Instruction: Generate impression based on findings.

Input: Evaluate for stroke and abscess in the setting of slurred speech and immunosuppression.History of prior ischemic infarct with right-sided weakness, presenting with progressive slurred speech for 3 months and subjective left sided weakness for past 6 days. There appears to be a small area of restricted diffusion in the anterior right pontomedullary junction. There is also scattered patchy T2 hyperintensity in the pons. There is also encephalomalacia in the bilateral basal ganglia with associated susceptibility effect that likely represents chronic hemorrhage. There are a few scattered foci of susceptibility effect in the bilateral cerebral hemispheres, as well. There is extensive patchy cerebral white matter T2 hyperintensity predominantly in a periventricular and deep white matter distribution. There is no evidence of abnormal intracranial fluid collections. 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, and scalp soft tissues are grossly unremarkable. There are a small amount of secretions in the left maxillary sinus. There is degenerative spondylosis at C3-4 with a posterior disc-osteophyte that impinges upon the spinal cord.

Output: 1. Apparent small recent, perhaps subacute, infarct in the anterior right pontomedullary junction superimposed upon chronic pontine and bilateral basal ganglia infarcts and microhemorrhages.2. Extensive white matter abnormality may represent chronic small vessel ischemic disease or HIV encephalopathy, or a combination thereof, for example.3. Degenerative spondylosis at C3-4 with a posterior disc-osteophyte that impinges upon the spinal cord. Dedicated cervical spine imaging may be considered for further evaluation if clinically warranted.4. No evidence of acute infarct or intracranial abscess.


Instruction: Generate impression based on findings.

Input: headache and vomiting. No evidence of acute ischemic or hemorrhagic lesion on this scan.There is 8.5mm x 6mm sized non enhancing well circumscribed T1 low and T2 high attenuation on the pineal gland, which most likely represent pineal cyst.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Pineal cyst, 8.5mm x 6mm.Otherwise unremarkable brain MRI scan.


Instruction: Generate impression based on findings.

Input: Rule out septic joint/osteomyelitis the right knee in a patient with edema/edema despite broad-spectrum antibiotics. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Best seen on series #3, image 25 is a small full-thickness medial patellar facet cartilaginous defect.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. No specific evidence to suggest osteomyelitis, septic joint, or abscess. There is a deep ulcer without subjacent bony changes that is partially visualized on this examination just lateral to midline along the anterior knee skin surface.2. Focal chondromalacia of the patella as described above.3. Findings compatible with patient's known history of dermatomyositis.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: l mca strokeSigns and Symptoms: L mca strokeWeakness and neglect. 60 years old male. MRI of the brainThere is diffusion restriction present involving the left insular cortex, the left middle and inferior frontal lobe gyri as well as the left parietal lobe and portions of the posterior aspect of the left temporal lobe superior temporal lobe gyrus. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.On susceptibility imaging there are lower signal serpiginous flow-voids at the edge of the area of infarction signifying hypoxia along the watershed zone.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 and scattered opacities elsewhere.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a occlusion of the left middle cerebral artery distal to the left anterior temporal artery. There is some antegrade flow present along the left frontal orbital artery which appears to originate from the left anterior temporal artery.The anterior communicating artery is identified and is medium size. There is fetal origin of the posterior cerebral arteries bilaterally associated with small P1 segments. The left vertebral artery is small and predominantly supplies the left posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the right carotid bifurcation. On the basis of NASCET criteria there is 90% stenosis at the origin of the left internal carotid artery. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from a common trunk with the right common carotid artery. The right subclavian artery has an aberrant origin originating distal to the left subclavian artery. Findings suggest narrowing at the proximal right common carotid artery just distal to the origin of the left common carotid artery with approximately 50% stenosis of the right common carotid artery. The origin of the right vertebral artery is narrowed by approximately 50%. The left vertebral artery is small.

Output: 1.Subacute left middle cerebral artery territory infarction involving the left insular cortex, left inferior and middle frontal gyri and left parietal lobe as well as the left superior temporal gyrus. There is no evidence for hemorrhagic conversion at this time.2.Occlusion of the left middle cerebral artery at the M1 segment with some antegrade filling of the left anterior temporal artery to appears to be fairly large probably supplying part of the left frontal lobe and temporal lobe.3.90% stenosis at the origin of the left internal carotid artery.4.50% stenosis at the proximal right common carotid artery artery just distal to the origin of the left common carotid artery. Please note that the right subclavian artery has an aberrant origin and the right common carotid artery and left common carotid artery have a common trunk.5.50% stenosis at the origin of the right vertebral artery which is associated with a very small left vertebral artery


Instruction: Generate impression based on findings.

Input: Right arm and leg weakness. There is a heterogeneous hypodensity associated with calcifications located in the left parietal lobe. This finding was present on the recent MRI of the brain. There are periventricular hypodensities present which are matched with periventricular white matter changes identified on the recent MRI of the brain. There is no evidence for a new hemorrhage. There are calcifications present along the left parietal lobe and gyral structures.The patient is status post left-sided craniotomy.Limbic calcifications are present in the right eyeballThe visualized mastoid air cells and middle ears are clear. Visualized ethmoid and frontal sinuses are clear.

Output: 1.Status post left sided craniotomy for brain tumor. There is associated the mass effect at the site of the enhancing tumor identified on a recent MRI comparing to the previous CT scan from February there appears to be progression. If clinically appropriate to more accurately explain the patient's symptoms an MRI of the brain may be of benefit. There is no acute hematoma identified within the tumor bed rather there appear to be gyral calcifications along medial tumor bed.2.Periventricular hypodensities of a marked degree are present and have been present since the prior MRI exam and were less conspicuous on the February exam. This could represent post treatment change or tumor infiltration. The former more likely.


Instruction: Generate impression based on findings.

Input: 66 years, Female, GBM, had SRS to basal ganglia lesion, patient on PD 1 and CTLA4 Abs. Compared to 12/17/2015, there is interval increase in masslike T2/FLAIR hyperintensity involving the left optic tract, hypothalamus, and extending into the optic chiasm highly suspicious for tumor progression. There is also increased associated enhancement.There are postsurgical changes in the left anterior temporal lobe with blood products again seen along the posterior aspect of the resection cavity similar to prior. There is however interval increase in FLAIR hyperintensity in the left anterior temporal lobe posterior to the resection cavity with increased heterogeneous areas of nodular enhancement suspicious for tumor progression. More superiorly, at the level of the left basal ganglia, left periatrial white matter, and the left posterior temporal lobe, there is also increase in masslike FLAIR hyperintensity as well as increased in enhancement with mild restricted diffusion. Perfusion images demonstrate elevated cerebral blood volumes in the above-mentioned areas of increased enhancement and FLAIR hyperintensity.As before there is a left occipital resection cavity which communicates with the atrium of the left lateral ventricle. There is no midline shift or herniation. No hydrocephalus. There is diffuse opacification of the right maxillary sinus as before.

Output: Compared to 12/17/2015, findings are highly concerning for progression of multifocal glioblastoma, particularly in the region of the left optic tract and posterior to the anterior left temporal resection cavity as describe above. Additional areas of increased FLAIR hyperintensity and enhancement described above in the left basal ganglia and the left posterior temporal cortex are also suspicious. These areas demonstrate elevated cerebral blood volumes.


Instruction: Generate impression based on findings.

Input: Female, 27 years old. Reason: goiter History: goiter RIGHT LOBE MEASUREMENTS: 2.2 x 1.6 x 5.2 cmLEFT LOBE MEASUREMENTS: 1.9 x 1.5 x 4.9 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Heterogeneous echotexture. A mid to lower pole ill-defined hypoechoic region measures 0.9 x 1.2 x 1 .2 cm, noncalcified, nonvascular. A cystic lower pole nodule measures 0.4 x 0.3 x 0 .6 cm, noncalcified, nonvascular.LEFT LOBE: Heterogeneous echotexture without focal lesion.ISTHMUS: Heterogeneous echotexture without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A right level 3 lymph node measures 0.8 x 0.4 x 1.7 cm, with a fatty hilum.OTHER: No significant abnormality noted.

Output: Heterogeneous thyroid with a 1 cm hypoechoic region which possibly represents a discrete solid nodule in the inferior right thyroid.


Instruction: Generate impression based on findings.

Input: 23-year-old female with pain and swelling. 9 months status post MPFL injury. Suboptimal examination secondary to inability to use the age to the coil and patient body habitus.MENISCI: The menisci appear intact.ARTICULAR CARTILAGE AND BONE: Note is made of metallic susceptibility artifact about the articular cartilage of the patella, centrally, which is presumably postsurgical in etiology, related to prior microfracture/chondroplasty. There is associated subchondral signal abnormality, likely degenerative in etiology. Again seen is a shallow femoral trochlea, superiorly, suggestive of mild dysplasia.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: 1. Postsurgical changes of prior medial patellofemoral ligament reconstruction. The graft appears intact.2. Again seen is borderline patella alta and findings suggesting trochlear dysplasia which can be seen in patient's with patellar instability. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with bilateral lower extremity weakness. Please note that a shortened examination was performed due to patient discomfort. No evidence of restricted diffusion is seen. A few scattered small foci of FLAIR hyperintensity are seen within the cerebral hemispheres, a nonspecific finding. No evidence of significant parenchymal edema or mass effect is observed. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricles are normal in size and morphology.

Output: No definite acute intracranial abnormality and no specific findings which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female, 39 years old, with history of multiple sclerosis, new bladder urgency and gas incontinence. Evaluate for progression. Brain:Scattered small T2 hyperintense lesions are demonstrated within the periventricular and juxtacortical white matter of the cerebral hemispheres. One small lesion in the left superior parietal lobule appears to be new. The other lesions are not convincingly changed accounting for differences in technique.A previously prominent lesion along the right lateral wall of the fourth ventricle has decreased in size. There appear to be two small new lesions along the left lateral pons.No enhancing lesions are detected. Cerebral morphology is otherwise unremarkable. Parenchymal volume is preserved. The ventricles remain normal in size and morphology.Spine:Scattered T2 hyperintense lesions are seen throughout the spinal cord, primarily involving the cervical region. A lesion in the left lateral cord at C3-4 is new and lesions in the lateral aspect of the cord bilaterally at C4-5 are slightly more conspicuous. The remaining lesions are unchanged. No enhancing lesions are identified. Cord volume is preserved.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Scattered marrow space lesions are seen with signal characteristics compatible with benign hemangiomas, most notably in the T5 vertebral body. These have not significantly changed. Minimal degenerative findings are noted. At no level is there any significant spinal canal or foraminal stenosis.

Output: Multiple lesions are demonstrated in the brain and spinal cord compatible with demyelinating disease. On comparison with the prior examination, some lesions are smaller, a few are new, and many are unchanged. No enhancing lesions are seen to suggest active inflammation.


Instruction: Generate impression based on findings.

Input: Dementia with unresolving AMS. There is diffuse cerebral white matter T2 hyperintensity bilaterally. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions with high T1 and low T2 signal and diffuse mucosal thickening within the right maxillary sinus.

Output: 1. Probable chronic small vessel whiter matter ischemic disease and mild diffuse cerebral volume loss, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Complete opacification of the right maxillary sinus with hyperattenuating components and mild protrusion into the nasal cavity, which may be related to chronic inspissated secretions.


Instruction: Generate impression based on findings.

Input: Patient with 3 episodes of TIA/stroke like symptoms. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are multiple scattered foci of T2 hyperintensity in the cerebral white matter. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is hyperostosis frontalis and scattered prominent dural ossification.

Output: No evidence of acute infarct. Rather, multiple scattered foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Ankle pain TENDONS: The Achilles tendon is intact although there is slight enlargement and increased signal intensity distally and a focus of near fluid signal intensity noted approximately 6 cm from its insertion.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: 1. Mild tendinosis of the Achilles tendon with a tiny focus of increased signal intensity which may represent a small intrasubstance tear or more focal tendinosis.2. Probable ganglion at the base of the third metatarsal.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate status of NSCLC brain metastases. Status post WBRT in 1-15. Signs and symptoms: Brain metastases. Pre and post enhanced brain MRI:Examination demonstrates noticeable interval improvement of parenchymal metastatic lesions since prior study. As for example a high convexity (median frontal metastatic lesion which measured approximately 13 mm in transverse axis has decreased to 8 mm on current exam and with minimal residual surrounding vasogenic edema.A large necrotic rim enhancing tumor in the right posterior temporal lobe which measured that 22 x 19 mm on prior exam has decreased to approximately 12 x 11.5 mm. Moderate surrounding vasogenic edema and regional mass effect with this lesion is present.A left posterior temporal enhancing metastatic lesion which measured at 11 mm on prior study has decreased to approximately 6.5 mm on current exam.Additional smaller metastatic lesions all demonstrate interval further decrease in size as well. Ventricular system remains within normal size and the maintained midline.Similar to prior exam there are patchy and confluent foci of FLAIR hyperintensity in the white matter of bilateral cerebral hemispheres (left greater than right) without change which could represent a combination of post treatment/radiation change and small vessel ischemic strokes.Calvarium is unremarkable.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: Interval decreased size and surrounding vasogenic edema of multiple intracranial metastatic lesions as detailed/measured above.


Instruction: Generate impression based on findings.

Input: Right hip pain ACETABULAR LABRUM: Focal tearing of the anterior superior labrum is noted. This is superimposed upon intrasubstance degeneration. The posterior labrum appears normal.ARTICULAR CARTILAGE AND BONE: Mild cartilaginous thinning and osteoarthritis of the hips is noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Tearing of the anterior superior labrum superimposed upon intrasubstance degeneration. Mild cartilage loss of the left hip is also noted.


Instruction: Generate impression based on findings.

Input: 40 year male with abnormal echo findings, concern for noncompaction. MRI ordered for further evaluation. Left VentricleThe left ventricle is mildly dilated with decreased systolic function. The overall LV ejection fraction is 48%. The LVEDV is 246 ml (normal range 142+/-34), the LV end diastolic volume index is 119 ml/m2 (normal range: 74+/-15), the LVESV is 129 ml (normal range 47+/-19) and the LV end systolic volume index is 63 ml/m2 (normal range 25+/-9). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There are findings consistent with ventricular noncompaction, focused in the apical ventricular myocardium as well as the mid-distal lateral wall. Native myocardial T1 values are normal (1055 msec). No evidence of iron overload.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with decreased systolic function. The overall RV ejection fraction is 39%. The RVEDV is 204 ml (normal range 142+/-31), RV end diastolic volume index is 99 ml/m2 (normal range 82+/-16), the RVESV is 125 ml (normal range 54+/-17), and the RV end systolic volume index is 60 ml/m2 (normal range 31+/-9). Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a non-specific patchy interstitial abnormality, isolated to the bilateral lung bases of unclear significance. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is mildly dilated with decreased systolic function. The overall LV ejection fraction is 48%.2. Right ventricle is mildly dilated with decreased systolic function. The overall RV ejection fraction is 39%.3. Findings consistent with ventricular noncompaction in a limited pattern present in the apical and mid-distal lateral region of the left ventricular myocardium. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Encephalopathy, unspecified [G93.40], Reason for Study: ^Reason: evaluate for encephalitis History: pt with acute confusion, hashimoto encephalitis Significant motion artifacts degraded exam quality.There are multifocal bihemispheric restricted diffusion lesions which most are new lesions comparing to prior scan. Previously seen multifocal restricted diffusion lesions are most likely not demonstrating diffusion restriction on today's scan. On FLAIR images, both prior restricted diffusion lesions and current new lesions all show high signal intensity.Especially those prior lesions with high signal intensity on T2/FLAIR images show progressed volume loss. Those lesions include right parietal inferior parietal lobule, left parieto-occipital lobe, right temporal lobe and right occipital lobe with corresponding ventricles show ex vacuo changes. There is no evidence of hemorrhagic lesion on this scan.There is no evidence of abnormal enhancement on this scan.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. Interval development of multifocal new non enhancing bihemispheric restricted diffusion lesions.2. Interval progression of volume loss (encephalomalacia) on previously seen high signal intensity lesions on T2/FLAIR as described above.


Instruction: Generate impression based on findings.

Input: 77-year-old male with history of prostate cancer. Evaluate for disease. Fusion biopsy to follow. Biopsy with Gleason 3+3 in right base lateral, Gleason 3+3 in left mid medial, Gleason 3+3 in left mid lateral. PELVIS:PROSTATE:Prostate Size: The prostate measures 7.7 cm in transverse, 6.1 cm in AP, and 7.4 cm in craniocaudal length.Peripheral Zone: Thin rim of peripheral zone parenchyma. In the right lateral mid gland, there is a 0.6 cm focus of T2 and ADC hypointense signal (series 301 image 80, series 508 image 24) touching the prostate capsule.In the right paramedian mid gland, there is a 0.8 cm ADC hypointense focus (series 508 image 344). However, correlation on the T2 sequence is nonspecific.Central Gland: Marked multinodular appearance of BPH. On the ADC sequence, there are multiple central gland hypointense foci that are difficult to confirm on the T2 sequence and remain indeterminate.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: Trabeculated bladder related to chronic bladder outlet obstruction.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant lesion in the peripheral right mid gland measuring up to 0.6 cm.2.Trabeculated bladder related to chronic bladder outlet obstruction from severe BPH.


Instruction: Generate impression based on findings.

Input: 34-year-old male with NF1 and multiple plexiform neurofibromas. Please delineate the margins of his tumors. There are innumerable masses of low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, some of which have a target appearance, compatible with nerve sheath tumors and the stated history of neurofibromatosis type I. Plexiform lesions are noted in the soft tissues adjacent to the right lung apex with a smaller concentration of neurofibromas noted in the soft tissues adjacent to the left lung apex. Please note that the brachial plexus is not included in its entirety on this chest study. Neurofibromas are noted along all thoracic nerve roots bilaterally with additional neurofibromas involving the intercostal nerves at all levels. Additional solitary neurofibromas of varying size are noted within the musculature and soft tissues of the chest wall. For reference purposes, a tumor in the right anterolateral chest wall is approximately 2.4 x 1.3 cm in transverse dimension and 3.5 cm in oblique craniocaudal dimension. There are a couple of right-sided paraspinal lesions at the level of the thoracic inlet measuring approximately 3 x 2.1 x 3.5 cm and 3 x 1 x 2.5 cm. There may also be a few small mediastinal nerve sheath tumors. Small nerve sheath tumors are also noted within the arms bilaterally. We see no specific imaging findings to suggest malignancy.

Output: Findings compatible with neurofibromatosis as described above.


Instruction: Generate impression based on findings.

Input: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disc heights are well-maintained. There is a T1 hyperintense signal in the L5 vertebra, which likely represents a fat-containing hemangioma or focal fatty replacement. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-2 level.T12-L1: No significant spinal canal or foraminal stenosis. L1-L2: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. L2-L3: Mild facet arthropathy and thickening of the ligamentum flavum. No significant spinal canal or foraminal stenosis. L3-L4: Mild facet arthropathy and thickening of the ligamentum flavum. No significant spinal canal or neural foraminal stenosis. L4-L5: Mild facet arthropathy and thickening of the ligamentum flavum. Minimal right foraminal narrowing related to mild disk bulge. No significant spinal canal or left foraminal stenosis. L5-S1: No significant spinal canal or foraminal stenosis. Unchanged atrophic changes involving the left iliopsoas musculature.

Output: 1. Mild degenerative changes in the lumbar spine including mild facet arthropathy, which may be contributing to patients back pain. No significant spinal canal or foraminal stenosis. 2. Atrophic changes of the left iliopsoas musculature.


Instruction: Generate impression based on findings.

Input: A 7 x 7 mm intensely enhancing lesion is noted in the left precuneus with surrounding vasogenic edema causing mild sulcal effacement (series 12, image 42). An additional intensely enhancing lesion is visualized in the peripheral right inferior temporal gyrus measuring 6 x 6 mm (series 12, image 103). There is also mild surrounding vasogenic edema which causes mild sulcal effacement at this level. These lesions are compatible with small metastases. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1.No evidence of acute ischemia or intracranial hemorrhage.2.Subcentimeter enhancing lesions in the left parietal and right temporal lobes consistent with metastatic disease. There is surrounding vasogenic edema and mild local mass effect.


Instruction: Generate impression based on findings.

Input: Measures are somewhat limited by patient motion. The ventricles and sulci are somewhat prominent, consistent with mild global mild volume loss greater than expected for patient's stated age. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. Please note that 3-D T1 post contrast images are degraded by artifact. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Again noted is a small T2 hyperintense lesion within the with paramedian posterior aspect of the anterior pituitary gland. The remainder of the midline structures and craniocervical junction are within normal limits. A small left sphenoid mucosal retention cyst.CERVICAL SPINE

Output: 1.Redemonstration of benign appearing tiny T2 hyperintense lesion within the left paramedian pituitary gland which is nonspecific and likely incidental. Otherwise, unremarkable contrast enhanced MRI of the brain.2.No significant cervical spine abnormality. Minimal mid to lower cervical spondylotic changes without significant stenosis at any level.


Instruction: Generate impression based on findings.

Input: Female, 20 months old, with multiple intracranial lesions (hypothalamic, tectal and vermian) status post biopsy of the vermian lesion Sequelae of the prior occipital approach biopsy are barely detectable. Again seen is a somewhat polypoid area of parenchymal thickening centered on the right cerebellar vermis with projection into the fourth ventricle. As before, this lesion follows the signal characteristics of the surrounding brain parenchyma on all sequences, and there is no associated pathologic enhancement. The lesion does not appear to have significantly changed in size.Also unchanged is periaqueductal thickening with stenosis of the cerebral aqueduct. The previously reported hypothalamic lesion is not well visualized on the present study.No new lesions are detected. No parenchymal edema or mass effect is observed. The right cerebral hemisphere is smaller than the left. A right frontal approach ventricular catheter is in stable position. The supratentorial ventricles remain decompressed.

Output: 1.Stable lesion of the right cerebellar vermis.2.Stable periaqueductal thickening with associated aqueduct stenosis.3.The previously demonstrated hypothalamic lesion is not well visualized on the present study.4.The shunted supratentorial ventricles remain decompressed similar to prior.


Instruction: Generate impression based on findings.

Input: Left frontal opacification. There are post-surgical findings related to left orbital exenteration, left maxillectomy, left ethmoidectomy, and left rhinectomy. There are secretions in the left anterior ethmoid sinuses and frontoethmoid recess deep to the surgical flap. There is trace mucosal thickening in the left frontal sinus, but no evidence of secretions. The right maxillary, right ethmoid, right frontal, and bilateral sphenoid sinuses are unremarkable. There is patchy presumed enhancement of the soft tissues in the posterior left orbital exenteration cavity. The right orbit is unremarkable. There is extensive irregularity and presumed enhancement of the left maxillary alveolus. The intracranial structures are unremarkable.

Output: 1. Postoperative findings in the left face with retained secretions in the left anterior ethmoid sinuses and frontoethmoid recess deep to the surgical flap. 2. Persistent nonspecific patchy presumed enhancement of the soft tissues in the posterior left orbital exenteration cavity, which is incompletely characterized on this exam, but may represent treatment effects or a small amount of tumor. 3. Extensive irregularity and presumed enhancement of the left maxillary alveolus may be related to radiation necrosis. Please refer to the prior CT report for additional details.


Instruction: Generate impression based on findings.

Input: Known right breast cancer, MRI #2 on protocol. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.The index lesion in the right breast 3:00 position posteriorly has decreased in size now measuring 11 x 10 x 9 mm. Previously it measured 19 x 25 x 25 mm. The biopsied satellite lesion is also decreased now measuring as a 5 mm focus, previously 9 x 9 x 7 mm. AP distance inclusive of these lesions is 4.7 cm. Other satellite lesions are not seen above the level of background enhancement. Enhancement of the skin adjacent to the satellite lesion is likely related to the prior biopsy.The axillary biopsy clip is seen, though all right axillary nodes are normal in morphology at this time. Node associated with the clip measures about 5 mm on the T2 images. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in left axillary region.

Output: Interval decrease in size of proven index malignancy and satellite lesion. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 50 year-old female status post craniotomy for meningioma. Postoperative changes status post bifrontal craniotomy, with pneumocephalus, surgical hardware, and skin staples evident. Previously described partially calcified lesions along the anterior interhemispheric fissure just right of midline and along the high left frontal convexity are unchanged. There is marked low attenuation within the frontal lobes, right greater than left, corresponding to edema seen on MRI. The previously described area of focal low attenuation in the medial left frontal lobe appears increased compared with the prior study, concerning for ischemia. Punctate high attenuation in the medial left frontal lobe may represent a calcification or hemorrhage, though thrombus within the anterior cerebral artery may have this appearance.A small curvilinear focus of high attenuation is seen in the medial right frontal lobe inferior to the partially calcified lesion, which may represent a small focus of hemorrhage, unchanged from the prior study. The degree of leftward midline shift and ventricular volumes are unchanged. The remainder of the cerebral and cerebellar hemispheres and brainstem demonstrate normal morphology and attenuation. Postoperative changes affect the frontal bones, with the remainder of the calvarium and osseous structures appearing intact. There is partial opacification of the left anterior ethmoid air cells, with the remainder the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Continued evolution of focal low attenuation in the medial left frontal lobe, suspicious for anterior cerebral artery territory or venous infarction.2. Extensive postoperative changes with residual tumor and mass effect unchanged.


Instruction: Generate impression based on findings.

Input: Male 73 years old with hypoglycemia. Evaluate for insulinoma. Evaluation is limited by motion artifact.ABDOMEN:LIVER, BILIARY TRACT: No enhancing liver lesion, biliary ductal dilatation or ascites.SPLEEN: No significant abnormality noted.PANCREAS: Limited evaluation due to motion artifact. Within the limitations of this exam no pancreatic mass is identified. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nonobstructing renal stones. Numerous bilateral renal cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Generalized colonic dilatation is similar to previous CT and is compatible with the history of ovary syndrome.BONES, SOFT TISSUES: Heterogeneous bone marrow signal may be due to fatty replacement.OTHER: No significant abnormality noted.

Output: 1.Limited exam with no evidence of pancreatic lesion.2.Persistent massive colonic dilatation compatible with the patient's history of overuse syndrome.


Instruction: Generate impression based on findings.

Input: 23 years, Male, yolk sac tumor, brain metastases. There is a 3 x 2 mm right lateral medullary enhancing lesion which is slightly smaller than on prior study from 12/16/2015 and more clearly decreased in size since 8/6/2015. There is no new or enlarging mass or focus of abnormal parenchymal or meningeal enhancement. Additional treated lesions including the right frontal lobe, left posterior temporal lobe, and inferior right cerebellum seen on earlier study from 8/6/2015 again demonstrate no enhancement; there is residual susceptibility effect compatible with chronic blood products or mineralization at the prior lesions as seen before.No evidence of acute infarct or hemorrhage. Ventricles and sulci are normal in size. No midline shift or herniation. No extra-axial collections. Calvarium is intact. Diffuse opacification of the right mastoid air cells is again seen.

Output: Slight further decrease in size of the residual right lateral medullary lesion. No new or enlarging lesions to suggest disease progression.


Instruction: Generate impression based on findings.

Input: CT evidence of extra-axial mass on the left frontal lobe. Seizure, right-sided weakness There is a 20 x 22 x 21.5 mm sized extra-axial mass on the left frontal lobe. The mass is compressing the left side paracentral lobule. There is brain edema on the left paracentral lobule.On contrast enhanced images, the mass shows relatively homogeneously enhancing with the multiple lobulation. In addition, there is a tumor extension towards superior sagittal sinus without showing evidence of obstruction.There is no evidence of superior sagittal sinus occlusion.Bihemispheric dural thickening and enhancement may indicate previous surgery related changes, no change since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion on the scanOn gradient echo images, there are susceptibility artifacts on the left central sulcus which is corresponding to postoperative changes demonstrated on postoperative CT scan. In addition, scattered nodular susceptibility lesions on bilateral frontal lobes which indicate parenchymal calcifications or chronic hemorrhagic lesions do not show any 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. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval recurrence of left frontal lobe extra dural mass likely represent meningioma as described above.2. Evidence of tumor extension towards superior sagittal sinus as described above.3. Diffuse thickening with enhancing bihemispheric dura, no change since prior scan.


Instruction: Generate impression based on findings.

Input: 33-year-old female with diagnosis of on Hippel-Lindau disease, evaluate growth of existing cerebellar lesion and any new lesions as well as special attention to inner ear. BRAIN

Output: 1. Two enhancing nodules involving the inferior left cerebellar hemisphere surface and the right superior cerebellar hemisphere surface with minimal associated edema are not significantly changed since MRI dated 2/19/2014 allowing for differences in technique and are compatible with small hemangioblastomas.2. No suspicious lesions in the cervical, thoracic, or lumbar spine.3. No findings to suggest endolymphatic sac tumor.4. Please refer to separate report for findings in the abdomen.


Instruction: Generate impression based on findings.

Input: Right-sided low back pain with sciatica and history of herniated disc on prior imaging 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.Multilevel degenerative changes are seen, 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: There is a disc bulge eccentric to the left and a left paracentral disc protrusion which effaces the left lateral recess and may be impinging on the descending left L4 nerve root. No significant central spinal canal stenosis. There is minimal narrowing of the neural foramina.L4-L5: There is a larger right central disc protrusion which effaces the right lateral recess where there may be impingement of the descending right L5 nerve root. There is also a disc bulge with a left foraminal component. No significant central spinal canal stenosis. There is mild left and minimal right neural foraminal narrowing. L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Disc protrusions at the left L3-L4 and right L4-L5 levels which may be impinging on the left L4 and right L5 nerve roots in the lateral recesses, respectively.2. No significant central spinal canal stenosis at any level. There is mild left L4-L5 neural foraminal stenosis. No high-grade neural foraminal stenosis at any level. Additional details as above.


Instruction: Generate impression based on findings.

Input: 16-year-old female, concern for hydrocephalus in a patient with history of seizure disorder. Developmental delays, reported seizures. The Sylvian fissures are normally formed and easily recognized however the other major sulci are not well formed or difficult to identify. The gyral pattern appearance of the cortex is disordered with evidence of diffuse polymicrogyria involving both cerebral hemispheres, more so superiorly than inferiorly. The pattern of the fissures and gyri in the cerebellum also appear to be somewhat disordered. There is patchy periventricular T2 hyperintensity along the atria and also more anteriorly in the corona radiata. The lateral ventricles appear widened specifically at the atria and temporal horns, favored to reflect a paucity of white matter. The frontal horns show normal contour. No findings to suggest elevated intraventricular pressure are seen. Prominence of the retrocerebellar CSF space is noted. The cerebellar vermis does appear to be normally formed, however, and the fourth ventricle and foramen of Magendie are unremarkable.The pituitary region is within normal limits. The corpus callosum is fully formed and intact. The brainstem is within normal limits.

Output: 1.Diffuse polymicrogyria with evidence of white matter loss and white matter injury. Findings could entirely reflect the sequelae of TORCH infection, or alternately, may reflect a prior parenchymal insult on a background of a syndromic migrational anomaly.2.Mild ventriculomegaly affecting the atria and temporal horns is favored to reflect loss of white matter rather than elevated intraventricular pressures.3.Prominence of the retrocerebellar CSF space may represent a mega cisterna magna or possibly an arachnoid cyst.


Instruction: Generate impression based on findings.

Input: There are two small chronic infarcts within the left frontal lobe and left superior parietal lobule (including the postcentral gyrus) as well as a slightly larger chronic infarct within the left inferior parietal lobule. There is susceptibility compatible with hemosiderin deposition along the right posterior superior frontal and right precentral sulci.There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is unchanged mild global volume loss. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The distal internal carotid flow voids are absent bilaterally. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1.No evidence of acute ischemia.2.Chronic infarcts within the left frontal and parietal lobes.3.Absent distal internal carotid flow voids bilaterally compatible with known occlusion. 4.Hemosiderin deposition involving the right posterior frontal lobe sulci likely related to remote subarachnoid hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Internuclear ophthalmoplegia. There are numerous, greater than 10, T2 hyperintense white matter and thalamic lesions, including a lesion in the posterior midbrain, around the midline, and left paramedial posterior pons. Many of the lesions display low T1 signal, but no associated enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is flattening of the pituitary gland. 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. Findings compatible with demyelinating lesions suggestive of multiple sclerosis with involvement of the medial longitudinal fasciculus, which could account for the internuclear ophthalmoplegia.2. Nonspecific flattening of the pituitary gland, which can be a manifestation of pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Reason: RO UCL tear History: Medial elbow pain LIGAMENTS: The ulnar and radial collateral ligaments appear intact within the limitations of this non arthrogram study. The lateral ulnar collateral ligament is heterogeneous with increased signal intensity which may indicate a sprain, however, fibers can be traced to the level of the insertion.TENDONS: The flexor and extensor tendons appear intact. The biceps and brachialis muscles and tendons appear intact. The triceps muscle and tendon appears intact. There is increased signal on fluid sensitive sequences within the distal triceps at the level of the myotendinous junction as well as within the common flexor tendon which may represent a mild strain. There is also increased signal abnormality within the supinator which is nonspecific but may represent a strain.ARTICULAR SURFACES AND BONE: Note is made of a nondisplaced fracture through the radial neck with intra-articular extension to the radiocarpal articulation. There is bone marrow signal abnormality in the surrounding area. No additional fractures are identified. No other bone marrow signal abnormality is seen.ADDITIONAL

Output: Nondisplaced radial head fracture with intra-articular extension, as described above. Moderate size joint effusion. Other findings as described.


Instruction: Generate impression based on findings.

Input: Demyelinating lesions treated with IV steroids. LP showed oligoclonal bands and myelin basic protein. There are essentially unchanged scattered punctate supratentorial T2 hyperintense lesions, predominantly in a subcortical distribution. Punctate foci of apparent high signal in the right parietal lobe on the post-contrast axial spin echo is likely artifactual. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. 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. Essentially unchanged presumed demyelinating lesions in the brain.2. DIffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: Pain, evaluate for medial meniscal pathology. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits without fracture. The articular cartilage of the tibiofemoral and patellofemoral compartments is intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Unremarkable examination.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Rule out bleed or hematoma. Signs and symptoms: Mental status change. Examination demonstrates a gyriform area of increased density in the high convex to the left parietal cortex (axial image 20). This finding is associated with an adjacent area of encephalomalacia . The finding is believed to represent calcific changes of an area of old stroke which was noted on prior MRI exam. Less likely possibility of a new small hemorrhagic cortical stroke cannot be entirely ruled out. Prominence of cortical sulci and folia of the cerebellum as well as prominence of the ventricular system is concerning for underlying parenchymal volume loss.

Output: See above comments.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for ischemia History: Dizziness, L sided headache and veering to L MRI BRAIN:There is crowding at the foramen magnum with descent of the slightly pointed cerebellar tonsils 8 mm below the foramen magnum, compatible with a Chiari 1 malformation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. Minimal mucosal thickening of an anterior ethmoid air cell, otherwise the sinuses are grossly clear.MRI CERVICAL SPINE:There is mild reversal of the normal cervical lordosis. There is multilevel disc desiccation with mild degenerative disc disease at C5-C6 and C6-C7. There are multilevel degenerative endplate marrow signal. Vertebral body heights are intact. Cerebellar tonsils again extend 8-9 mm below the level of the foramen magnum. There is focal prominence of the central canal within the cord extending from C1-C2 to C2-C3. There is cystic dilatation of the central canal extending from C5-C6 to T2-T3, measuring 4 x 4 mm in maximum dimension, with at least one septation.C2-C3: No significant spinal or neuroforaminal stenosis.C3-C4: No significant spinal or neuroforaminal stenosis.C4-C5: Mild posterior disc osteophyte complex and uncovertebral joint hypertrophy without significant spinal or neural foraminal stenosis.C5-C6: Mild posterior disc osteophyte complex and uncovertebral joint hypertrophy. No significant spinal stenosis. Moderate bilateral neural foraminal stenosis.C6-C7: Mild posterior disc osteophyte complex. No spinal canal stenosis. Moderate bilateral neural foraminal stenosis.C7-T1: No significant spinal or neuroforaminal stenosis.Prominence of the palatine tonsils bilaterally. There is asymmetry of the piriform sinuses, much larger on the right, however the larynx is incompletely evaluated on this exam.

Output: Chiari I malformation with cystic dilatation of the central canal, likely representing syringohydromyelia. Postcontrast images through the cervical spine are recommended to exclude underlying abnormal enhancement. Additionally, while the inferior margin of the syrinx appears to terminate at T2-T3, MR of the remaining cord may be considered to evaluate for additional cord abnormality.2. Moderate bilateral foraminal narrowing due to spondylotic changes at C5-C6 and C6-C7.3. Asymmetric prominence of the palatine tonsils bilaterally which is nonspecific, possibly relating to hypertrophied lymphoid tissue. Correlation direct inspection is recommended.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:3/8/1961) PROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level. This is stable.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild the ligamentum flavum hypertrophy at this level. There are some mild loss of disc space height at this level and minor disc desiccation. This is stable.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some endplate reactive change present which is high signal on T1 and T2 and unchanged since the prior exam. There are some disc desiccation at this level which is also unchanged since the prior exam.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is minimal disc bulge present at this level. There are some mild disc desiccation at this level. These findings are stable.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are some mild degenerative changes present in the lumbar spine which are stable since the prior exam. There is no compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 37 year-old woman with history of left hip pain for approximately 1 month. ACETABULAR LABRUM: Given the limits of a non-arthrogram study, we see no full-thickness labral tear. There is a small defect with increased signal intensity within the undersurface of the labrum at the 2-3 o'clock position anteriorly that may represent a small undersurface tear, but this is equivocal.ARTICULAR CARTILAGE AND BONE: A small focus of increased signal intensity within the articular cartilage along the superior aspect of the joint suggests a focal cartilage defect (image 8, series 801). A small focus of decreased signal intensity within the overlying acetabular dome may be degenerative in etiology or may be a bone island. We see no cam deformity. We see no findings to suggest pincer deformity.SOFT TISSUES: The musculature of the hip is unremarkable.ADDITIONAL

Output: 1.Small focus of cartilage degeneration along the superior aspect of the left hip joint.2.Possible focal undersurface tear of the anterosuperior labrum.3.Otherwise, no specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Preoperative planning: glioblastoma. There are prior postoperative findings related to biopsy of a rim-enhancing mass centered in the right temporal stem and posterior right insula that measures up to approximately 5 cm, with multiple adjacent smaller peripherally-enhancing nodules and extensive surrounding edema involving right thalamus, right middle cerebral peduncle, right basal ganglia, and right parietal lobe. There are areas of T2 hyperintensity in the right parietal lobe white matter without corresponding enhancement. There is effacement of the temporal horn of the right lateral ventricle and most of the third ventricle, but prominence of the left lateral ventricle. There is 10 mm of midline shift to the left. There is no evidence of acute infarct. The major cerebral flow voids are intact. There is prominence of the bilateral optic nerve discs and optic nerve sheath cerebrospinal fluid, which is suggestive of raise intracranial pressure. There are retention cysts in the left maxillary sinuses. There are skin fiducial markers.

Output: Preoperative planning MRI demonstrates a dominant necrotic mass centered in the right temporal stem and posterior right insula, with multiple satellite lesions, compatible with high grade glial neoplasm. The mass effect is associated with 10 mm of midline shift to the left and obstructive hydrocephalus.


Instruction: Generate impression based on findings.

Input: Reason: new lesion on MRI at T7-please bx-hx of head and neck ca History: as above Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: T7 vertebral bone biopsy under CT guidance. A total of eight samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Clinical question: History of lung cancer, evaluate for metastases, compared to prior. Signs and symptoms: None. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Post enhanced images are degraded due to artifact which precludes precise assessment for detection of very small lesions. Within this limitation however there is no convincing evidence of any residual parenchymal or leptomeningeal enhancement to suggest metastatic disease. This is an improvement compared to prior study.Patchy foci of FLAIR hyperintensity in the periventricular and subcortical white matter of cerebral hemispheres remain grossly similar to prior exam and suggestive of chronic small vessel ischemic strokes as well as overlapping postradiation changes. Mildly dilated supratentorial ventricular system with maintained midline remain similar to prior exams.No detectable abnormal enhancement of calvarium.Unremarkable images through the orbits including axial fat sat post enhanced series.All paranasal sinuses demonstrate normal pneumatization signal patterns.

Output: 1.No detectable residual metastatic disease. Note however should be made that post enhanced images are degraded due to artifacts which preclude detection of tiny metastatic lesions.2.Periventricular and subcortical FLAIR hyperintensity grossly similar to prior exam and likely representing a combination of chronic small vessel ischemic strokes and post treatment/radiation changes.3.Unremarkable calvarium, paranasal sinuses and orbits.


Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental status, unspecifiedClinical question: eval for PRESSigns and Symptoms: somnolence bone marrow transplantComments: Patient does not need sedation but is on Precedex and Dilaudid so needs appropriate monitoring | There is a mild degree of generalized brain atrophy for the patient's stated age of 22.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for cerebral infarction or other intracranial lesion. There is no evidence for posterior reversible encephalopathy syndrome.2.For the patient's stated age of 22 there is a mild degree of generalized brain atrophy present which is unchanged since the prior exam. This is nonspecific but is not significantly changed since the prior exam3.Examination is mildly degraded due to patient motion. This may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 70-year-old female with history of RCC status post nephrectomy. Surveillance scan. ABDOMEN:LIVER, BILIARY TRACT: Stable bilobar T2 hyperintense hepatic lesions which may represent hemangiomas or cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post left adrenalectomy.KIDNEYS, URETERS: Status post left nephrectomy with no suspicious lesions within the nephrectomy bed.Heterogeneous and complex lesion in the right interpolar lesion measures 1.8 x 1.6 cm, previously 1.3 x 1.3 cm, slowly increasing in size since 2012.Septated right inferior pole cystic lesion measures 1.6 x 1.0 cm, previously 1.5 x 1.0 cm (image 29 series 4).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is absent or atrophic.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.Slowly enlarging right interpolar heterogeneous lesion which most likely represents renal cell carcinoma.2.No evidence of recurrence on the left.


Instruction: Generate impression based on findings.

Input: Female; 57 years old. Reason: Evaluation H/O PSC History: weight loss, right-sided pain ABDOMEN:LIVER, BILIARY TRACT: Again seen are multifocal intra- and extrahepatic biliary ductal strictures, including focal strictures at Klatskin point, the mid common bile duct, and at the ampulla, unchanged in morphology. No new dominant stricture or suspicious hepatic mass is identified to suggest HCC or cholangiocarcinoma. Cholecystectomy clips.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change in findings of PSC affecting the intra-and extrahepatic biliary tree. No evidence of cholangiocarcinoma or HCC.


Instruction: Generate impression based on findings.

Input: Anal/pelvic pain. Possible pudendal neuropathy PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy evident.BOWEL, MESENTERY: No significant abnormality noted. Normal caliber and wall thickness of the visualized distal bowel. No mesenteric edema or inflammation. No visualized intra-abdominal fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: The pudendal nerves are grossly unremarkable in appearance bilaterally.

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Reason: screening for recurrent BCC compared to previous MRI History: Pervious BCC with family history of NMSC, pt also has history of multiple neurofibromas. Again seen are postoperative findings in the left nasal ala and nasolabial fold region, as well as in the left frontal scalp region. There is deformity of the left nasal ala and predominantly linear low T1 and T2 signal tissue in the surgical bed, which likely represents scar tissue, but no measurable enhancing tumor. There is no evidence of significant lymphadenopathy in the partially imaged neck. Inferior aspect of the neck is not included on the axial sequences. The salivary glands are unremarkable. The orbital contents and imaged intracranial structures are unremarkable.

Output: Postoperative findings related to left nasal skin tumor resection without evidence of locoregional tumor recurrence. No significant cervical lymphadenopathy in the imaged upper neck.


Instruction: Generate impression based on findings.

Input: Patient with elevated CK and upper extremity weakness, concern for myositis. Please evaluate for inflammatory changes of the muscle. There is increased T2 signal within the muscles of the bilateral supraspinatus, infraspinatus, subscapularis, teres minor, posterior lateral aspect of the deltoid, and pectoralis major muscles. There is also increased T2 signal within the short head of the biceps and the distal triceps muscles bilaterally. There is no muscle atrophy. The underlying bone cortex is intact.There is a non-specific T2 focus within the left humerus proximal metaphysis which may represent a cyst or an enchondroma. There is atelectasis of the lung bases.

Output: Bilateral proximal shoulder, pectoralis major, and distal triceps muscle edema without atrophy suggestive of an inflammatory disorder such as polymyositis/dermatomyositis.


Instruction: Generate impression based on findings.

Input: Left parietal progressive glioblastoma and history of facial soft tissue rhabdomyosarcoma. There are postoperative findings related to left parietal craniotomy. There has been interval increase enhancing component of the tumor with a residual focus of nodular enhancement that measures up to 12 x 17 mm in the axial plane along the medial aspect of the resection cavity. Diffuse linear enhancement along much of the posterior margins of the resection cavity and the surrounding confluent T2 hyperintensity appear stable to slightly more prominent. Furthermore, there is interval increase in size of an enhancing extra-axial lesion along the left lateral temporal lobe convexity, which measures 14 x 16 mm in the axial plane. There is an unchanged anterior left middle cranial fossa arachnoid cyst. There is no significant midline shift. There is no evidence of acute territorial infarction. There is right tympanomastoid fluid. The regional extracranial structures are unchanged.

Output: 1. Findings suggestive of interval tumor progression in the left parietal lobe region treatment bed.2. Interval increase in size of the extra-axial lesion, which may represent a radiation-induced meningioma


Instruction: Generate impression based on findings.

Input: Hearing loss, evaluate for cochlear implantation. Brain: The myelination is appropriate for age, including terminal zones of myelination in the bilateral parietal lobes. There is no evidence of intracranial hemorrhage, heterotopia, mass, or infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is diffuse paranasal sinus mucosal thickening.Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1. No gross inner ear anomalies or evidence of cochlear nerve deficiency.2. No evidence of gross seizure foci of structural brain anomalies.3. Findings suggestive of sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate for possible right sided submandibular gland mass/tumor: right submandibular enlargement. There is diffuse mild enlargement of the right submandibular gland, while the left submandibular gland appears to be atrophic. However, there is no evidence of mass lesions or significant cervical lymphadenopathy. The parotid glands and thyroid gland are unremarkable. The major cervical flow voids are intact. There is lack of the usual cervical kyphosis and mild multilevel degenerative spondylosis. The airways are patent. The imaged intracranial structures are unremarkable.

Output: Diffuse mild enlargement of the right submandibular gland may be compensatory to apparent atrophy of the left submandibular gland, without evidence of underlying mass lesions or significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Reason: knee injury, fall x2 History: pain MENISCI: The medial and lateral menisci are within normal limits.ARTICULAR CARTILAGE AND BONE: A punctate focus of abnormal signal intensity in the patella likely represents a small bone contusion. There is no underlying cartilaginous injury to suggest degenerative changes. The medial and lateral articular cartilage are within normal limits.LIGAMENTS: The cruciate and collateral ligament complexes are within normal limits. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Small patellar bone contusion. Otherwise, unremarkable exam of the right knee.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with history of metastatic breast cancer now with worsening low back pain. Thoracic:Marrow replacement of the T2 vertebral body and pedicles is again seen. Mild progressive extraosseous disease spread is seen along the left anterior paraspinal space. There is mild encroachment of the ventral and lateral epidural spaces at T2, but no significant thecal sac narrowing. The vertebral body otherwise appears similar to prior. No loss of height or retropulsion is seen. Since the prior examination, however, multiple new patchy and nodular areas of marrow replacement are seen in almost every thoracic vertebral body and to a lesser degree the posterior elements. None of these new lesions is associated with any significant epidural disease spread. No retropulsion or loss of vertebral body height is detected.The thoracic spinal canal remains patent throughout. There is no evidence of significant spinal canal stenosis. The left T2-3 and right T3-4 neural foramina are narrowed due to expansile tumor.The visualized spinal cord shows normal signal intensity and morphology. No pathologic intradural enhancement is seen.Lumbar:Again seen is evidence of instrumented posterior fusion of L5 and S1. Posterior element resection has also likely been performed.Since the prior examination, extensive tumor involving the left aspect of the L5 and S1 vertebral bodies appears more heterogeneous and less bulky perhaps representing the effect of therapy. As before, this lesion results in no significant epidural encroachment or spinal canal narrowing.However, as in the thoracic spine, there are numerous new patchy areas of marrow replacement in every lumbar vertebral body level. None of these lesions is associated with significant epidural encroachment. No loss of vertebral body height or retropulsion is seen.No significant degenerative disc disease is seen. The spinal canal and neural foramina remain patent although the L5-S1 foramina which are not well assessed due to artifact.The visualized distal spinal cord, conus and cauda equina show normal signal intensity and morphology. No pathologic intradural enhancement is seen.

Output: 1.Slight interval expansion of metastatic tumor involving the T2 vertebral body with mild epidural encroachment but no significant spinal canal stenosis.2.Metastatic disease involving the L5 and S1 vertebral bodies appears somewhat less bulky than on the prior examination which may reflect response to therapy.3.Multiple new metastatic lesions are evident within the marrow space involving nearly every level of the thoracic and lumbar spine. None of these new lesions is associated with any significant epidural encroachment or spinal canal stenosis. No vertebral body compression or retropulsion is seen.


Instruction: Generate impression based on findings.

Input: Recent Chiari surgery: apnea. There are postoperative findings related to Chiari decompression surgery. There is minimal high TY2 signal in the inferior cerebellar hemispheres bilaterally. There is no evidence of acute infarct. The supratentorial brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Postoperative findings related to Chiari decompression surgery without evidence of brainstem lesions.


Instruction: Generate impression based on findings.

Input: Patient with known left shoulder mass. There is destruction of the scapula and a subglenoid lucency, consistent with destructive involvement by patient's known soft tissue tumor. Please refer to the MRI from 2/29/2016 for further characterization. Patient bones appear demineralized. There are degenerative changes at the AC joint.

Output: 1.Subglenoid lucency, consistent with scapular destruction, suggestive of involvement by patient's known soft tissue tumor.2.Degenerative changes at the AC joint.


Instruction: Generate impression based on findings.

Input: There has been marked interval worsening of disk extrusion at C4-5 with mild superior and inferior migration, measuring previously 6 mm craniocaudally and now up to 23 mm (series 601 image 7), and up to 7 mm in maximal thickness compared to 4 mm previously. There is moderate to severe spinal canal stenosis with flattening of the cord at this level secondary to mass effect from the extruded disk material. There is subtle T2 cord signal at this level. There is also interval worsened height loss of the C4-5 disk space. There is mild facet arthropathy at this level, however the neural foramina at this level appear grossly intact. There is no osseous marrow edema. There is mild loss of T2 signal in essentially all cervical disks. There is straightening of the cervical spine.C2-3: Tiny right paracentral disk osteophyte complex. No spinal stenosis.C3-4: No endplate or disk degenerative changes. No spinal stenosis.C4-5: Described above.C5-6: Disk osteophyte complex and bilateral uncovertebral hypertrophy with facet arthropathy causing mild spinal canal stenosis. Moderate left and mild right neural foraminal stenosis without change.C6-7: Disk osteophyte complex and uncovertebral hypertrophy causing no significant spinal canal stenosis and mild to moderate right and moderate to severe left neural foraminal stenosis.C7-T1: No significant disk/endplate degenerative changes or spinal stenosis.

Output: 1.Marked interval worsening of disk extrusion at C4-5 compared to 8/7/2012 with moderate to severe spinal canal stenosis. There is subtle T2 cord signal abnormality. Mild interval loss of disk height at this level as well. Please see details above.2.No other significant interval changes.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 60 years old. Knee buckling with + Lachman's MENISCI: There is a predominantly radial tear of the posterior horn of the medial meniscus. The body of the medial meniscus is partially extruded and appears blunted. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is extensive full-thickness articular cartilage loss involving the medial femoral condyle and medial tibial plateau with underlying bone marrow edema and subchondral cyst formation. There is diffuse mild thinning of the lateral compartment articular cartilage, without focal defects identified. There is full-thickness cartilage loss of nearly the entire medial patellar facet with underlying marrow signal abnormality. There is also marked cartilage thinning of the lateral patellar facet.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.High-grade articular cartilage loss involving the medial and patellofemoral articulations as above.2.Tear of the medial meniscus as above.3.The ACL is intact.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other musculoskeletal symptoms referable to limbs(729.89)Clinical question: concern for cervical compression of descending corticospinal tractsSigns and Symptoms: weakness of the left leg, tingling of the left arm MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal cervical curvature. The exams is degraded by patient motion.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge at this level with mild narrowing of the spinal canal. The CSF behind the cord is not effaced.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge at this level with mild narrowing of the spinal canal. The CSF behind the cord is not effaced.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge at this level with mild narrowing of the spinal canal. The CSF behind the cord is not effaced.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge at this level with mild narrowing of the spinal canal. The CSF behind the cord is not effaced.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Multilevel disk bulges are present in the cervical spine without significant compromise to the spinal cord or exiting nerve roots.2.Straightening of the normal cervical curvature is a non-specific finding which may related to patient positioning or muscle spasm.3.Partial empty sella is an incidental finding.4.Exam is degraded by patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Invasive bladder cancer. Confusion, for 1 week. Rule out brain metastasis. Study is mildly limited by patient motion.There is no space-occupying or contrast-enhancing brain mass. However, there is a 3 mm focal T2-hyperintensity without contrast enhancement or diffusion restriction (only T2 shine through) involving the cortex in the right superior parietal lobule, which is best seen on image #176 of series #306. This is nonspecific and too small to definitively characterize. It may represent late subacute or even chronic tiny infarct. There is generalized mild-to-moderate brain volume loss manifested by expansion of the ventricles and other CSF-containing spaces. There is trace if any frontal periventricular white-matter T2-hyperintensity. There is no significant brain abnormality otherwise. Major intracranial basilar flow voids are preserved, affecting gross patency.There is trace mucosal thickening in the maxillary and anterior ethmoid sinuses. There is no gross orbital abnormality. There is no destructive skull lesion. Hyperostosis frontalis interna is a common finding of no clinical significance.

Output: 1.Study is limited by patient motion.2.Punctate T2-hyperintense cortically based lesion in the right parietal lobe without contrast enhancement or diffusion restriction is nonspecific and may represent late subacute or chronic tiny infarct. 3.There is no contrast-enhancing or space-occupying brain lesion to indicate metastasis.4.Mild-to-moderate brain volume loss.


Instruction: Generate impression based on findings.

Input: Low back pain with pain and numbness radiation into the left L5 distribution. The study is interpreted with the assumption that the last well-formed disc, which also happens to be the most degenerative disc, is at L5-S1. Sagittal alignment is notable for straightening and minimal L2 relative to L3 posterior subluxation associated with mild-to-moderate disc desiccation and height loss. The vertebral bodies are preserved in height. Marrow signal is benign with mixture of type I and type II degenerative marrow signal, most pronounced in relation to the L5-S1 endplates where there is edema in the bone marrow. Milder degenerative marrow changes are present at L3-L4 and L4-L5, where there is disc desiccation and mild height loss. The conus medullaris is unremarkable. The tip of the conus medullaris lies at the lower T12 level. T10-T11 (only on sagittal imaging), T11-T12, T12-L1, and L1-L2: There is no significant spinal canal or foraminal stenosis.L2-L3: The posterior subluxation and associated disc uncovering/bulge result in shallow ventral indentation of the thecal sac but no significant spinal canal or foraminal stenosis.L3-L4: Degenerative disc/endplates along with mild ligamenta flava thickening and right more than left facet arthropathy result in mild central and right more than left paracentral spinal canal stenosis. There is also mild-to-moderate right more than left foraminal stenosis.L4-L5: Degenerative disc disease along with ligamentum flavum thickening result in moderate-to-severe spinal canal stenosis. There is moderate left greater than right foraminal stenosis.L5-S1: There is a small left paracentral disc protrusion narrowing the left subarticular recess. The advanced disc/endplate degenerative disease along with severe left more than right facet arthropathy and severe ligamenta flava thickening result in moderate-to-severe spinal canal stenosis and severe left and moderate to severe right foraminal stenosis. The advanced facet arthropathy is associated with focal T2 hyperintensities that probably represent small synovial cyst projecting posterior to the facet joints.

Output: 1.Multilevel degenerative lumbar spondylosis is most pronounced at L5-S1 and L4-5 resulting in moderate-to-severe spinal canal stenosis. There is up to severe left L5-S1 foraminal stenoses. Additional levels as described above.2.For the purposes of numbering the most inferior well-defined disc space is labeled L5-S1.


Instruction: Generate impression based on findings.

Input: Intracranial hemorrhage. Please evaluate for underlying cause. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an intraparenchymal hematoma (IPH) centered in the right superior temporal lobe sulcus and right superior temporal gyrus but involves the posterior aspect of the right middle temporal gyrus and a small portion of the posterior aspect of the right inferior temporal gyrus and extends into the right inferior parietal lobule. It measures 89x51mm sagittal dimensions, 51x44mm coronal dimensions and 83 x 48 mm axial dimensions. The discrepancy in size between these measurements and the CT are likely related to differences in modality because there are fluid like components with fluid fluid levels along the anterior aspect of the hematoma which are hypodense on the CT scan. There is a halo of edema present.The septum pellucidum is shifted 7mm to the left of midline and is stable since the prior CT. There is compression of the right lateral ventricle.There is redemonstration of a subdural hematoma and subarachnoid blood adjacent to the above described IPH. The subdural hematoma measures 5mm thickness. There is a small amount of intraventricular blood present.The right PCOMA appears compressed. The right nasal vein of Rosenthal is asymmetrically smaller.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is no convincing evidence for microhemorrhage to support a diagnosis of amyloid angiopathy.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.Incidental note is made of partial empty sella.

Output: 1.Large intraparenchymal hematoma centered in the right temporal lobe and its sulci with associated subdural hematoma and subarachnoid blood as well as uncal herniation.2.No convincing MRI evidence for AVM on the basis of this exam although a small AVM may not be visible or an AVM may be obscured by mass effect.3.No convincing MR evidence for amyloid angiopathy.4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 70-year-old male with left medial joint pain. MENISCI: There is poorly defined increased signal intensity within the posterior horn and body of the medial meniscus that contacts the tibial articular surface indicating a combination of intersubstance degeneration and undersurface fraying/tearing. There is also blunting of the posterior horn closer to the root, indicating a partial thickness radial tear. The anterior horn appears intact. There is intersubstance degeneration of the lateral meniscus, but no discrete tear.ARTICULAR CARTILAGE AND BONE: There is full thickness loss of articular cartilage along the patella, particularly along the lateral facet with similar full thickness loss of articular cartilage along the lateral facet of the femoral trochlea. There are also small subchondral cysts in the patella. The femoral trochlea appears shallow, perhaps reflecting mild dysplasia. There is relatively mild degeneration of the articular cartilage of the tibiofemoral compartments with cartilage heterogeneity particularly noticeable along the lateral tibial plateau. There are small tricompartmental osteophytes. There is a small focus of signal abnormality within the tibial plateau posteriorly, likely representing a degenerative cyst/ganglion at the posterior cruciate ligament attachment. LIGAMENTS: The anterior and posterior cruciate ligaments appear normal for age as does the medial collateral ligament. There is intermediate signal intensity within the proximal fibers of the lateral collateral ligament proper suggesting mild degeneration. EXTENSOR MECHANISM: The quadriceps tendon appears slightly thickened, which may reflect tendinosis or prior strain injury with mild edema in the fat pad posterior and medial to the distal tendon. There is a small amount of ossification of the proximal patellar tendon, suggesting chronic tendinosis.ADDITIONAL

Output: 1.Medial meniscal tearing as described above.2.Full thickness cartilaginous degeneration involving the patellofemoral joint.3.Other findings as above.


Instruction: Generate impression based on findings.

Input: Evaluation for change in cavernoma, right facial and foot weakness. There are two susceptibility artifacts on the left centrum semiovale indicating small cavernomas, comparing to prior scan, there is no interval change in terms of size and MR characteristics.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection, 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.

Output: No interval change of left centrum semiovale cavernomas since prior scan.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 4-year-old male with a prolonged seizure, history VPS. Intracranial VP shunt catheter tubing is intact. Catheter tubing traverses the right parietal lobe, through the atria of the right lateral ventricle, and terminates with tip in the body of a mildly dilated left lateral ventricle. No change in the position or course of the catheter compared to previous examination. The right lateral ventricle remains collapsed and unchanged from previous exam, and the left ventricle also appears grossly unchanged compared to most recent brain MRI allowing for differences in the two modalities. Significant brain volume loss consistent with periventricular leukomalacia as well as abnormal callosal thinning. There is no evidence of periventricular edema to suggest elevated ventricular pressures. There is no evidence of intracranial hemorrhage, mass, or edema. The bones of the calvaria are thin and there is triangulated appearance of the skull, consistent with mild trigonocephaly. The brain may be small for age, correlate clinically for microcephaly. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.No significant change in ventricular size or configuration allowing for difference in technique between CT and MRI.2.PVL and callosal abnormality. refer to most recent MRI for further morphologic description.3.trigonocephaly with possible small size to the brain. Clinically correlate for microcephalus.


Instruction: Generate impression based on findings.

Input: Worsening bilateral weakness/clonus. Evaluate for cord involvement. Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: Minimal dorsal annular fissure and small central protrusion. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.Paraspinous soft tissue structures appear within normal limits.Thoracic: The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. Bone marrow signal is benign. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. No abnormal cord signal, enhancement, or evidence of spinal canal stenosis in the cervical spine.2. No abnormal cord signal, enhancement, or evidence of spinal canal stenosis in the thoracic spine.


Instruction: Generate impression based on findings.

Input: left side weakness and numbness, seizure There is focal restricted diffusion on the right frontal periventricular white matter (series 405, image 192/34) indicating acute ischemic stroke. There is no evidence of susceptibility artifacts indicating hemorrhagic transformation.Diffuse patchy high signal intensities on bilateral periventricular white matters and centrum semiovale indicate extensive non specific small vessel ischemic disease. Focal encephalomalacia on the left side lower midbrain extends toward upper pons were seen. Multifocal various sized tissue losses on bilateral centrum semiovale indicating chronic ischemic infarction.Another encephalomalacia on the left mesial aspect of the cerebellum was also seen.There is evidence of linear encephalomalacia on the right lateral ventricle occipital horn with surrounding susceptibility artifacts indicating prior hemorrhagic lesion with associated ventricular dilatation.The ventricles, sulci and cisterns are 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. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Focal restricted diffusion on the right periventricular white matter indicating focal acute ischemic stroke without evidence of hemorrhagic transformation.2. Multifocal chronic ischemic infarctions with encephalomalacia involving bilateral centrum semiovale, bilateral periventricular white matter, left side pons, left midbrain and left cerebellum as described above.3. Focal encephalomalacia on the right occipital lobe with hemosiderin deposition indicating chronic hemorrhagic infraction.


Instruction: Generate impression based on findings.

Input: 22 years Female (DOB:12/5/1993)Reason: hemorrhage History: surveillancePROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE MRI of the brainThere is redemonstration of a left frontal lobe lesion which is associated blood products. It measures now 27 x 23 mm axial dimensions whereas it previously measured 35 x 28 mm axial dimensions. The edema surrounding the lesion has regressed. Blood products within it have evolved. Centrally it has a mixture of T1 hyperintensity and intermediate signal and on T2 imaging it has a mixture of T2 hyperintensity and some intermediate signal.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The soft palate appears symmetrically thick more so than on the prior exam.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size.. The posterior communicating arteries are small in the right side and medium size on the left. The vertebral arteries are similar in size. There is extracranial origin of the left posterior inferior cerebellar artery.

Output: 1.Continued evolution of a left frontal lobe hematoma.2.No evidence for intracranial cerebrovascular occlusive disease.3.Some thickening of the soft palate in a symmetric fashion could be related to superimposed secretions and is nonspecific.


Instruction: Generate impression based on findings.

Input: Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus [G40.309] / Weakness [R53.1], Reason for Study: ^Reason: evaluate for poss met, vs post infarct encephalomalacia History: Status epilepticus on presentation There is no evidence of acute ischemic lesion.However, there is late subacute ischemic infarction involving left occipital lobe cuneus with minimal surrounding edema but without diffusion restriction. On post contrast scans, the lesion shows gyriform enhancement indicating luxury perfusion status. On gradient echo images, the left occipital lobe lesions show punctate susceptibility artifacts indicating hemorrhagic transformation.In addition, there are multifocal chronic ischemic infarct lesions involving left inferior parietal lobule and right occipital lobes, in particular cuneus and anterosuperior aspect of lingual gyrus. There is no evidence of abnormal nodular enhancement suggesting possible metastatic nodule on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening on the right maxillary sinus.

Output: 1. Late subacute ischemic infarct lesions involving left occipital lobe cuneus as described above.2. Chronic ischemic infarctions involving right inferior parietal lobule as well as right occipital lobes as described above.3. No evidence of acute ischemic or hemorrhagic lesion.