Instruction: Generate impression based on findings.

Input: Reason: L1 bone and sacrum biopsy History: pt with bil. lower extremity pain Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. There is anterior fusion of T12 on L1.

Output: L1 vertebral bone biopsy under CT guidance. A total of seven samples were delivered to pathology for analysis. One sample for flow cytometry and six for surgical pathology.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 3 ml of a of Omnipaque 240 (to confirm the intra-articular position of the needle) was injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. Next, a mixture of 1 cc Aristospan and 3 cc lidocaine was injected into the joint without complication. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 11 seconds

Output: Successful right hip injection without immediate complication.


Instruction: Generate impression based on findings.

Input: Unspecified disturbances of skin sensation [R20.9] / Spastic hemiplegia affecting unspecified side [G81.10], Reason for Study: ^Reason: CN evaluation History: ? Multiple CN symptoms namely 5 and 7 There is no evidence of acute ischemic lesion scan.There is a 13 mm x 24 mm sized left posterior aspect of the basal ganglia tissue loss which may represent prior hemorrhagic stroke.Multifocal bihemispheric scattered and somewhat patchy high T2 signal intensity white matter lesions indicate non specific small vessel ischemic disease. Since the slice thickness of this imaging study was 3mm with 4mm gap, it is not possible to evaluate cranial nerves precisely. The right cavernous sinus shows low signal intensity on T2 (series 5, image 13/39). The lesion does not show evidence of mass effects against carotid artery but intense enhancement on contrast infusion. This low signal intensity of the right cavernous sinus may indicate partial volume averaging artifacts.Otherwise there is no MR evidence of abnormal enhancement. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There is mucosal thickening of the right maxillary sinus, bilateral ethmoid sinuses and frontal sinus.

Output: 1. No acute ischemic lesion. No abnormal enhancement.2. Chronic hemorrhagic infarction with tissue loss on the right basal ganglia.3. Non specific small vessel ischemic disease.Comment: Since the imaging study was not tailored for cranial nerve examination, the study may need to be repeated without additional charge.


Instruction: Generate impression based on findings.

Input: 79-year-old female. Enlarging left hip mass. Pain. Evaluate for chronic calcified trochanteric bursitis. 5.1 x 2.2 cm lesion in the left buttock subcutaneous tissues immediately dorsal to the gluteus maximus muscle (series 6, image 15). It is comprised of speckled T1/T2 hypointense foci diffusely consistent with calcifications, better seen on prior CT, and shows interspersed fat, most likely representing fat necrosis. This lesion is not significantly changed in size from immediate prior CT, and was present on 2005 CT, though difficult to compare as it was incompletely imaged on that exam.Diffuse atrophy of the pelvic muscles. Bone marrow signal intensity is within normal limits. No evidence of trochanteric bursitis.

Output: Calcified left buttock subcutaneous lesion most consistent with fat necrosis. No evidence of trochanteric bursitis.


Instruction: Generate impression based on findings.

Input: Seizure. 18-year-old male 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.Some metal artifact appears to be present along the right frontal scalp tissues. This is not evident on the recent CT of the head however.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 minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Hippocampi are symmetric.

Output: 1.There is no evidence for cerebral infarction.2.No abnormal mass lesion is appreciated intracranially


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:5/22/1962)Reason: evaluate for demyelinating disease History: as abovePROVIDER/ATTENDING NAME: RAYMOND J ROOS RAYMOND J ROOS MRI thoracic spine:There are patchy T2 hyperintense lesions present within the thoracic spinal cord. This includes the right posterior lateral aspect of the spinal cord at T6 and the left posterior lateral aspect of the spinal cord at T8.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine: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 a diffuse disc bulge present this level associated with moderate bilateral facet and ligamentum flavum hypertrophy. There is preservation of the fat at the lateral recess and the exiting nerve roots are surrounded by fat within the neural foramina.At L4-5 there is some loss of disc space height, disc desiccation, diffuse disc bulge and moderate bilateral facet ligamentum flavum hypertrophy associated with mild anterior subluxation of L4 and L5. There is effacement of the fat at the lateral recess bilaterally at this level and crowding of the nerve roots within the thecal sac. Within the neural foramina the exiting nerve roots on the right side are surrounded by fat however the fat surrounding the exiting nerve roots in the left side is effaced. At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a small broad-based central disc protrusion present at this level.

Output: 1.There are lesions present within the thoracic spinal cord as detailed above which are suspicious for demyelinating process.2.There are degenerative changes present in the lumbar spine which are worse at L4-5 where there is a moderate degree of spinal stenosis and encroachment of the left-sided exiting nerve roots due to degenerative changes.


Instruction: Generate impression based on findings.

Input: 28 years, Female, Reason: please evaluate the thickness of the anterior uterine wall History: preterm contractions. PELVIS: FemaleUTERUS, ADNEXA: There is a monochorionic twin intrauterine pregnancy. The placenta is positioned anteriorly without evidence of previa. Grossly normal amount of amniotic fluid. Please note that evaluation of the fetus is limited due to motion and this study was not protocoled for evaluation of fetal anomalies.There is diffuse thinning of the anterior myometrium to approximately 4 mm. There is focal irregularity and thickening in the lower uterine anterior abdominal wall measuring up to 8 mm which likely corresponds to a C-section scar. No focal fluid collections. No evidence of dehiscence at the scar.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: Diffuse uterine thinning with irregularity at C-section scar. No evidence of dehiscence or focal fluid collections.


Instruction: Generate impression based on findings.

Input: 68-year-old male with elevated PSA, previous biopsy reveals ASAP and HG PIN PELVIS:PROSTATE:Prostate Size: 4.9 x 2.5 x 3.8 cm.Peripheral Zone: Streaky T2 hypointensities throughout the peripheral zone may reflect prostatitis. There is no discrete focus suspicious for malignancy.Central Gland: Moderate degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: Right-sided bladder diverticula.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Status post right total hip arthroplasty artifact that limits evaluation of the right hip region.OTHER: No significant abnormality noted.

Output: 1.Streaky T2 hypointensities throughout the peripheral zone can be seen in prostatitis. This finding lowers the sensitivity for the detection of prostate cancer. 2.Within these limitations, there is no discrete focus suspicious for malignancy.


Instruction: Generate impression based on findings.

Input: evaluate for possible seizure etiology in pt with first time seizure No abnormal diffusion restriction. No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or midline shift. No extra-axial fluid collections. The ventricles, sulci, and cisterns are normal in size without evidence of hydrocephalus. Gray-white matter differentiation is preserved. There is symmetric size, configuration, and preservation of internal architecture of the bilateral hippocampi. Nonspecific scattered opacification of ethmoid air cells and bilateral sphenoid, maxillary and right frontal mucosal thickening. Imaged mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable. Normal flow voids are present within major intracranial vasculature.

Output: No specific structural seizure focus is identified. Nonspecific sinus disease.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with neck pain and radiculopathy; with back pain and right lower extremity radiculopathy. Cervical:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The visualized spinal cord shows normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left facet arthropathy. Mild uncovertebral hypertrophy. Mild right foraminal narrowing. No spinal canal stenosis. C4-5: Left facet arthropathy. Mild uncovertebral hypertrophy. Moderate left and mild right foraminal narrowing. C5-6: Facet arthropathy. Mild posterior disc-osteophyte complex formation. Mild spinal canal stenosis without significant cord deformation. Moderate to severe bilateral foraminal narrowing. C6-7: Facet arthropathy, left more than right. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Lumbar:Alignment is anatomic. Vertebral body height and morphology are within normal limits. Edema along the anterior inferior endplates of L3 and L4 is likely degenerative in nature. No concerning marrow replacement is demonstrated.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: Small left paracentral disc protrusion. No significant spinal canal or foraminal stenosis. L2-3: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging. No significant spinal canal narrowing. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Disc bulging. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Disc bulging with left foraminal annular fissuring. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Facet arthropathy. Minimal disc bulging. No spinal canal stenosis. Mild right foraminal narrowing.

Output: 1.Multilevel degenerative findings are seen in the cervical spine. No high-grade spinal canal stenosis is demonstrated. However, moderate to severe foraminal narrowing is evident bilaterally at C5-6, with scattered mild to moderate foraminal narrowing at additional levels as above.2.Multilevel degenerative findings are also seen in the lumbar spine. No high-grade spinal canal stenosis is demonstrated. Only mild scattered foraminal narrowing is seen.


Instruction: Generate impression based on findings.

Input: 72-year-old female with cerebellar degeneration experiencing ataxia. Redemonstrated are foci of T2/Flair hyperintensity in the cerebral white matter, without associated restricted diffusion, mass effect, susceptibility abnormality, or enhancement. There are a few more lesions compared to the 2012 study, especially notable within a cluster identified in the left frontal lobe white matter.Redemonstrated is developmental venous anomaly in the left frontal lobe. The ventricles, sulci and cisterns are prominent, with a slightly disproportionately greater degree of cerebellar atrophy. However, there is no apparent adjacent pons atrophy. Overall, the degree of supratentorial and infratentorial atrophy is stable.The gray-white matter differentiation is maintained. 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. Mucosal thickening and a small superimposed air-fluid level is present within the right maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear.

Output: 1.Progressive chronic small vessel ischemic disease.2.Stable mild supratentorial cerebral atrophy and stable mild to moderate cerebellar atrophy.3.Mucosal thickening and a small superimposed air-fluid level is present within the right maxillary sinus.


Instruction: Generate impression based on findings.

Input: 10 year old female. Evaluate brain for abscess/ICP issues. Patient with fever and mental status changes. Increased seizure frequency. Microcephaly is noted. Extensive diffuse encephalomalacia appears similar to prior MRI. Parenchymal calcifications are noted. The ventricles are stably enlarged. There is no evidence of acute intracranial hemorrhage. There is no evidence of abscess formation given the limitations of noncontrasted CT.No acute abnormalities are noted in the calvaria and skull base. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Extensive encephalomalacia and enlarged ventricles that appears unchanged when compared to prior MRI.


Instruction: Generate impression based on findings.

Input: 66-year-old female with headaches and a known meningioma. Evaluate meningioma size.Further history from electronic medical record: History of breast cancer. There is no evidence of intracranial hemorrhage or acute infarct. There is no signal abnormality within the brain parenchyma. Along the superior sagittal sinus overlying the right parietal lobe there is a 16 x 16 mm extra-axial lesion which is heterogeneous on T1 and T2 weighted images, dark on susceptibility weighted images, and heterogeneously enhancing. There is no surrounding edema. The adjacent sagittal sinus is thinned but enhances suggesting maintenance of flow. There is no abnormal enhancement elsewhere. 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. Status post right lens replacement. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 16 x 16 mm extra-axial lesion along the right parietal lobe adjacent to the superior sagittal sinus compatible with meningioma.


Instruction: Generate impression based on findings.

Input: 38-year-old with history of pancreatitis and history of prior abnormal pancreatic imaging. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No focal hepatic lesions identified.Patient is status post cholecystectomy. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: The spleen is normal.PANCREAS: There is mildly increased diffusion restriction in the uncinate process, head, and tail of the pancreas with mild infiltration of the surrounding fat planes.The main pancreatic duct appears normal in caliber. There is no pancreas divisum. An 8 mm nonenhancing, T2 bright focus in the neck of the pancreas (9/33) appears to communicate with the main pancreatic duct. Additionally, there is a punctate focus of T2 hyperintensity in the pancreatic tail (9/25).ADRENAL GLANDS: No significant abnormality .KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subacute pancreatitis involving the head and tail.2.Subcentimeter sidebranch IPMN in the pancreatic neck. Additional nonspecific punctate cystic lesion in the pancreatic tail, could represent a tiny pseudocyst or additional sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with anoxic brain injury now with increasing seizure frequency. Evaluate for new bleed or focus of seizure. Nonenhanced CT of brain:There is prominence of cortical sulci and significant dilatation of ventricular system with interval worsening since prior study. Prominence of cortical sulci may indicate underlying parenchymal volume loss. Enlarged lateral ventricles and third ventricle are highly concerning for hydrocephalus. There is significant ballooning of the frontal horns bilaterally.There is also evidence of significant interval increase in extra-axial bilateral temporal, frontal and parietal CSF density subdural collections. Further follow-up with an MRI is recommended. There is no evidence of acute hemorrhage, edema or midline shift.

Output: 1. Interval increase in bilateral large CSF density subdural collections in temporal -- frontal and parietal regions and2.significant interval increase in the size of the supratentorial ventricular system concerning for hydrocephalus.3.No evidence of acute intracranial hemorrhage, edema or midline shift.4.Prominence of cortical sulci is concerning for underlying volume loss.


Instruction: Generate impression based on findings.

Input: Female 32 years old Reason: hx menorrhagia; endometrial masses History: menorrhagia PELVIS:UTERUS, ADNEXA: The uterus is retroverted and retroflexed. Small subcentimeter focus of thickening of the junctional zone at the uterine fundus suggestive of focal adenomyosis. Multiple follicular cysts identified within both ovaries. Some of these demonstrate intrinsic T1 hyperintense signal suggestive of hemorrhagic cysts. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild disk bulging at the L4-L5 level.OTHER: Trace pelvic free fluid, likely physiologic.

Output: 1.Small focus of focal adenomyosis at the uterine fundus.2.Subcentimeter hemorrhagic ovarian cysts.


Instruction: Generate impression based on findings.

Input: Ankle pain and injury TENDONS: The tibialis posterior, flexor digitorum longus and flexor hallucis longus tendons appear normal. The peroneus complex appear normal. The Achilles tendon appear normal.LIGAMENTS: The anterior and posterior tibiofibular ligaments are normal. The anterior talofibular ligament is normal. The deltoid ligament is normal.BONE: No bone bruise. No acute fracture. The visualized talar dome is normal.ADDITIONAL

Output: No evidence of ligamentous or bony injury of the left ankle.


Instruction: Generate impression based on findings.

Input: Clinical question: Lumbar spinal stenosis. Signs and symptoms: Pain. Nonenhanced lumbar MRI:Lowermost visualized thoracic spine and thoracic cord is unremarkable.T12 -- L1 demonstrate mild degenerative changes and unremarkable otherwise.L1 -- L2 demonstrate mild degenerative changes and unremarkable otherwise. L2 -- L3 demonstrate moderate disk disease and loss of disk height, shadow diffuse bulging disk, mild bilateral ligamentum flavum hypertrophy and mild facet disease. There is no evidence of spinal stenosis however moderate left neural foraminal compromise is present.L3 -- L4 demonstrate mild to moderate disk disease and loss of disk height, moderate left and mild right ligamentum flavum hypertrophy and minimal facet disease. There is a tiny left lateral disk protrusion at this level which projects into the inferior aspect of the left neural foramina. Degenerative changes on the left results in mild neural foraminal compromise and patent right and central spinal stenosis.L4 -- L5 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis. Moderate right neuroforaminal compromise is sagittal images.L5 -- S1 demonstrate moderate disk disease with loss of disk height, moderate right and mild left ligamentum flavum hypertrophy, moderate bilateral (right greater than left) facet hypertrophic changes are noted. Constellation of the above findings results in mild grade 1 anterolisthesis however no convincing evidence of central spinal stenosis. There is moderate left lateral recess and left neural foraminal compromise . There is a suspected small synovial cyst on the right projecting anterior to the right ligamentum flavum.

Output: 1.No convincing evidence of a spinal stenosis at any level.2.Extensive degenerative changes at L5 -- S1 level with resultant mild grade 1 anterolisthesis and moderate left neural foraminal and lateral recess compromise.3.Mild to moderate degenerative changes at other levels however without central spinal stenosis.4.Neural foraminal compromise as detailed level above.


Instruction: Generate impression based on findings.

Input: Reason: cellulitis left wound with swelling, s/p debdridement on wound vac, R/o osteomyelitis of foot History: cellulitis left foot s/p debridement The dorsal soft tissues of the foot are swollen, and there is thickening of the skin in this region. There are longitudinal fluid collections within the dorsal soft tissues overlying the midfoot, which could represent small seromas in the debridement bed. The larger and more medial fluid collection measures 3.2 x 0.6 x 5.3 cm, and the smaller fluid collection measures 1.8 x 0.4 x 2.6 cm. There is no evidence of abscess formation. The underlying bone marrow signal is within normal limits. There is no abnormal bone marrow signal intensity elsewhere within the visualized foot to suggest osteomyelitis. Mild osteoarthritis affects the midfoot.

Output: Soft tissue swelling and small fluid collections, without evidence that they are abscesses and without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Evaluate for retropharyngeal abscess. Patient is status post tracheostomy with signs of abscess on endoscopy. Neck CT:Again noted is bone and disk space destruction consistent with diskitis - osteomyelitis at C5, C6, and C7 levels as reported on recent CT study. Kyphotic angulation at the level of diskitis - osteomyelitis, with uncovering of bilateral C5 - C6 facet joints are again noted. Again noted are postsurgical changes of laminectomy. A thin layer of epidural abscess is again seen along the posterior longitudinal ligament of the cervical spine as described on prior MRI of cervical spine.There is significant heterogeneous soft tissue thickening involving the prevertebral space, retropharyngeal space and pharyngeal mucosal space, extending from the level of C2 - C3 to C7 - T1 level, superior to the tracheostomy tube placement. There is air tracking in the prevertebral space. Given the presence of osteomyelitis - diskitis, this probably represents acute inflammatory changes and phlegmon. However, there is no discrete fluid collection to suggest retropharyngeal abscess. Presence of soft tissue mass in hypopharynx representing tumor recurrence cannot be excluded.There is left pleural effusion. There are emphysematous changes in the lung apices.There is bony erosion of anterior left paramedian region of the left maxillary alveolus. This is unchanged.

Output: 1. Diskitis - osteomyelitis involving C5, C6, and C7 levels with kyphotic angulation of the cervical spine and uncovering / subluxation of the bilateral C5-C6 facet joints.2. Small residual epidural abcess in cervical spine.3. Heterogeneous soft tissue thickening involving the hypopharynx, extending from pharyngeal mucosal space to retropharyngeal space, with air tracking in the prevertebral space, likely representing a combination of inflammatory soft tissue edema and phlegmon. No evidence of discrete abscess in retropharyngeal space. Presence of recurrent tumor in the hypopharynx cannot be excluded based on imaging appearance.4. Left pleural effusion.


Instruction: Generate impression based on findings.

Input: 35-year-old female with melanoma with brain and lung metastases. Evaluate progression. CT of brain without and with infusion:Enhancing lesion measuring approximately 7 mm times 6 mm in transaxial dimension within the pons is noted. No evidence of surrounding edema. This finding was noted on prior MRI and considering the difference in technique no definitive interval change is detected. Images two posterior fossa otherwise demonstrate no detectable metastatic lesion.Images through supratentorial space demonstrate an area of encephalomalacia along the interhemispheric aspect of right frontal lobe with no abnormal enhancement. This was noted on prior MRI examination at the site of prior craniotomy.A small calcific/hemorrhagic and with possible enhancement in the right posterior temporal adjacent to the trigone of right lateral ventricle measuring 4 mm x 4 mm is consistent with an additional metastatic lesion. This was noted on prior MRI exam and is stable. No definitive detectable additional lesions.Calvarium demonstrates post operative changes of right frontal craniotomy and is otherwise negative. Mastoid air cells and paranasal sinuses are unremarkable.120 cc of Omnipaque 350 was utilized for the above study.

Output: The visualized lesions on this exam are similar to what were noted on the prior MRI examination. CT is significantly less sensitive to detect smaller lesions.


Instruction: Generate impression based on findings.

Input: Type 2 diabetes, nonhealing ulcer. MR evaluation demonstrates marked signal abnormality and questionable cortical bone loss involving the distal tuft of the first right toe. Plain film correlation would be helpful for confirmation, however cortical margins are not well visualized and underlying enhancement is observed. Underlying subungual soft tissue and/or possible pus with surrounding inflammation and no clear ulceration. There are visualized second toe and remaining visualized digits are otherwise unremarkable. More proximally proximal phalanx and metatarsals are also unremarkable. Alignment preserved throughout.

Output: Suspected multiple changes compatible with osteomyelitis of the tuft of the first toe. Plain film correlation would be helpful


Instruction: Generate impression based on findings.

Input: Knee pain for weeks to months post rugby with persistent lateral joint line pain, weakness. Evaluate for lateral meniscal tear. MENISCI: There is a small cleft along the undersurface of the periphery of the posterior horn of the lateral meniscus. While it is possible that this could represent a small tear in the red zone, it may simply represent an interface with one the popliteomeniscal fascicles, and is not necessarily of clinical significance. The medial meniscus appears intactARTICULAR CARTILAGE AND BONE: Articular cartilage and bone appear normal.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism appears normal.ADDITIONAL

Output: Small cleft along the undersurface of the periphery of the posterior horn of the lateral meniscus could conceivably represent a very small tear in the red zone, although it may simply represent the interface with one of the popliteomeniscal fascicles and is not necessarily of clinical significance.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. Subsequently, 1 ml of Kenalog was injected into the joint. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute 27 seconds

Output: Successful injection of gadolinium and Kenalog into the right hip.


Instruction: Generate impression based on findings.

Input: 49 year old man with history of previous pulmonary sarcoidosis, coronary disease with previous PCI, and worsening LV dysfunction who was referred for cardiac MRI to evaluate for possible sarcoidosis. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 8%, the LV end diastolic volume index is 120 ml/m2 (normal range: 74+/-15), the LVEDV is 204 ml (normal range 142+/-34), the LV end systolic volume index is 110 ml/m2 (normal range 25+/-9), the LVESV is 188 ml (normal range 47+/-19), the LV mass index is elevated at 125 g/m2 (normal range 85+/-15), and the LV mass is 214 g (normal range 164+/-36). There is global hypokinesis with regional variation. For example, akinesia is demonstrated by the anterior and basal two thirds of the inferior walls, severe hypokinesia of the septum and apical two thirds of the lateral wall. There is no evidence of myocardial edema. There is no late gadolinium enhancement to suggest myocardial fibrosis, infiltration or inflammation. The global relative enhancement ratio is normal. No intracardiac thrombus.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 82 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no evidence of pericardial inflammation or effusion.Extracardiac FindingsA right adrenal mass is present which measures 4.2 x 4.4 cm on the coronal view. This is a heterogeneous mass with areas of enhancement, better characterized on the MR abdomen performed 12/8/2015.

Output: 1. Severely dilated left ventricle with severely reduced systolic function (EF = 8%). 2. Normal sized RV with moderately reduced systolic function (EF = 40%). 3. Moderately dilated left atrium. 4. No evidence of late gadolinium enhancement to suggest myocardial inflammation, infiltration or fibrosis. 5. Heterogeneous right adrenal mass, better characterized by dedicated abdominal imaging to be performed today.


Instruction: Generate impression based on findings.

Input: 42-year-old male with history of high-grade renal cancer. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense nonenhancing foci compatible with cysts are stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy without evidence of local recurrence. The left kidney is normal in appearance without a suspicious lesion or hydronephrosis. RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a T2 hyperintense nonenhancing focus in the midline pelvis anteriorly compatible with a cystic focus measuring 1.0 x 0.9 cm (series 18, image 24) which may represent a urachal remnant.

Output: Status post right nephrectomy without evidence of recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: There are post-surgical related to Chiari decompression. There is a residual extradural CSF intensity fluid collection remains that measures up to 5 mm in thickness, previously 11 mm. The inferior cerebellum has an unchanged configuration. There is biphasic CSF flow anterior across the anterior neo-foramen magnum, but somewhat blunted CSF flow posteriorly. The vertebral body heights and alignment are unchanged. There is no evidence of syringohydromyelia. The bone marrow signal is unremarkable. A posterior disc-osteophyte complex at C5-6 and ligamentum flavum thickening result in spinal canal stenosis, which appears to have slightly progressed.

Output: 1.Post-surgical findings related to related to Chiari decompression with a small amount of residual extradural fluid in the surgical bed, which may represent a pseudomeningocele.2.No evidence of cervical syringohydromyelia.3.Slight increase in spinal canal stenosis at the C5-6 level related to a disc-osteophyte complex and ligamentum flavum thickening. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 53-year-old female with knee pain Due to the patient's body habitus a high-definition knee coil could not be used. Use of the alternative coil results in slightly suboptimal image qualityMENISCI: There is minimal intrasubstance signal likely representing degeneration of the menisci without discrete tear.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage along the lateral patellar facet with focal near full-thickness degeneration inferiorly and associated degenerative subchondral bony changes. Mild degeneration of the articular cartilage of the trochlea. Mild subjective thinning of the medial tibiofemoral compartment without discrete defect.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL

Output: Articular cartilage degeneration as described above, particularly affecting the lateral patellar facet. No meniscal tear.


Instruction: Generate impression based on findings.

Input: Ms. Stefanski is a 56year old female with a personal history of left breast lumpectomy in 2013 for triple negative IDC followed by neoadjuvant chemotherapy and radiation. Personal history of BRCA2 mutation and two biopsy-proven fibroadenomas in the left breast. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Susceptibility artifact is seen in the left medial breast and left axillary region, corresponding to the surgical clips from patient's prior lumpectomy. Two stable lobulated masses are present in the left breast, compatible with biopsy proven fibroadenomata. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the left breast and axilla. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 78-year-old female with altered mental status. Query mass effect or hemorrhage. Review of medical record indicates history of pituitary tumor. Large sellar mass extending towards the cavernous sinus with rim calcifications is consistent with patient's history of pituitary tumor as has been described on prior MRIs. There is no evidence of intracranial hemorrhage or edema. The ventricles and the basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Large sellar mass consistent with patient's history of pituitary tumor, likely pituitary macroadenoma. Please note that a meningioma is also a differential consideration for this location.2. No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Reason: HCC screening History: Cryptogenic cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Subcentimeter T2 hyperintense lesion in the right hepatic lobe is stable, likely a cyst. No suspicious hepatic lesions. Mild perihepatic ascites. Prominent common bile duct measuring up to 1.3 cm with mild intrahepatic biliary ductal dilatation, unchanged. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is nondilated. There are several punctate cystic lesions within the pancreas including uncinate (7/20), head (7/18), and body (7/17) which are unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintensities within the kidneys, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small left pleural effusion is increased. Small amount of pelvic ascites.

Output: 1.Limited exam given lack of intravenous contrast. Given this limitation, no suspicious hepatic lesions are identified.2.Punctate cysts within the pancreas are unchanged and likely represent side branch IPMN's.3.Small left pleural effusion, slightly increased since the prior exam.


Instruction: Generate impression based on findings.

Input: Lung cancer and brain metastases surveillance. There are postoperative findings related to right frontoparietal craniectomy and cranioplasty with confluent T2 hyperintensity, but no discernible nodular enhancement in the treatment bed. However, there is interval increase in size of the peripherally enhancing mass in the left occipital lobe that measures up to 20 mm, previously 15 mm, with surrounding confluent T2 hyperintensity. There is an unchanged background of mild cerebral white matter T2 hyperintensity, which is nonspecific. There is no evidence of intracranial acute infarct. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The enhancing lesion in the squamous portion of the right temporal bone with a cortical defect appears to be unchanged. There is extensive hyperostosis frontalis.

Output: 1. Interval increase in size of the previously radiated left occipital lobe metastases and associated vasogenic edema.2. The metastasis in the squamous portion of the right temporal bone with a cortical defect appears to be unchanged.3. Post-treatment findings in the right frontal lobe without evidence of recurrent tumor in this area.


Instruction: Generate impression based on findings.

Input: Lumbago [724.2], Reason for Study: ^Reason: question osteo, discitis History: lower back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Subtle contrast enhancement of L3 infero- anterior endplate, L4-5 disc with adjacent end plates, L5-S1 disc space and upper endplate of S1 vertebral bodies are again demonstrated.The extent of enhancement especially on the L45 disc as well as adjacent endplates appears to be slightly decreased compared to prior scan. Especially on axial scan, the enhancing area of L45 appears to be more discrete than prior scan, however, this finding could be related to difference in imaging technique.There is no change of L45 disc height comparing to prior scan. Minimal bulging of disc on L45 is seen, no change since prior scan.Again these findings suggest possible discitis but degenerative changes cannot be completely excluded.There is no evidence of paravertebral abnormal soft tissue nor abnormal enhancement.There is no epidural or paraspinal mass.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level.

Output: 1. Interval subtle decreased extent of L45 disc and adjacent endplate enhancement comparing to prior scan.2. Contrast enhancement with endplate changes of L34 and L5S1 discs are redemonstrated, no significant interval change since prior scan. 3. No evidence of spinal canal stenosis, no neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Low back pain. Evaluate for spondylolisthesis L5-S1. There is a broad-based disc bulge at L5-S1 predominantly towards the left as well as mild moderate bilateral facet hypertrophy. There is associated effacement of the left lateral recess. There is mild deformity of the spinal canal at this level. There is mild neural foraminal narrowing bilaterally at this level. There is mild grade 1 anterolisthesis of L5 on S1. A disc bulge is also present at L3-L4 and L4-5 with no associated significant spinal canal or neural foraminal narrowing. The spinal cord displays normal signal and morphology. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: Mild multilevel degenerative changes of the lumbar spine predominantly affecting the L5-S1 level, where there is also mild anterolisthesis.


Instruction: Generate impression based on findings.

Input: 77-year-old male with left-sided weakness, poor balance and dysarthria Multiple areas of vasogenic edema and some with internal areas of high density are believed to represent multiple metastatic lesions some with hemorrhagic component. Further correlation with an MRI or a postinfusion CT is recommended. There appears to be a large mass within the corpus callosum with bilateral extension. Images through posterior fossa are unremarkable.

Output: 1.Findings findings concerning for multiple metastatic lesions some with hemorrhagic components.2.Follow-up with an MRI with infusion is recommended.


Instruction: Generate impression based on findings.

Input: History of rectal cancer. Status post neoadjuvant radiation. Patient with rectal bleeding pain and urgency. Evaluate circumferential margin.Rectal bleeding in May 2015 and was found to have a rectal mass. Colonoscopy revealed rectal cancer reported to be 5 cm from the anal verge. He is s/p neoadjuvant chemoXRT.7.11.2015 Rectal biopsy: Infiltrating moderately differentiated adenocarcinoma. Overall image quality: AdequatePELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: There are scattered lymph node with the largest measuring 0.8 x 0.5 cm (series 4, image 47); the distance from this lymph node to the mesorectal fascia is approximately 7 mm. Additionally, there is concern for lymphovascular invasion on the right as noted on coronal series 6, image 23).Lymph nodes outside the mesorectal fascia: NoneBOWEL, MESENTERY: Rectal Tumor:Size: 2.8 x 2.1 x 1.0 cm (image 18/series 5; image 48, series 4)Tumor appearance on T2-weighted images: The aforementioned lesion is hypointense.Tumor location: Anterior rectal wall approximately 5 cm from the anal verge.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 5 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 7 cmCircumference of the rectum involved: Less than 25%Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): No evidence of invasion of the prostate or seminal vesicles.Tumor Distance to Mesorectal Fascia: 7 mm (series 4, image 47)BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Finding findings concerning for rectal neoplasm with associated mesorectal lymph nodes and concern for lymphovascular invasion as detailed above.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: eval post fossa mass History: ataxia Brain MRI:There is 40 x 38 x 38mm sized heterogenous signal intensity mass arising posterior superior aspect of the 4th ventricle. The infero- mesial aspect of the right cerebellar hemisphere shows high signal intensity on T2/FLAIR but showing minimal or equivocal enhancement, nor restricted diffusion. Thus, this could represent extension of the original mass which are non-enhancing part (the phenotype of the tumor could be different) or could represent compressed right PICA territory with subacute or chronic ischemic infarction. The mass shows mass effects against 4th ventricle which shows compressed from the posterior aspect and cerebellar tonsils appear to be pushed down through the foramen magnum. Post Gad enhanced images show heterogenous enhancement.Ventricular system appears to be enlarged with periventricular high signal intensities on periventricular white matter indicating interstitial edema in obstructive hydrocephalus.Constellation of above findings indicate possible medulloblastoma and the differential diagnosis include ependymoma.The paranasal sinuses and mastoid air cells are clear.Spine MRI:There is 4th ventricular mass with heterogenous enhancement with mass effects towards cerebellar tonsils creating downward herniation.There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of T12-L1.The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues and musculature are unremarkable.There is no evidence of abnormal enhancement.

Output: 1. 4th ventricular heterogeneous mass with heterogenous enhancement, possible diagnosis include medulloblastoma and ependymoma.2. Normal spine MRI


Instruction: Generate impression based on findings.

Input: 26-year-old male with acute mental status change over past 9 days The density and morphology brain parenchyma remains entirely within normal limits for patient's stated age of 26. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Calvarium, paranasal sinuses and mastoid air cells are also unremarkable. Further follow-up with an MRI examination is recommended.

Output: Normal CT of brain without the infusion.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: Evaluate for cause of AMS with recent OHT History: Evaluate for cause of AMS with recent OHT No evidence of acute ischemic or hemorrhagic lesion on the scan.Several scattered susceptibility lesions on bilateral hemisphere white matter indicating chronic hemorrhagic foci or calcification, no change since prior scan.On FLAIR imaging, several scattered high signal intensity lesions on subcortical white matter indicating nonspecific small vessel ischemic disease, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No change of several punctate chronic hemorrhagic foci and non specific small vessel disease since prior scan.


Instruction: Generate impression based on findings.

Input: History of bladder cancer status post radical cystectomy with orthotopic neobladder, urinary diversion, evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter parenchymal T2 hyperintensities. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. Postsurgical changes to the right kidney. The kidneys enhance symmetrically without suspicious focal lesions. No filling defects are seen within the renal collecting systems and opacified portions of the ureters.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously described lymph node adjacent to the right psoas muscle measures 0.9 x 0.7 cm (series 8, image 40), not significantly changed. The distal colon is redundant.BONES, SOFT TISSUES: Sacral perineural cysts are again incidentally noted..PELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy with neobladder formation.BLADDER: Status post cystoprostatectomy with neobladder formation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Postsurgical changes without definite evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: Left partial glossectomy and neck dissection for T1N0 squamous cell carcinoma of the left posterior lateral oral tongue on 12/3/2015. There are post-treatment findings related to left partial glossectomy and neck dissection. There is no measurable tumor in the oral cavity. Likewise, there is no significant lymphadenopathy in the neck. The remaining salivary glands and thyroid are unremarkable. There is mild mucosal thickening in the ethmoid sinuses. The imaged intracranial structures are unremarkable. There is multilevel degenerative cervical spondylosis.

Output: Post-treatment findings related to left partial glossectomy and neck dissection, without measurable tumor in the oral cavity and no significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for new infarction, emboli, evolving lesion History: new left leg weakness, right arm weakness There is redemonstration of multiple punctate foci of diffusion restriction in both cerebral and cerebellar hemispheres predominantly in subcortical locations. There is a new punctate focus in the right cerebral hemisphere.There is a redemonstration of a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is redemonstration of multiple foci of punctate SWI signal loss in the thalami and to a lesser degree right cerebellar hemisphere, pons and basal ganglia. There is a punctate focus of diffusion restriction in the left temporal lobe.There is redemonstration of patchy and serpiginous signal loss on SWI in the right centrum semiovale associated with patchy T2/FLAIR signal hyperintensity.To a lesser degree this is also present in the left centrum semiovale.There is redemonstration of patchy signal loss on SWI in the right parietal lobe subcortical white matter associated with patchy T2/FLAIR signal hyperintensity..Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is redeomnstration of multiple punctate foci of infarction in the cerebral and cerebellar hemispheres with at least one new focus since the prior exam.2.There is redemonstration of multiple mucrohemorrhages in the thalami and to a lesser degree right cerebellar hemisphere, pons and basal ganglia. The pattern suggests hypertensive cause.3.Patchy foci of encephalomalacia are present in the right centrum semiovale, right parietal cortex and subcortical white matter and to a lesser degree left subependymal region and adjacent centrum semiovale. These likely represent encephalomalacia from prior events possibly associated with evidence of mineralization or hemosiderin deposition suggesting they are related to prior vascular events.


Instruction: Generate impression based on findings.

Input: 19-year-old woman with history of headache, vision changes, nausea, and vomiting. There is no diffusion-weighted abnormality to suggest ischemia. There is no susceptibility effect to suggest intracranial hemorrhage. There are no intracranial masses or mass-effect. The ventricles are within normal limits in size and configuration. The brain parenchyma is normal for age. There is no abnormal parenchymal or meningeal enhancement. The major flow-voids are preserved. Although this is not a dedicated MR of the orbits, the orbits and sella appear normal. The optic nerves are normal in caliber. There are small mucosal retention cysts in the maxillary sinuses bilaterally, otherwise the paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No finding to explain the patient's symptoms, specifically no evidence for acute intracranial hemorrhage, mass, or infarct.


Instruction: Generate impression based on findings.

Input: Right-sided weakness. History of CVA. Evaluate for ICH. There is a 4.1 x 3.4 cm subtle focal area of abnormal attenuation in the left vertex (image 21/30 on series 4) with a suggestion of surrounding vasogenic edema which may represent a mass which has increased in size when compared to the prior exam from 2006. Further evaluation of this lesion is recommended with a contrast-enhanced CT or MRI. Low attenuation in the periventricular and subcortical white matter is likely due to prior small vessel ischemia. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Possible mass in the left vertex as described above. Further evaluation with a contrast-enhanced CT or MRI is recommended. The ER was notified of these findings at 9:30 a.m. on 9/18/09.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: history of brain metastases s/p whole brain radiation History: none Brain MRIMotion artifact degraded image quality.There is no evidence of acute ischemic or hemorrhagic lesion.Multifocal bihemispheric scattered variable sized enhancing metastatic lesions including right frontal bone lesion do not show any significant interval change since prior scan.Underlying brain shows patch scattered FLAIR high signal intensity lesions on bilateral periventricular white matter indicating nonspecific small vessel ischemic disease, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Thoracic MRIThere is a laminectomy with external fixation T4 to T6.Multi-level vertebral body enhancing lesions are seen at T2, T4, T5, T6, T8 and L3 indicating metastatic lesions.Due to retropulsion of the T5 vertebral lesion, the spinal canal at this level shows severe stenosis. The spinal cord at this level cannot be precisely evaluated due to metallic artifacts.The T8 compression fracture appears to be progressed from about 30% to 50%. The right posterior aspect of the tumor mass abuts the thecal sac which is slightly progressed comparing to prior scan, but no significant retropulsion is seen and spinal cord signal intensity is normal. At this level, right side neural foramen shows minimal narrowing.In addition, there is about 41mm x 24mm sized right T6 level pleura based enhancing soft tissue mass likely represent either pleural metastatic lesion or right T6 rib lesion appears to be enlarged than prior scan. There is large amount of left pleural effusion.

Output: 1. No interval change of multifocal various sized brain metastatic lesions since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. Interval progression of metastatic vertebral lesions since prior scan. For example, T8 vertebral compression fracture has progressed, the right T6 extrapulmonary lesion has grown and the new development of pleural effusion.


Instruction: Generate impression based on findings.

Input: Female, 48 years old, history of low-grade salivary gland duct carcinoma of the right nasopharynx. No evidence of parenchymal edema, mass effect or pathologic intracranial enhancement is seen. No abnormal extra-axial fluid collections are detected. There is no evidence of acute intracranial hemorrhage. The ventricles are normal in size and morphology. Polypoid mucosal thickening centered on the right nasopharyngeal mucosa is not significantly changed in size measuring approximately 14 x 14 mm. A left globe prosthesis is in place.

Output: 1.No evidence of intracranial metastases.2.No significant change in size of a polypoid lesion within the right nasopharynx.


Instruction: Generate impression based on findings.

Input: New onset abnormal eye movements, not present at birth. Needs evaluation for CNS lesion versus inflammation. Brain: The brain shows appropriate for age myelination. There is no acute infarct or intraparenchymal hemorrhage. There is no definite structural abnormality. There is no mass or mass-effect and no abnormal intracranial contrast enhancement. The ventricles and sulci are normal in size. The major intracranial vascular flow voids are preserved. The pituitary gland is normal and there is no destructive skull lesion.Orbits: There is no evidence of abnormal signal or enhancement of the intraorbital optic nerves. The bilateral globes, lacrimal glands, extraocular muscles, and orbital fat appear unremarkable. There is no evidence of intraorbital mass lesions.

Output: 1. No evidence of acute infarction, intracranial hemorrhage, or intracranial tumor.2. No evidence of intraorbital lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are multiple unchanged patchy foci of T2 hyperintensity within the supratentorial and infratentorial white matter that are most compatible with chronic small vessel ischemic disease. There is unchanged mild global volume loss. There are multiple unchanged small foci of susceptibility effect throughout the supratentorial white matter, in a mainly subcortical distribution. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1.No evidence of acute infarct.2.Unchanged moderate small vessel ischemic disease.3.Multiple unchanged supratentorial chronic microhemorrhages in a mainly subcortical distribution, suggestive of amyloid angiopathy.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, with sensory and motor polyneuropathy, two years of progressive gait difficulty, history of prostate cancer. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits.Marrow signal is heterogeneous with scattered foci of T1 and T2 hyperintensity, likely representing focal fat or benign hemangiomas. No concerning marrow replacement or marrow enhancement is seen. Findings compatible with a developing Schmorl's node are noted at the superior endplate of L3.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No evidence of nerve root thickening or pathologic enhancement is observed.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. Moderate generalized spinal canal narrowing with slight crowding of the cauda equina nerve roots but no evidence of frank nerve root impingement. No significant foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a small superimposed central protrusion. Mild transverse narrowing of the spinal canal mild right foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Mild disc bulging. No significant spinal canal stenosis. Mild right foraminal narrowing.

Output: 1.Relatively mild degenerative findings are seen without evidence of any high-grade spinal canal or foraminal stenosis.2.No evidence of significant inflammation of the distal spinal cord or nerve roots is detected.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with cervical radiculopathy. Straightening of the cervical lordosis may be positional. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are normal. The visualized spinal cord shows normal signal intensity and morphology throughout. No epidural lesions are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild uncovertebral hypertrophy and facet arthropathy. No significant spinal canal or foraminal narrowing. C4-5: Mild uncovertebral hypertrophy. No significant spinal canal stenosis. Mild right foraminal narrowing.C5-6: Minimal uncovertebral hypertrophy. No spinal canal or foraminal stenosis.C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Very mild degenerative findings are seen without significant spinal canal or foraminal stenosis. 2.No spinal cord abnormalities are detected.


Instruction: Generate impression based on findings.

Input: History of right lower quadrant pain. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.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. The appendix is well seen, and is normal in caliber without surrounding fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Trace pelvic fluid of uncertain etiology.BONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: No significant abnormality noted.

Output: No specific findings to account for the patient's right lower quadrant pain. The appendix is well seen, and is normal in caliber without a surrounding fluid collection. Trace pelvic fluid of uncertain etiology.


Instruction: Generate impression based on findings.

Input: Male, 40 years old, with five days of unremitting migraine headache and one episode of vomiting. An ill-defined, bubbly multicystic lesion is demonstrated centered on the cerebellar vermis. Several of the small cysts suppress on FLAIR while others do not. The intervening vermian parenchyma is somewhat deformed, but no additional lesional tissue is suspected. No pathologic lesional enhancement is seen. However, there is one ill-defined focus of susceptibility within the lesion which could reflect blood product or mineralization. No large or abnormal vascular structures are suspected on either the postcontrast or susceptibility weighted images. The vermis may be very slightly expanded, but overall, no significant mass effect is seen. The contour of the fourth ventricle remains within normal limits.No additional lesions are seen. Morphology and signal characteristics of the supratentorial brain are within normal limits. No pathologic intracranial enhancement is seen. No abnormal extra-axial fluid collections are detected. There are no findings to suggest acute intracranial hemorrhage. The ventricular system is within normal limits.

Output: A bubbly appearing lesion is seen centered quite specifically in the cerebellar vermis which appears to be composed of numerous cysts and the deformed intervening vermian parenchyma. No pathologic enhancement is seen. No enlarged or abnormal vessels are detected. The lesion exerts little if any mass effect. There is one focus of associated susceptibility which could reflect blood product or mineralization.The differential diagnosis for this lesion is broad and would include a congenital dysplasia, sequelae of prior inflammation or infection, low-grade potentially involuted tumor, or an atypical presentation of Lhermitte-Duclos. A vascular malformation is considered unlikely.


Instruction: Generate impression based on findings.

Input: Tingling down right arm in C6-7 distribution. There is a congenitally narrow spinal canal. In addition, there are small posterior disc-osteophyte complexes at C3-4 through C7-T1 that at least partially efface the anterior thecal sac cerebrospinal fluid, but do not compress the spinal cord. There is also uncovertebral hypertrophy, which contribute to mild bilateral neural foraminal stenosis at C3-4, C4-5, and C7-T1, and at least mild to moderate neural foraminal stenosis bilaterally at C5-6 and C6-7. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Congenitally narrow spinal canal and small posterior disc-osteophyte complexes at C3-4 through C7-T1 that at least partially efface the anterior thecal sac cerebrospinal fluid, but do not compress the spinal cord. Uncovertebral hypertrophy, which contribute to mild bilateral neural foraminal stenosis at C3-4, C4-5, and C7-T1, and at least mild to moderate neural foraminal stenosis bilaterally at C5-6 and C6-7.


Instruction: Generate impression based on findings.

Input: History of lumbar lipomyelomeningocele repair and hemangioma on the back. Assess for hydrocephalus and cord tethering. BRAIN: The ventricular system is not enlarged. There are foci of susceptibility effect in the posterior right inferior temporal sulcus, left collateral sulcus, and right cerebellar tonsil. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. In particular, there cerebellar tonsils are not low-lying. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. SPINE: Thee are postoperative findings related to lipomyelomeningocele surgery with overlying incision plane that may contain a small amount of residual fluid. There is a lipomatous mass in the posterior spinal canal at the L1 through L4 levels, measuring 1.6 AP x 1.5 RL x 3.9 CC cm. The lipomatous mass abuts and mildly deforms the caudal spinal cord. The tip of the conus medullaris is situated at the L4 level. The lower spinal cord does not appear to shift in position from prone to supine. There is a linear high T2 and low T1 signal band in the midline posterior subcutaneous tissues at the L5 level, which extends from the spinal canal to the skin surface, where there appears to be a flat cutaneous lesion. There is no evidence of syrinx. The vertebral column alignment is anatomic. The vertebral body heights are intact, but there is apparent deficiency of the posterior elements at multiple levels of the lumbar spine, which may represent dysraphism or surgical alterations.

Output: 1.No hydrocephalus, acute intracranial hemorrhage, or acute infarct. Tiny foci of susceptibility effect involving the temporal lobes and the right cerebellar tonsil may represent cortical mineralization from previous ischemia, infection, or hemorrhage. 2.Postoperative findings related to repair of the lipomyelomeningocele. The residual lipomatous mass, or caudal lipoma, is attached to the deformed caudal spinal cord and the tip of the conus medullaris lies at the L4 level.3.Suggestion of a possible sinus tract in the posterior subcutaneous tissues at the L5 level, perhaps with associated with a overlying cutaneous hemangioma. Otherwise, no evidence of a residual meningocele.


Instruction: Generate impression based on findings.

Input: 36-year-old female. Complains of worsening pain swelling, decreased movement. MENISCI: Medial and lateral menisci are normal in signal intensity and morphology without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Focal full-thickness cartilage loss of the medial femoral condyle measuring approximately 13 mm in AP dimension. Diffuse moderate thinning of the patellar cartilage consistent with chondromalacia without a focal full thickness defect. Small tricompartmental osteophytes. No bone contusion or focal worrisome bone marrow signal abnormality. Patchy red marrow in the distal femoral metaphysis.LIGAMENTS: There is extensive edema around the MCL, particularly proximally, with intermediate signal abnormality and thickening of the tendon, consistent with MCL strain. ACL, PCL, and LCL complex are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Focal full thickness cartilage loss of the medial femoral condyle weight-bearing articular surface. Diffuse moderate patellar cartilage thinning/degeneration.2. MCL strain.3. Moderate knee joint effusion and small Baker's cyst.


Instruction: Generate impression based on findings.

Input: Reason: renal cancer on affinator; please compare with last MRI in 2/2016 History: restaging ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter enhancing lesion seen on the prior exam is no longer evident. Subcentimeter T2 hyperintensities are stable and likely represent cysts. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes from partial resection of right moiety and total resection of left moiety of horseshoe kidney. Enhancing lesion in the right mid pole is slightly decreased in size measuring 4.8 x 2.4 cm, previously 4.8 x 2.6 cm. There is increased enhancement on the arterial phase, which may reflect increased vascularity from treatment response or necrosis of fat. However, tumor thrombus into the right renal vein and IVC is decreased since the prior exam. Right lower pole cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Residual/recurrent tumor in the right mid pole is slightly decreased since the prior exam with decreased tumor thrombus into the right renal vein and IVC.2.No new lesions are evident.


Instruction: Generate impression based on findings.

Input: Clinical question: 60 years old female with probable meningioma. Need to evaluate carotid anatomy in relation to tumor. Signs and symptoms: Headaches CTA of intracranial circulation:65 cc of Omnipaque 350 is administered for this exam.Previous reformatted images of the intracranial vasculature were obtained utilizing an independent workstation.Right internal carotid:There is a normal appearing right internal carotid artery across the skull base. There is also normal-appearing right internal carotid artery across the cavernous sinus and to its supraclinoid component. There is no evidence of any encasement of the right internal carotid artery from patient's known right-sided subfrontal meningioma. The right middle cerebral artery appears to traverse direct D. posterior to the tumor and the no evidence of direct contact with the tumor or any evidence of encasement. On reformatted images there is suggestion of slight bowing of the right M1 posteriorly due to tumor immediately anterior to the right MCA. There is normal appearing bifurcation of right middle cerebral artery. The right MCA branches distal to M1 are unremarkable. The right and right ophthalmic artery is also well visualized and unremarkable. A small right posterior communicating artery is also identified.Left internal carotid.There is normal appearing left internal carotid artery across the skull base, cavernous sinus and in its supraclinoid component. There is no posterior communicating artery present. There is normal bifurcation the left internal carotid artery and normal visualization of both anterior and middle cerebral arteries and their branches. Anterior communicating artery is unremarkable. No evidence of vascular abnormality in particular no aneurysm or stenosis is detected. Incidental note is made of a large empty sella. There is inferior herniation of the suprasellar visual complex partially into the sella. This finding was also noted on prior MRI examination.Vertebral -- basilar system:Patent bilateral intracranial vertebral arteries. Normal basilar artery, posterior cerebral is and superior cerebellar arteries. There is a normal-appearing right pico however no visualization of left pico. There is a prominent left aica branch which is believed to supply the left pituitary. This is in normal anatomical variation.Nonenhanced head CT:There is a poorly visualized patient's known right anterior clinoid/subfrontal meningioma. There is no evidence of intracranial edema, hemorrhage, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray to white matter differentiation remains within normal

Output: 1.Unremarkable CTA of intracranial circulation and in particular no evidence of encasement of right internal carotid artery, right ophthalmic artery, right middle or anterior cerebral artery with patient's known right anterior clinoid/subfrontal meningioma.2.Unremarkable nonenhanced CT of brain. Very poorly visualized patient's known right sided meningioma.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with a left C6 radiculopathy clinically. Previous history of fasciculations of the left hand and forearm, status post foraminotomy on the left years ago because of weakness. Postoperative findings are seen along the posterior elements on the left at C6-7 suggesting at least partial laminectomy and facetectomy.Mild reversal of the normal cervical lordosis is seen, likely degenerative in nature. Sagittal alignment is otherwise unremarkable. Vertebral body heights are grossly preserved. Degenerative endplate signal abnormality is seen at C4, C5 and C6. No worrisome marrow replacement or evidence of significant marrow edema is observed.The visualized spinal cord is free of pathologic signal abnormality. Level specific findings are detailed as follows:C2-3: Left greater than right facet hypertrophy. Right paracentral and foraminal disc osteophyte formation resulting in effacement of the right lateral recess, but no significant generalized canal stenosis and no cord impingement. The right neural foramen is severely narrowed. The left neural foramen is patent. No significant interval change at this level.C3-4: Bilateral facet hypertrophy. Right paracentral and foraminal disc osteophyte formation which effaces the right ventral thecal sac and mildly deforms the ventral spinal cord. Mild generalized spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. No significant interval change at this level.C4-5: Mild bilateral facet hypertrophy. Broad disc osteophyte formation slightly asymmetric to the right. Effacement of the ventral thecal sac with slight flattening of the ventral cord. Mild generalized spinal canal narrowing. Severe right and moderate to severe left foraminal narrowing. No significant interval change at this level.C5-6: Right facet hypertrophy. Broad posterior disc osteophyte formation with a new small left lateral recess disc extrusion with mild caudal migration. No cord impingement or significant spinal canal narrowing. Severe left and moderate to severe right foraminal narrowing. C6-7: Disc osteophyte formation asymmetric to the left and particularly along the left uncovertebral joint. Superimposed PLL thickening is also seen below the disc space level. These findings contribute to produce a mild to moderate spinal canal stenosis with very slight impingement of the spinal cord. Severe left and moderate right foraminal narrowing. Postoperative findings as discussed above. No significant interval change at this level.C7-T1: Bilateral facet hypertrophy. Left subarticular and foraminal zone disc osteophyte formation. No significant generalized spinal canal stenosis. Severe left and mild right foraminal narrowing. No significant interval change at this level.

Output: 1.New small left lateral recess disc extrusion with mild caudal migration at C5-6 may correlate with C6 radiculopathy symptoms. Significant foraminal narrowing is also evident at most of the additional cervical levels as detailed above are otherwise not significantly changed.2.Stable degenerative spinal canal stenosis is seen at multiple levels, most severely affecting the C6-7 level where there is a mild to moderate stenosis and slight impingement of the spinal cord. No spinal cord signal abnormality to suggest cord edema at this or any other level.


Instruction: Generate impression based on findings.

Input: 27 years, Male, insomnia. Brain parenchyma appears within normal limits. No parenchymal signal abnormality. No intracranial mass or mass-effect. No diffusion abnormality. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is a small right maxillary sinus mucus retention cyst and trace maxillary sinus mucosal thickening. Paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: 12-year-old female with hip pain right side. Possible right hip dislocation. Evaluate for fragments in joint. Bone marrow signal intensity is normal. No evidence of fracture or malalignment. The femoral heads are well situated within the acetabula bilaterally. Bilateral hip joint spaces are normal. No osseous fragments are noted within the joint space as clinically questioned on this nonarthrogram study. The imaged lower lumbosacral spine is normal.The surrounding soft tissues, including pelvic musculature, are normal. There is no pelvic free fluid. The lower abdominal pelvic organs appear normal.

Output: No soft tissue or bone abnormality of the pelvis. No bone fragments within the hip joint space as clinically questioned on this nonarthrogram study.


Instruction: Generate impression based on findings.

Input: 2 days of right eye redness and irritation, blurry vision, and one day of right face weakness. On examination, also has decreased sensation to light touch in V2 and V3 distribution. The brain shows normal signal and no abnormal contrast enhancement, diffusion restriction or susceptibility effect. Tiny focal CSF-intensity in the very posterior aspect of the left external capsule is most probably a dilated perivascular space, which is a normal variation. The CSF-containing spaces, including the ventricles, are normal in size. There is no abnormal extra-axial fluid collection.There is asymmetrically increased contrast enhancement along the anterior and superior margins of the right internal carotid canal which may represent dural thickening and enhancement. In addition, there is asymmetrically increased contrast enhancement in the fundus of the right internal auditory canal that appears to extend into the labyrinthine segment and geniculate ganglion of the right facial nerve, which is best seen on axial images #90 and 91 of series #1101). The finding is not as reproducible on the coronal images but the examination is not optimized for cranial nerve assessment. Contrast enhancement along the tympanic and mastoid segments of the right facial nerve is symmetric compared to the left side and within normal limits. There is no gross evidence of abnormal enhancement along the membranous labyrinth. There is minimal, equivocal increased contrast enhancement along the posterior/inferior aspect of the medial end of the cartilaginous right external auditory canal but there is no correlating finding on physical examination. Mastoid air cells show no gross abnormality. There is a small retention cyst/polypoid mucosal thickening in the left sphenoid sinus. There is minimal mucosal thickening in the ethmoid sinuses. These findings are nonspecific.There is a 7 mm soft tissue nodule in the superficial part of the right parotid gland, which is most probably an intraparotid lymph node. The parotid glands are otherwise normal. There is a 10 mm, mildly enlarged upper right lateral retropharyngeal lymph node and a smaller one on the left side (node of Rouvière). This is nonspecific but possibly reactive.

Output: 1.No definite acute intracranial abnormality.2.While the study is not optimized for cranial nerve assessment, there is questioned abnormal, asymmetric contrast enhancement in the right internal auditory canal fundus and asymmetrically along the labyrinthine segment and genu ganglion of the right facial nerve, which is nonspecific in isolation. This is nonspecific and could relate infection/inflammation. Additional mural enhancement along the right IAC which may be dural in location, possibly relating to venous engorgement. Follow-up imaging with dedicated cranial nerve sequences may be obtained as clinically indicated. Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Matthew Burns over the phone on January 2, 2016 at 1300 hours. Given the current management plan, dedicated cranial nerve MRI imaging will be performed if clinically indicated.


Instruction: Generate impression based on findings.

Input: 51-year-old female patient with cramping pain in pelvis. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is mildly atrophic with pancreatic divisum noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stomach remained distended during the entirety of the examination, raising question of delayed gastric emptying.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Junctional zone thickness measures 9 mm, within normal limits. No significant abnormality is seen in the uterus or adnexa.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small Nabothian cyst is noted.OTHER: No free fluid in the pelvis.

Output: 1.No significant findings to account for patient's pelvic pain.2.Distended stomach raises question of delayed gastric emptying, which may be associated with patient's pain medication use.


Instruction: Generate impression based on findings.

Input: Intractable epilepsy, frequent falls with seizure, genotype is consistent with Autosomal Dominant Nocturnal Frontal Lobe Epilepsy variant. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. In particular, the hippocampal formations are intact and there is no evidence of heterotopia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No discernible seizure focus. A brain PET may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 36 year-old female with hematuria. Rule out renal stone. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There are numerous hepatic hypodensities of varying size, most likely cysts. In comparison with a 2006 examination, these appear larger and more numerous. If there is suspicion for a neoplasm with hypodense metastases, dedicated CT or MRI examination of the liver could be obtained. Layering density in the gallbladder suggests sludge.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No definite evidence of obstructing renal stone. No radiodense renal calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Constipation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No acute abnormality to explain hematuria. Enlarging liver cysts. Gallbladder sludge.


Instruction: Generate impression based on findings.

Input: Similar to yesterday, the patient was uncooperative and unable to hold still; multiple attempts were made with repeat imaging. Given this caveat:Cervical spine MRI with contrast:No gross abnormal enhancement, although images are significantly motion degraded.Thoracic spine MRI without contrast:There is mild chronic anterior wedge deformity of T10 without fragment retropulsion. Sagittal and axial T2 images appear to be fairly diagnostic and demonstrate no spinal cord signal abnormality. T1 images are motion degraded. Postcontrast images are significantly motion degraded and demonstrate no gross abnormal enhancement. There are no disc herniations or stenoses.

Output: 1.Similar to yesterday, the patient was uncooperative and unable to hold still; multiple attempts were made with repeat imaging.2.Cervical spine MRI with contrast: No gross abnormal enhancement, although images are significantly motion degraded.3.Thoracic spine MRI without contrast: Sagittal and axial T2 images appear to be fairly diagnostic and demonstrate no spinal cord signal abnormality. Postcontrast images are significantly motion degraded and demonstrate no gross abnormal enhancement.


Instruction: Generate impression based on findings.

Input: GBM, on CCNU There has been no significant change in size or morphology of the resection cavity incorporating the right anterior temporal lobe, a portion of the right insula, and the right inferior frontal lobe. Compared to 3/25/2016 and 2/26/2016, extensive T2/FLAIR abnormality surrounding the resection cavity is not appreciably changed. Ex vacuo enlargement of the right lateral and the third ventricles is again noted. Punctate focus of diffusion restriction along the anterior medial aspect of the resection cavity is unchanged and consistent with treatment change.Nodular foci of enhancement along the medial aspect of the resection cavity/right frontal horn margin as well as along the margins of the bilateral lateral ventricles are slightly increased in prominence since 3/25/2016 and increased more so in prominence when compared to 2/4/2016.Otherwise, there is no new enhancing or T2 hyperintense lesion. Mild periventricular T2 hyperintensity along the left lateral ventricle is unchanged and probably related to treatment. Ventricular size and morphology are stable.The major intracranial arterial flow voids are preserved otherwise. There are small retention cysts in the maxillary sinuses. Chronic fluid signal in the right mastoid air cells is still present.

Output: Nodular foci of enhancement medial to the resection cavity/right frontal horn margin as well as along the surface of the lateral ventricles demonstrate slight increase in prominence compared to several recent studies and are concerning. Of note, however, nodular foci of enhancement along the bilateral frontal horns were more prominent on more remote MRI study from 10/9/2015, presumably pre-Avastin therapy (which can be confirmed with history). Otherwise no evidence of a discrete recurrent mass at the resection site.


Instruction: Generate impression based on findings.

Input: Right nasopharyngeal carcinoma, treated with and radiation and chemotherapy. There are post-treatment findings in the right nasopharynx with mild right asymmetric pharyngeal mucosal space thickening without measurable residual mass. Rather, there is paucity of enhancement in a large area of the right nasopharyngeal treatment bed and adjacent prevertebral and parapharyngeal spaces, extending towards the internal carotid artery. There is no evidence of significant cervical lymphadenopathy based on size criteria. There are denervations changes in the right masticator muscles. The thyroid and major salivary glands are unchanged. There is persistent asymmetric enhancement within the right mandibular ramus and right parotid gland, which is likely related to treatment effects. There is mild anterolisthesis of C3 on C4 and C4 on C5, as well as cervical spondylosis with at least moderate spinal canal stenosis at C5 and C6 and retrolisthesis of C6 on C7. There are bilateral maxillary sinus retention cysts. There are degenerative changes in the right temporomandibular joint with an associated trace effusion. There is mild diffuse prominent intracranial dural enhancement, including along the clivus.

Output: 1. Post-treatment findings in the right nasopharynx and cental skull base without measurable residual tumor. Rather, there is necrotic tissue in the right nasopharyngeal treatment bed and adjacent prevertebral and parapharyngeal spaces, extending towards the internal carotid artery.2. Degenerative spondylosis of the cervical spine with spinal canal stenosis at C5 and C6.3. Findings suggestive of right Eustachian tube dysfunction.


Instruction: Generate impression based on findings.

Input: Resection of hard palate polymorphous low-grade adenocarcinoma (PLGA) on 2/4/2016 with negative margins. There is a defect in the right hard palate with adjacent enhancing soft tissue prominence. There is no evidence of significant lymphadenopathy in the neck. The major salivary glands are unremarkable. The thyroid gland is also unremarkable. The sinonasal cavities are intact. There is a narrow cervical spinal canal with disc-osteophyte complexes that impinge upon the spinal cord at multiple levels. The imaged intracranial structures and orbits are unremarkable.

Output: 1. A defect in the right hard palate with adjacent enhancing soft tissue prominence may represent postoperative granulation tissue at the site of the resected tumor.2. No evidence of significant lymphadenopathy in the neck. 3. Narrow cervical spinal canal with disc-osteophyte complexes that impinge upon the spinal cord at multiple levels.


Instruction: Generate impression based on findings.

Input: 33 year old male with buttock abscess and tenderness to palpation. Evaluate for perirectal abscess. ABDOMEN:This examination is limited by absence of IV contrast. LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: There is extensive diffuse soft tissue thickening subcutaneously in the right medial buttock that extends to the anus. The enteric contrast has not reached the distal colon and rectum. Without IV and enteric contrast, it is difficult to define an abscess or fistula. No definite abscess was found. No intrapelvic extension. If this condition persists or further evaluation is required, a non-contrast MRI scan may be most helpful.There is diffuse vascular calcifications in the pelvis.

Output: Right buttock subcutaneous inflammatory changes, but no definite abscess. Sensitivity is limited without enteric or IV contrast. Consider MRI if further evaluation is required.