or abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size but with mild flattening of bilateral posterior sclera, and even slight elevation of the right optic nerve head. There is no associated enhancement or focal diffusion abnormality. There is also slight nonspecific fluid distension of the distal optic nerve sheaths bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1.Unremarkable MRI of the brain.2.Slight flattening of the posterior sclera with subtle elevation of the right optic nerve head and slight fluid distension of distal optic nerve sheaths, compatible with history of papilledema. 3. Normal MRV.


Instruction: Generate impression based on findings.

Input: Moyamoya disease [437.5], Reason for Study: ^Reason: hx moya moya, eval vasculature. Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.Previously recognized right lateral medullary subtle high signal intensity on diffusion weighted image is not showing restricted diffusion on today's scan, therefore this lesion is likely represent artifacts.Diffuse volume loss with multifocal patch high signal intensity of white matter on the left hemisphere indicating chronic ischemic lesions, do not show any interval change since prior scan.Multiple tortuous small signal voids around suprasellar cistern especially left MCA M1 segment area as well as left side ambient cistern indicate Moyamoya vessels, no change since prior scan.Post enhancement scan shows prominent enhancement of bihemispheric cortical vessels most likely cortical veins. This finding may suggest relatively slow flow or increased blood volume.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate non visualization of the left distal ICA and MCA but prominent left ACA. The distal right ICA and right MCA show luminal irregularity but the lumen size appear to be maintained. No significant interval change since prior scan.Perfusion MRIPerfusion MR scan using DSC technique shows mildly increased mean transit time on the left hemisphere especially frontal and posterior parietal lobes. The corresponding areas show slightly increased CBV and equivocal CBF.Please be reminded that the MR perfusion study can only provide relative value comparing to the other side which in this case is the right side.

Output: 1. No change of chronic ischemia related tissue loss on the left hemisphere, no change since prior scan.2. Moyamoya vessels on suprasellar cistern especially bilateral MCA M1 segment area and the left side ambient cistern.3. Occlusion of the left distal ICA and left MCA with prominent left ACA. Luminal irregularities were seen on the distal right ICA and right MCA with maintaining lumen size.4. Slightly increased MTT, increased CBV and equivocal CBF of the left hemisphere indicate possibly compensatory hypoperfusion status.


Instruction: Generate impression based on findings.

Input: 61 years, Male, left optic atrophy and vision changes. Additional provided history includes Chiari I malformation without spina bifida or hydrocephalus. MRI BRAIN: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Minimal foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. No other abnormal T2 signal is evident in the brain. There is been suboccipital craniectomy and resection of the posterior arch of C1 related to Chiari decompression surgery. The posterior fossa contents including the cerebellar tonsils are well decompressed. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Mild mucosal thickening is demonstrated in the frontal sinuses, posterior and anterior anterior ethmoid air cells, and bilateral maxillary sinuses. The mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. MRI ORBITS: No abnormal mass or abnormal enhancement is seen. The left optic nerve appears to be mildly asymmetrically diminutive compared to the right. There is no abnormal signal in the optic nerves. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1. Postoperative changes related to prior posterior fossa decompression. Posterior fossa structures are well compressed. Remainder of the brain parenchyma is otherwise within normal limits for age.2. No abnormal signal within the optic nerves is definitively appreciated. The left optic nerve is mildly asymmetrically smaller than the right, which is of uncertain significance. Orbital MRI appear otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 11 year old female with history of moyamoya disease and headache at the surgical site Postsurgical changes status post left parietal burr hole and left temporal craniotomy is noted. The bones appear to be in normal anatomic alignment.There is no evidence of intracranial hemorrhage, midline shift, mass or edema. Previously identified periventricular hypoattenuation are again noted and not significantly changed considering positional and technical differences, compatible with known moyamoya disease. The ventricles, cortical sulci and basal cisterns are normal in size and configuration.The visualized paranasal sinuses and mastoid air cells are well pneumatized.

Output: 1.No acute intracranial abnormality.2.Postsurgical changes status post left parietal burr hole and left temporal craniotomy.3.Periventricular white matter hypoattenuation not significantly changed compared to prior exam considering positional and technical differences, and compatible with known history of moyamoya disease.


Instruction: Generate impression based on findings.

Input: Clinical question: 35- week old infant with apnea. Evaluate for intracranial abnormality. Signs and symptoms: Apnea. Unenhanced head CT:There is no evidence of intracranial hemorrhage, mass-effect, midline shift or hydrocephalus. Although there is no suggestion of any edematous changes of brain parenchymal immature brain parenchymal can obscure subtle edema brain parenchyma. If clinical concern for ischemic change is high recommend an MRI examination. The cortical sulci, ventricular system and CSF cisterns are unremarkable for patient's stated age. No definitive abnormality in the posterior fossa is detected. Calvarium is intact.

Output: 1.No definitive evidence of acute intracranial abnormality.2.Immature brain parenchymal can obscure subtle edematous changes of brain on head CT. If clinical concern persist recommend an MRI examination.


Instruction: Generate impression based on findings.

Input: Clinical question: Tumor growth. Signs and symptoms: Falcine meningioma. Pre and post enhanced brain MRI:Examination demonstrates a right parafalcine posterior parietal dural based enhancing meningioma measuring at 33 x 14 mm coronal post enhanced series and approximately 22.5 x 14 mm in transaxial dimensions. Compared to prior exam there is no evidence of any appreciable interval change in the size, extent or uniform pattern of enhancement of the tumor.There is subtle buckling of the adjacent right parietal lobe similar to prior exam. There is revisualization of extensive cystic encephalomalacia of the left posterior parietal without interval change.Stable broad-based shallow right parietal parafalcine T1 hypointense finding representing pulsing calcification. An additional smaller similar finding in the left anterior frontal parafalcine region without interval change is also again noted.Images through posterior fossa demonstrate prominence of cerebellar and vermian folia for stated age of 43 however without change since prior exam. Unremarkable and stable study otherwise.Note from radiology resident on call indicates patient developed hives after injection of contrast which was treated with 50 mg of Benadryl and was discharged without complications.

Output: 1.No evidence of an acute or new finding since prior study.2.Stable right parafalcine posterior parietal meningioma as detailed.3.Stable falcine calcification in the right parietal and left anterior frontal similar to prior exam.4.Prominence of cerebellar and vermin folia for stated age of 43 without change since prior exam.5.Unremarkable and stable pre- and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: 50-year-old male with history of urothelial cancer. Status post right nephroureterectomy and right adrenalectomy in 2014. Please assess for disease progression. ABDOMEN:LIVER, BILIARY TRACT: Loss of signal intensity of the hepatic parenchyma between the in and out of phase sequences compatible with hepatic steatosis.SPLEEN: Splenomegaly measuring 15 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post right adrenalectomy. Normal left adrenal gland.KIDNEYS, URETERS: Status post right nephrectomy. No recurrent lesion identified in the surgical bed. Normal enhancement of the left renal parenchyma. No hydronephrosis. No filling defect of the left collecting system or left ureter.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Tiny hiatal hernia. Mild colonic diverticulosis without evidence for acute diverticulitis.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No abnormal filling defects or asymmetric wall thickening.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.Status post right nephrectomy. No evidence of local tumor recurrence or metastatic disease.2.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain and spinal cord [198.3], Reason for Study: ^Reason: 61 yo F with metastatic thyroid cancer to brain s/p resection, eval for cavity size. Previously seen left parietal lobe precuneus intra axial mass has been resected.There is localized hemosiderin deposition on the resection cavity.On Gadolinium enhanced images, thin peripheral enhancement was seen following the resection cavity which likely represent reactive enhancement but cannot completely exclude possibility of residual lesion.About 6mm sized nodular enhancing lesion on the left putamen is again seen, no change since prior scan in terms of size and enhancing pattern.About 3mm sized right inferior frontal gyrus area lesion just above the fronto-marginal sulcus appears to be stable. The lesion appears to be within the right front-marginal sulcus but could be an intra axial lesion located on the cortex, 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. Interval resection status of the left posterior parietal lobe, precuneus lesion since prior scan.2. No change of left putamen and right inferior frontal lobe enhancing lesions since prior scan.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsionsClinical question: Please evaluate for etiology (embolic etc) of seizuresSigns and Symptoms: Seizures MRI of the brainThere are small foci of diffusion restriction present along the right and left superior and middle frontal gyri bilaterally . Additional punctate foci of diffusion restriction are present in the parietal lobes and right periventricular white matter. The distribution is somewhat watershed. The ADC map abnormality is larger than the diffusion-weighted imaging abnormality for these lesions.Temporal horns of the lateral ventricles are large.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Compared to the prior exam there are a few more on the current exam than on the prior.A punctate foci of T2 hyperintensity scattered in the cerebellar hemispheres bilaterally which were also present on the prior exam and do not appear to have changed substantially. Similarly punctate T2 hyperintense foci in the basal ganglia are also stable.On susceptibility imaging there are multiple punctate foci of signal loss in the subcortical white matter.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus with near complete opacification as well as scattered opacities in the ethmoid air cells, mucosal thickening in the sphenoid sinus and an air-fluid level in the left sphenoid sinus. The visualized portions of the mastoid air cells are near completely opacified. The patient is status post endotracheal intubation.. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the right posterior cerebral artery with a fairly large right P1 segment. The left posterior communicating artery is very small. Anterior communicating artery is also very small. The left vertebral artery is slightly larger than the right vertebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There are small foci of subacute infarction present bilaterally in the frontal and parietal lobes in a watershed type distribution.4.There are multiple microhemorrhages in the subcortical white matter. This pattern is suggestive more of amyloid angiopathy as a potential cause. Although some of these were present on the prior exam from 2009, there is no susceptibility weighted imaging on the prior exam just gradient T2. As a result a direct comparison cannot be made.5.Periventricular and subcortical white matter lesions are present which are likely vascular related at this age, however, they have only mildly progressed compared to the previous exam.


Instruction: Generate impression based on findings.

Input: Knee pain. Knee injury three weeks. MENISCI: The menisci appear intact.ARTICULAR CARTILAGE AND BONE: Articular cartilage appears intact. Bone marrow signal intensity appears normal.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is perhaps mild edema of the quadriceps fat pad, but this is of questionable clinical significance.ADDITIONAL

Output: Mild edema of the quadriceps fat pad is of questionable clinical significance. I otherwise see no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer, brain metastases status post right cerebellar lesion resection and RT and AP26113 therapy. There are postoperative findings in the posterior fossa with mild nonspecific linear enhancement along the anterior aspect of the right cerebellar hemisphere surgical margin. There is an unchanged subcentimeter partially cystic and partially enhancing lesion in the right middle frontal gyrus, measuring up to 5 x 13 mm overall. There are also unchanged punctate lesions in the right parietal lobe, left superior frontal gyrus, and paracentral gyrus. There is persistent vasogenic edema associated with the lesions. There is no evidence of new intracranial lesions. 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. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged.

Output: 1. Postoperative findings in the posterior fossa with mild nonspecific linear enhancement along the right cerebellar hemisphere surgical margin. 2. Unchanged small supratentorial metastases.


Instruction: Generate impression based on findings.

Input: 5 year old female with subdural fluid collection. Postoperative exam. Right-sided shunt ventriculostomy catheter is unchanged in position. Right frontal catheter terminating in subdural collection unchanged. There is a new right parietal catheter terminating in subdural collection. The left frontal catheter terminating in subdural collection unchanged in position.There is new air in the right subdural collection. The right subdural collection is not significantly changed in size, measuring approximately 3.9 cm and greatest thickness, previously measured 4.1 cm (series 80498, image 43).The left subdural collection with internal air is not significantly changed, measuring 1.7 cm in greatest thickness, previously measured 1.8 cm (series 80498 on image 29). No evidence of acute hemorrhage.The common lateral ventricular chamber is unchanged in morphology or size, measuring approximately 8.0 cm in maximal transverse dimension, previously measured 8.2 cm (series 8 stroke 498, image 30).There is stable displacement of cerebellar tonsils below foramen magnum by 9 mm, previously this measured 9 mm.There is persistent abnormal morphology of the brain parenchyma and sulci, consistent with severe periventricular leukomalacia and areas of porencephaly in superior frontal and right occipital lobes, as described on recent MRI and unchanged. Abnormal morphology of calvarium, with bilateral burr holes unchanged.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.Stable ventricular size.2.Stable size of bilateral subdural collections, with new air and new catheter in right subdural collection.3.Abnormal brain parenchyma, calvarium, and ventricular configuration; findings are unchanged and most consistent with severe periventricular leukomalacia and porencephaly, as described on recent MRI. 4.Stable inferior displacement of cerebellar tonsils, consistent with Chiari I malformation.


Instruction: Generate impression based on findings.

Input: Outside imaging concerning for hepatocellular carcinoma. History of alcoholic cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with micronodular contour and reticular T2-weighted fibrotic changes. Moderate perihepatic ascites.In segment 7 of the liver there is a 3.6 x 2.9 cm (series 13/59) intrinsically T1 hyperintense lesion demonstrating postcontrast enhancement which is less than the background liver and no definite washout.Additional 1.3 cm lesion in the right hepatic dome (series 13/73) demonstrates similar imaging characteristics. Additional T2-weighted hypointense subcentimeter nodules are noted in the liver.No intra or extrahepatic biliary ductal dilatation.Partially distended gallbladder with numerous gallstones. Nonspecific minimal pericholecystic fluid.The vessels appear patent.SPLEEN: Splenomegaly measuring 16.5 cm in the craniocaudal dimension with numerous siderotic micronodules.PANCREAS: 1.6 x 1.6 pancreatic body cystic lesion demonstrates no postcontrast enhancement but has mild internal complexity. No definite communication with the main pancreatic duct which is normal in caliber. Normal variant ductal anatomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach is significantly distended to the level of the second portion of the duodenum without a discrete mass lesion evident, of unclear etiology. Small volume ascites.BONES, SOFT TISSUES: Recannulated periumbilical vein. Bilateral gynecomastia.OTHER: No significant abnormality noted.

Output: 1. Cirrhotic liver with extensive fibrosis and nodularity. 2. 3.6 cm segment VII lesion does not meet imaging criteria for hepatocellular carcinoma at this time and may represent a giant regenerative nodule or dysplastic nodule. Additional 1.3 cm right hepatic dome lesion with similar imaging characteristics. Continued surveillance imaging is recommended.3. Small volume ascites, splenomegaly and collateral vessel formation compatible with portal hypertension.4. 1.6 cm pancreatic body cystic neoplasm with mild internal complexity but no postcontrast enhancement. Follow up is suggested.


Instruction: Generate impression based on findings.

Input: Epilepsy, unspecified, not intractable, without status epilepticus [G40.909], Reason for Study: ^Reason: hx of brain mets , ams , seizures History: ams There is redemonstration of left frontal craniotomy changes related to resection of left frontal lobe metastatic lesion with resultant ex vacuo dilatation of the anterior horn of the left lateral ventricle. Scattered areas of enhancement surrounding the surgical bed appears similar to prior examination. There is confluent T2/FLAIR signal surrounding the surgical cavity also similar to prior examination. A dominant enhancing lesion in the left cerebellum appears unchanged from prior examination. A low T1/T2 focus adjacent to the temporal horn of the right lateral ventricle (series 1103, image 85) also appears grossly unchanged without surrounding edema. There is subtle increased T2/FLAIR signal and enhancement which likely represents vascularity involving the left parietal, occipital, and posterior temporal lobes with additional area of increased T2 signal involving the left hippocampus, findings which may be postictal. There is mild fullness of the left parietal lobe gyri. Small foci of diffusion restriction involving the left occipital lobe may be artifactual or also related to postictal state.Several scattered foci of susceptibility likely relating to hemosiderin deposition appear unchanged from prior examination. No midline shift or mass effect is appreciated. There is diffuse mucosal thickening of the left maxillary sinus and mild mucosal thickening of the ethmoid air cells.

Output: 1. Redemonstrated postsurgical changes related to resection of left frontal lobe lesion with dominant enhancing lesion in the left cerebellum, similar to prior examination. No new or enlarging lesions to suggest progression of metastatic disease.2. There is subtle increased T2/FLAIR signal and increased vascularity involving the left parietal, occipital, and posterior temporal lobes with additional area of increased T2 signal involving the left hippocampus. These findings are suspected to be postictal in etiology.3. Small apparent foci of diffusion hyperintensity in the left occipital lobe may be artifactual or also related to postictal state.4. There is diffuse mucosal thickening of the left maxillary sinus and mild mucosal thickening of the ethmoid air cells.


Instruction: Generate impression based on findings.

Input: New daily headache and visual disturbance. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a several scattered punctate foci of cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Several scattered punctate foci of cerebral white matter T2 hyperintensity are nonspecific, but may represent sequela of vasculitis, migraines, small vessel ischemic disease, and demyelination, for example. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarction.


Instruction: Generate impression based on findings.

Input: 73-year-old female with history of cervical disc bulge with left shoulder/arm pain and tingling. Evaluate for changes. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is straightening of the cervical spinal curvature, with otherwise grossly preserved alignment. Bone marrow signal is benign. Motion degradation somewhat limits exam. No appreciable cord signal abnormality. There is developmental narrowing of cervical spinal canal with superimposed degenerative changes in the cervical spine as described below:C2-3: There is a disc osteophyte complex eccentric to the left with moderate spinal canal stenosis involving the left aspect of the spinal canal. There is deformity of the left ventral cord. No cord signal abnormality. There is mild to moderate bilateral neural foraminal stenosis. Bilateral facet arthropathy.C3-4: Disc osteophyte complex with moderate spinal canal stenosis. There is moderate to severe right neural foraminal stenosis. Left neural foramen is patent. There is right-sided facet arthropathy.C4-5: No significant compromise to the spinal canal aside from developmental narrowing. There is moderate left neural foraminal stenosis. No significant right neural foraminal narrowing. There is left greater than right facet arthropathy.C5-6: There is a disc osteophyte complex with mild spinal canal stenosis. There is moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy.C6-7: Small disc osteophyte complex without significant compromise to the spinal canal. There is severe bilateral neural foraminal stenosis.C7-T1: Small disc osteophyte complex. No significant compromise to the spinal canal. Mild bilateral neural foraminal narrowing. There is facet arthropathy, right worse in left.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes throughout the cervical spine which have slightly progressed since 6/6/2008. 2. There is up to moderate spinal canal stenosis involving the left aspect of the spinal canal at the C2-C3 level as well as moderate spinal canal stenosis at the C3-C4 level related to degenerative disease superimposed on a developmentally narrow spinal canal. No cord signal abnormality.3. Multilevel neural foraminal stenosis including right C3-C4, left C4-C5, bilateral C5-C6, and bilateral C6-C7 levels. Please see additional details above.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is minimal increased signal of the supraspinatus tendon distally. The remaining rotator cuff tendons are normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. Specifically, the labrum appears normal.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Minimal tendinopathy of the supraspinatus tendon distally. Remaining evaluation of the shoulder is otherwise normal.


Instruction: Generate impression based on findings.

Input: Knee pain following injury MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a nondisplaced fracture of the lateral tibial plateau with minimal depression of the articular surface. There is some irregularity of the articular cartilage overlying the fracture site of the tibial plateau. The articular cartilage of the remaining lateral compartment appears thin but is otherwise intact. There are no full-thickness defects of the articular cartilage of the medial or patellofemoral compartments.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Nondisplaced fracture of the lateral tibial plateau with minimal depression. There is a large associated lipohemarthrosis. These findings were discussed with the ordering physician Dr. S. Naaman at the time of interpretation.


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate for bleed. Signs and symptoms: Altered mental status. Status post fall. Nonenhanced head CT:Examination demonstrates no evidence of intracranial hemorrhage.Large area of low-attenuation involving the left posterior temporal and extending into the left occipital lobe and further superiorly into the parietal lobe. There is only suspected subtle mass effect and effacement of adjacent cortical sulci in particular in the parietal component. This finding although has the appearance of an old stroke possibility of a subacute component cannot be ruled out. There is no associated hemorrhage. Recommend further follow-up weighted and MRI exam to exclude acute/subacute stroke. One there is no evidence of hemorrhage midline shift or hydrocephalus.Calvarium is intact. Visualized mastoid air cells and middle ear cavities are pneumatized and unremarkable.Debris within bilateral external auditory canals.CT of cervical spine:Images through the skull base are unremarkable. The articulation of C1 and C2 remains within normal no fracture is detected. Degenerative changes of cervical spine with multilevel neural foramina compromise is identified. There is however no evidence of cervical spinal fracture. The alignment the vertebral column is unremarkable. There is however scoliosis.No detectable soft tissue abnormality of the neck.CT of orbits:Examination demonstrates preseptal periorbital swelling likely result of recent trauma. There is no evidence of fracture. The retro-orbital fat is within normal limits. There is normal morphology and density of globes with intact lenses. The extraocular musculature is unremarkable. Visualized paranasal sinuses are unremarkable.

Output: 1.Negative CT of cervical spine for fracture. Degenerative disk disease is noted.2.Head CT demonstrates large area of low-attenuation in the left posterior temporal extending to occipital and left parietal lobe. Although large segment of this finding appears as an old cortical stroke there are suspected areas of effacement of cortical sulci in the parietal region may indicate an overlapping acute/subacute new stroke. Recommend further follow-up with an MRI. There is no evidence of posttraumatic intracranial abnormality.3.CT of orbits demonstrate right sided preseptal periorbital swelling likely result of recent trauma. No evidence of fracture or any abnormality in the retroseptal region.


Instruction: Generate impression based on findings.

Input: 34-year-old man with history of complex left renal cyst and left middle to left upper quadrant pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal. The gallbladder is normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: Spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: There is mild caliectasis of the left kidney in addition to a 43 x 26 mm parapelvic cyst (series 801, image 19). No obstructing mass is identified in the collecting system. There is a small inferior right renal pole cyst, otherwise the right kidney appears normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted. BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.MRA ABDOMEN: The aorta is normal in caliber and the mesenteric and renal arteries are normal.

Output: 1.Mild left renal caliectasis and additional parapelvic cyst. There is likely a left UPJ obstruction, however no focal lesion identified.2.Normal abdominal MRA.


Instruction: Generate impression based on findings.

Input: Axial T2 images are motion degraded. Given this caveat:There is straightening of the upper cervical spine. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Mild posterior osteophyte disc complex and uncinate hypertrophy without significant stenosis.C4/5: Mild posterior osteophyte disc complex and uncinate hypertrophy resulting in mild left neural foraminal stenosis.C5/6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is flattening of the anterior cord without intrinsic T2 cord signal abnormality. There is mild central and moderate bilateral neural foraminal stenosis.C6/7: UnremarkableC7/T1: Unremarkable

Output: 1.The cervical and upper thoracic cord is normal in signal without abnormal enhancement.2.C4/5: Mild left neural foraminal stenosis.3.C5/6: Mild central and moderate bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 31-year-old male with VP shunt. Headache. There has been interval removal of a right-sided shunt catheter. Overall, third and lateral ventriculomegaly is improved. Enlarged third ventricle correlates with findings on prior brain MRI. There is no evidence of intracranial hemorrhage.There is a large sellar mass with extension into the basal cistern. Extensive calcifications are again seen. No significant change in the sellar mass.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Improved ventriculomegaly of the lateral and third ventricles.


Instruction: Generate impression based on findings.

Input: Malignant (primary) neoplasm, unspecified [C80.1] / Human immunodeficiency virus (HIV) disease [B20] / Secondary malignant neoplasm of bone [C79.51] / Disorder of bone, unspecified [M89.9], Reason for Study: ^Reason: cord compression protocol - rule out Cervical MRI:Motion artifacts degraded exam quality.There is normal cervical lordosis. The cranial-cervical junction is normal.Spinal cord signal intensity is normal.There are focal protrusion of discs without creating spinal stenosis at the level of C45 (central to left) and C56 (central to right) level.There is an enhancing mass on the left side paravertebral muscle (21.6mm x 19.8mm) indicating possible lymph node enlargement or muscle mass.Vertebral bodies appears to be within normal limits.Thoracic MRIThere is normal thoracic kyphosis and spine alignment is normal.Spinal cord signal intensity is normal.There is T2 high signal intensity lesion at T10 vertebral body which most likely represent hemangioma. There is irregular shaped enhancing mass lesion on the left side of upper mediastinum which is adjacent to the junction of aortic arch and descending aorta as well as proximal subclavian artery suggesting possible malignant lesion. Dedicated imaging study such as Chest CT scan with enhancement can be considered for further imaging evaluation.No evidence of cord compression.Lumbar MRINormal lumbar lordosis. The spine alignment is anatomic.No evidence of spinal cord compression. The conus medullaris terminates at the level of T12-L1. There is 16.9mm x 18.5mm left adrenal gland nodule. The clinical significant of the lesion can be assessed with dedicated adrenal gland imaging, please consult to abdominal imaging department.There is evidence of soft tissue mass replacing cortical bone on the left side pedicle of the L1 vertebral body with the mass extension toward posterior aspect of the L1 body. The mass appears to be extended toward the left side neuroforamen. There are multifocal vertebral body marrow replacing lesions including L2 vertebral body left side, S1 vertebral body and right side ilium, most likely represent metastatic lesion.This lesion is consistent with metastatic lesion.

Output: 1. No evidence of spinal cord compression.2. Multiple enhancing soft tissue mass lesions including left posterior upper mediastinum, left adrenal gland and left side pedicle with L1 vertebral body indicating possible metastatic lesions.3. Soft tissue masses on the L2, S1 and right side ilium indicating possible metastatic lesions. Comment: considering multiple bony and adrenal metastatic lesions, dedicated imaging studies such as adrenal gland imaging and lumbar spine or pelvic imaging can be considered.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82] / Disorientation, unspecified [R41.0], Reason for Study: ^Reason: 77F with vascular disease, prior CVA, acute change in MS. No evidence of acute ischemic or hemorrhagic lesion on the scan.Patchy bi-frontal white matter high signal intensities on FLAIR and T2-weighted imaging are redemonstrated, no change since prior scan.There is no mass lesion on this scan.Post cataract surgery status on the right eye lens and possible prior retinal detachment change on the left orbit, 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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Minimal mucosal thickenings on the right ethmoid sinus and bilateral maxillary sinuses.

Output: No evidence of acute ischemic or hemorrhagic lesion.Bifrontal white matter lesions, no change since prior scan.


Instruction: Generate impression based on findings.

Input: 74-year-old female with history of cecal mass on colonoscopy. Rule out metastatic disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Small hypodense lesions scattered in both the liver, largest measuring less than 1 cm. There are two small to accurate characterize but are more likely to be cysts. Further evaluation with MRI may be helpful for better characterization if clinically indicated.SPLEEN: 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: Accent wall thickening involving the cecum consistent with patient's known history of carcinoma. 9 x 5 mm lymph node adjacent to the cecum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Multiple subcentimeter hypodense lesions scattered in both l lobes of the liver. Statistically they are more likely to represent cysts. MRI of the liver may be helpful in further characterization of these small lesions is clinically indicated. eccentric wall thickening of the cecum consistent with patient's known history of colonic carcinoma.


Instruction: Generate impression based on findings.

Input: 58-year-old male patient with severe dermatomyositis with proximal muscle wasting. Evaluate muscle mass. ROTATOR CUFF: There is mild thickening and increased signal intensity within the distal fibers of the supraspinatus tendon consistent with mild tendinosis, but no full-thickness tear. There is increased signal intensity within the supraspinatus muscle with minimal muscle atrophy. The tendons of the infraspinatus, teres minor, and subscapularis are intact. The muscles of the infraspinatus, teres minor, and subscapularis demonstrate increased signal intensity on T2-weighted images with minimal atrophy, more pronounced in the subscapularis.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is no significant fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The labrum appears intact. There is a small glenohumeral joint effusion. Degenerative cysts are noted within the posterolateral humeral head.BICEPS TENDON: The long head of the biceps tendon appears intact. ADDITIONAL

Output: 1. Diffuse signal abnormality within the visualized musculature of the right shoulder consistent with inflammation and provided history of dermatomyositis.2. Supraspinatus tendinopathy but no full thickness rotator cuff tear.3. Small glenohumeral joint effusion.


Instruction: Generate impression based on findings.

Input: Night times back pain, lower extremity numbness. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Individual levels as described 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.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is a disc bulge with central disc protrusion without significant central spinal canal stenosis. There is mild left neural foraminal stenosis. Right neural foramen is patent. There is also a Schmorl's node involving the posterior superior S1 vertebral body endplate with mild adjacent edema.Paraspinous soft tissues are within normal limits.

Output: 1. L5-S1 disc protrusion without significant central spinal canal stenosis. There is mild left neural foraminal stenosis. There is also intravertebral herniation (Schmorl's node) involving the superior endplate of the S1 vertebral body with mild surrounding edema.2. No significant disc disease, spinal canal or neural foraminal stenosis in the remainder of the lumbar spine.


Instruction: Generate impression based on findings.

Input: 39 year old female with strong family history of breast cancer (sister diagnosed with breast cancer at age 38) presents for screening MRI. There is scattered fibroglandular tissue in both breasts.Moderate 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: Newly diagnosed right sided non enhancing brain lesion: preoperative planning for biopsy. There is mildly expansile infiltrative high T2 signal within multiple lobes of the right cerebral hemisphere. There is partial effacement of the right lateral ventricle and 10 mm of midline shift to the left. There also appears to be a 10 mm wide focus encephalomalacia in the anterior left gyrus rectus. There are skin fiducial markers.

Output: Preoperative planning MRI demonstrates an infiltrative neoplasm involving multiple lobes of the right cerebral hemisphere, which is suggestive of gliomatosis cerebri.


Instruction: Generate impression based on findings.

Input: Left arm numbness. No evidence of acute ischemic or hemorrhagic lesion on the scan.Bilateral asymmetric high signal intensities on basal ganglia specifically globus pallidi on FLAIR images are seen. There is another lesion on the right side of cerebral peduncle which extends caudally to the level of upper pons. Interestingly, there is no imaging evidence of mass effects from these lesions except the left globus pallidus lesion.Those lesions do not show any restricted diffusion or susceptibility artifacts on gradient echo images.These findings are non specific thus the list of potential diagnosis could be very long.The differential diagnosis of these lesions include; demyelinating disease, inflammatory disease such as Neuro-Behcet disease, chronic toxic lesion such as carbon monoxide or methanol, metabolic lesions such as chronic liver disease or diabetes related non ketonic hyperglycemia or post infectious lesion such as post acute demyelinating encephalomyelopathy. Gadolinium enhanced MRI with clinical correlation might be helpful to narrow down the differential diagnosis.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.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.

Output: 1. Non specific bilateral globus pallidi as well as right cerebral peduncle, mid brain and upper pontine high signal intensity lesions on FLAIR images as described above. Gad enhanced MR images with clinical correlation are recommended. 2. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: Acute lymphoid leukemia, without mention of having achieved remission(204.00)Clinical question: stroke in pt w/ ALLSigns and Symptoms: acute onset of UE weakness, ptosis, slurred speech MRI of the brainThere is a 30 x 14 mm axial dimension focus of diffusion restriction located in the left centrum semiovale and extending to the subcortical white matter predominantly adjacent to the left frontal lobe extending towards the left parietal lobe. Transmedullary veins in the region are somewhat more prominent and hypointense on susceptibility weighted imaging. On FLAIR imaging there is only subtle signal hyperintensity in the area of diffusion restriction. No sulcal hyperintensities are appreciated on FLAIR MRI.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. Findings suggest some mild narrowing along the inferior division branch of the left middle cerebral artery at the distal M1 segment which supplies angular and posterior parietal arteries. It is quite possible this is related to artifact as well.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Findings are compatible with acute ischemic cerebral infarction involving left centrum semiovale and extending towards the subcortical white matter of the left frontal lobe and to lesser degree left parietal lobe. There is no evidence for hemorrhagic conversion.2.No intracranial cerebral vascular occlusion is appreciated.3.No extracranial cerebrovascular occlusion is appreciated. There is no evidence for carotid or vertebral dissection on the basis of this exam.


Instruction: Generate impression based on findings.

Input: History of testicular cancer. ABDOMEN:LIVER, BILIARY TRACT: Mild hepatic steatosis without focal lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts and probable too small to characterize cysts are present. No hydronephrosisRETROPERITONEUM, LYMPH NODES: No measurably enlarged retroperitoneal lymph nodes are evident.BOWEL, MESENTERY: No significant abnormality noted.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 abnormally enlarged lymph nodes. Prominent inguinal nodes bilaterally are less than 1cm in short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: known sickle cell disease patient evaluation and follow up. Evaluate for moyamoya syndrome. There is focal high signal intensity on FLAIR image on the right side cuneus lateral aspect white matter (seris 6, image 15/28). However there was subtle increased signal intensity on prior FLAIR images and there was no evidence of enhancement on today's images. Thus, this finding is most likely represent non specific finding.Otherwise there is no evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement either.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.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.

Output: 1. Subtle increased signal intensity on the right cuneus white matter which likely represent non specific lesion as described above. 2. Otherwise unremarkable brain MRI and normal brain MRA.