Instruction: Generate impression based on findings.

Input: 33-year-old female, status post laparoscopic total proctocolectomy for Crohn's disease. Status post ileostomy takedown and intravesical fistula repair of bladder in 10/09. Persistent pelvic pain with periodic drainage. Evaluate for abscess or other abnormality. ABDOMEN:LUNG BASES: Clear lung bases. No infiltrates, nodules or effusions.LIVER, BILIARY TRACT: Cholelithiasis. No biliary duct dilatation or obstruction. The anterior branch of the right portal vein is patent and the previous noted portal vein thrombosis has resolved. Otherwise, hepatic vasculature remains patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes status post total proctocolectomy and end ileostomy in the right lower quadrant. Moderate amount of soft tissue inflammation and fat stranding surrounding the ileostomy site has resolved. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: New 2.2 cm diameter left adnexal cyst has an enhancing rim at image 117 of series 3. This may represent a small abscess that can be imaged with transvaginal ultrasound or pelvic MRI, if indicated. This uniloculated cyst may be physiologic, as there is no adjacent fat stranding, excess free fluid or lymphadenopathy. BLADDER: Moderate thickening of the posterior bladder wall is likely postoperative status post takedown of the iliovesicular fistula with bladder wall repair.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The presacral percutaneous right pelvic drain has been removed. No acute abnormality was found. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Percutaneous pigtail drain in presacral region has been removed. New left adnexal cyst has an enhancing rim. Transvaginal ultrasound or pelvic MRI exam may be helpful for further evaluation. 2. Thrombosis of the anterior branch of the right portal vein has resolved. Cholelithiasis. 3. Otherwise, stable postoperative changes.


Instruction: Generate impression based on findings.

Input: Thoracic or lumbosacral neuritis or radiculitis, unspecifiedClinical question: hematoma, nerve compression, abscess. Signs and Symptoms: 55 yo male with history of metastatic cancer w/ bony mets s/p laminoforaminotomy presenting with R leg pain and weakness There is redemonstration of the multiple marrow replacing lesions throughout the visualized lumbar spine, lower thoracic spine sacrum and pelvis. Some of these extend beyond the cortex of the bone. There is some patchy enhancement associated with these lesions. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. There is mild loss of vertebral body height at L4. The conus medullaris on sagittal imaging is grossly intact. There is a heterogeneous signal intensity fluid collection present at the surgical site at the L3-4 level which impresses on the thecal sac from posteriorly. It extends between the spinous processes and measures 26 x 23 mm sagittal dimensions and 21 x 5 mm axial dimensions.The patient is status post laminotomies at the L3-4 level.At L5-S1 there is a diffuse disc bulge present associated with effacement of the fat at the lateral recesses bilaterally and encroachment of the nerve roots at the lateral recesses. The exiting nerve roots within the neural foramina are surrounded by fat. Overall there is moderate spinal stenosis at this level. These findings were also present in the April examinationAt L4-5 there is loss of disc space height, diffuse disc bulge and mild ligamentum flavum hypertrophy associated with effacement of fat at the lateral recesses bilaterally and crowding of the nerve roots within the thecal sac leading to spinal stenosis. Additionally the posterior aspect of the L4 vertebral body bulges into the spinal canal and narrows the thecal sac leading to spinal stenosis. At L3-4 there is diffuse disc bulge associated with facet hypertrophy and effacement of the spinal fluid within the thecal sac and crowding of the nerve roots. There is a mild degree of facet and ligamentum flavum hypertrophy at this level. Behind the L3 vertebral body there is a ventral fluid collection measuring 35 x 6 mm AP dimension and 11 x 6 mm axial dimension the cauda equina is crowded behind this ventrally oriented fluid collection within the thecal sac. There is a fluid collection present at the surgical site at the L3-4 level which impresses on the thecal sac from posteriorly.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild facet and ligamentum flavum hypertrophy at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.There is a right sided renal cystic lesion present measuring 10 x 11 mm axial dimensions.

Output: 1.There is spinal stenosis at L5-S1 predominantly related to degenerative changes.2.There is spinal stenosis at L4-5 and at the L4 vertebral body level related to bulging of the vertebral body posteriorly from the neoplasm and to some degree degenerative change.3.There is spinal stenosis present at L3-4 related to degenerative changes, a small postoperative complex fluid collection as well as what appears to be an arachnoid cyst on the ventral aspect of the thecal sac. The complex fluid collection is a nonspecific. Differential considerations do include blood products and early abscess formation.4.There are multiple marrow replacing lesions throughout the visualized bony structures compatible with patient's known metastatic disease. There is a mild compression fracture at L4.


Instruction: Generate impression based on findings.

Input: Exam is limited by patient motion.ORBITS: There is mildly increased fluid surrounding the left optic nerve especially distally compared with the right. The optic nerves are otherwise symmetric and normal in size and signal intensity. There is no chiasmatic mass or parasellar abnormality. There is no intraorbital mass or abnormal enhancement. The extraocular muscles are unremarkable. There are bilateral lens implants.BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are multiple small patchy foci of T2 hyperintensity within the supratentorial and infratentorial white matter most compatible with chronic small vessel ischemic disease, as well as scattered chronic lacunar infarcts. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is unchanged atelectasis of the left maxillary sinus. The skull, paranasal sinuses, and scalp soft tissues are otherwise unremarkable.

Output: 1.There is mildly increased fluid surrounding the left optic nerve compared with the right, a non-specific finding. The orbits are otherwise unremarkable. 2.Mild to moderate supratentorial and infratentorial chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 11-year-old male with tuberous sclerosis.EXAMINATION: MR Kidneys without and with IV contrast 12/27/2016 ABDOMEN:LUNG BASES: Bibasilar subsegmental atelectasis.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. No hydronephrosis. No fat-containing lesions or cysts.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: Normal examination. The angiomyolipomas seen on sonogram are punctate and thus unlikely to be seen by MRI.


Instruction: Generate impression based on findings.

Input: 60 year-old male with worsening lower extremity numbness, date disturbance, multiple sclerosis Brain: Given differences in technique, there has been no significant change in the patients burden of T2 hyperintense lesions in the periventricular and subcortical white matter with morphology and distribution compatible with known demyelinating disease. A previously demonstrated prominent left frontal lobe lesion has decreased in size. There are also multiple infratentorial lesions in the brainstem and cerebellar hemispheres. Lesions are also noted in the dorsomedial midbrain and upper pons including the region of the medial longitudinal fasciculus, particularly on the left which may explain patient's internuclear ophthalmoplegia. Minimal enhancement is noted within a right periatrial/periventricular lesion (series 24, image 12). There is also mild parenchymal volume loss with mild thinning of the corpus callosum for age. There is no intracranial mass, mass effect, midline shift or herniation. No hydrocephalus.Cervical Spine: Redemonstrated are T2 hyperintense lesions within the cervical cord with morphology and distribution consistent with known demyelinating disease, stable in appearance. As before, the most prominent lesions are present at the C2 level involving the bilateral posterior aspects of the cord, right greater than left, as well as at the left ventrolateral C3-C4 level. None demonstrate contrast enhancement. Mild volume loss is redemonstrated involving the dorsal cervical cord associated with the C2 lesions.Vertebral body heights and alignment in the cervical spine are normal. Minimal degenerative changes include small disc osteophyte complex, eccentric to the right at the C4-C5 level. There is no significant spinal canal stenosis at any level. There is mild to moderate multilevel neural foraminal stenosis related to facet arthropathy and uncovertebral hypertrophy, relatively worse at the right C4-C5 level, unchanged.

Output: 1.Given differences in technique, there has been no significant change in the patients burden of T2 hyperintense lesions in both supratentorial and supratentorial brain. A previously demonstrated prominent left frontal lobe lesion has decreased in size. Minimal enhancement is noted within a right periatrial/periventricular lesion (series 24, image 12).2.Redemonstrated are T2 hyperintense lesions within the cervical cord, stable in appearance, without enhancement.3.Both brain and cervical cord findings are consistent with the provided history of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate left lumbar radiculopathy. Findings and symptoms: Back pain extending to left lower extremity, anesthesias. Nonenhanced lumbar MRI:The signal intensity of the vertebral column is unremarkable and the alignment remains anatomic.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 is unremarkable.L3-L4 demonstrate mild ligamentum flavum hypertrophy and unremarkable otherwise.L4-L5 demonstrate mild bilateral ligamentum flavum hypertrophy and unremarkable otherwise.L5-S1 demonstrate moderate disc disease and loss of T2 signal intensity and height and mild bilateral ligamentum flavum hypertrophy. There is a central and left para median shallow broad-based disc protrusion which is best appreciated on axial T2 series 6 image 37, axial T2 series 8 image 22 and 23. There is no spinal stenosis or neural foraminal compromise. Disc protrusion and mild hypertrophic changes of the left articulating facet and ligamentum flavum results in compromise of the left lateral recess and mass effect on the left S1 nerve root which is best appreciated on axial T2 series 8 on images 23 and 24.Unremarkable paraspinal soft tissues.

Output: 1.L5-S1 demonstrate a left lateral shallow broad-based disc protrusion which in combination with mild left facet and ligamentum flavum hypertrophy results in compromise of the left lateral recess and mass effect on the left S1 nerve root as detailed above.2.Essentially unremarkable nonenhanced lumbar MRI study otherwise.


Instruction: Generate impression based on findings.

Input: Foci of diffusion are seen along the posterior margin of the resection cavity, which are less prominent than the previous study.There is a rounded resection cavity in the right superior temporal gyrus surrounded by similar extent of T2/FLAIR high signal, not significantly changed since the previous study. The cavity measures 23 x 18 mm, unchanged. Along the posteromedial wall of the resection cavity and along the lateral wall there are foci of susceptibility suggestive of chronic blood products, unchanged from the previous study.There is a rind of enhancement seen along the posterior margin of the resection cavity which has slightly decreased in thickness since the previous study. The previous nodule of enhancement that was seen along the superomedial margin of the resection cavity is decreased in size from 4 mm previously, to 2 mm currently. The previous enhancement that was seen along the anteroinferior margin of the resection cavity is decreased from 5 mm previously to 2 mm in the current study. No hyperperfusion is seen in the areas of enhancement at the level of the resection cavity.Ventricular size is normal with no midline shift. The basal cisterns are patent.

Output: 1. Status post resection of GBM in the right superior temporal gyrus. The resection cavity size is unchanged with areas of enhancement scattered along the resection cavity margins which are slightly decreased in size. No evidence of hyperperfusion in the areas of the enhancement at the level of the resection cavity.2. Similar extent of surrounding FLAIR hyperintensity likely representing a combination of nonenhancing tumor, residual vasogenic edema, and/or post-treatment changes.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is again referred to as L5-S1. There is grade 1 retrolisthesis at L3-4, unchanged. Patient is status post partial L1 and complete L2 laminectomies and resection of previously identified intradural mass at the level of L2. IIn the operative bed there is diffuse enhancement of the soft tissues extending up to and including, to some degree, the dorsal dura, compatible with scarring. There is no nodular soft tissue or suspicious enhancement within the thecal sac to suggest recurrence. There is no canal stenosis or compression of the thecal sac. Multilevel degenerative changes are not substantially changed since the prior exam. There is desiccation with loss of disk height at L2-3, L3-4 and L5-S1. Disc bulges at L3-4, 4-5, and 5-1 are again identified. Modic type II endplate degenerative changes at L3-4, unchanged.

Output: Expected postoperative changes status post resection of the previously identified L2 intradural mass and laminectomies, as described above, with no evidence of recurrence.


Instruction: Generate impression based on findings.

Input: Clinical question: Known brain tumor with postop epidural fluid collection. Evaluate fluid collection. Signs and symptoms: None Non-enhanced CT of brain:Postoperative changes of right temporal -- frontal craniotomy for large partial resection of right frontal and anterior temporal lobe and. CSF density intradural collection at the surgical site.Epidural collection under the craniotomy flap measures 18-mm in thickness and extend along the entire length of the craniotomy flap (approximately 89 mm). The epidural collection has a thick high density rim along its medial aspect which is believed to represent thickened scarred and possibly calcified dura. When compared with prior MRI examination there is interval decrease in the thickness of epidural collection from 22.9-mm on prior exam to 18-mm on current exam. There is a subtle mass effect on the right frontal horn likely due to large extra-axial intradural CSF collection at the site of partial lobectomy. No midline shift is detected. There is no evidence of any edema of the adjacent brain parenchymal to this CSF collection.

Output: 1.Interval decrease in the size of epidural collection under the craniotomy flap in the right frontal region from prior MRI measurements of 22.9-mm to 18-mm on current exam.2.Postoperative changes of a large right anterior frontal and temporal lobectomy related CSF collection at the surgical site.3.No evidence of any new edema of the adjacent brain parenchymal to the lobectomy site.4.No evidence of hydrocephalus or midline shift.


Instruction: Generate impression based on findings.

Input: 29-year-old male with cerebral cyst status post fenestration 3/30 with reservoir placement, prior hemorrhage. History of pleomorphic xanthoastrocytoma, status post laser ablation. Susceptibility from the patient's ventricular drain reservoir induces artifact. Given this caveat:Redemonstrated is a partially cystic, partially solid tumor centered on the tectum. The overall size of the lesion, inclusive of both cystic and solid components, measures 35 x 37 mm transaxial by 43 mm craniocaudal, previously 35 x 37 mm transaxial by 48 mm craniocaudal (as measured on the most recent noncontrast head CT 4/8/2015), demonstrating a decrease in its craniocaudal dimension. This lesion continues to exert mass effect with deformation of adjacent structures. A cystic component of the lesion extends into and deforms the right cerebral peduncle to a similar degree as identified on the recent CT. As before, the cerebral aqueduct is displaced to the left and narrowed, and the cerebellar vermis is displaced posteriorly. The primarily more posteromedially located enhancing portion of the mass measures 18 x 18 mm in transaxial dimension, demonstrating some enlargement when compared to the most recent contrast enhanced MRI exam of 3/31/2015 were it measured 18 x 16 mm when measured at the same location.Previously identified hemorrhage within the right frontal lobe appears to have resolved, although portions of this previously identified hemorrhage are obscured on some sequences by the aforementioned artifact.Stable position of two frontal ventriculostomy catheters. The more anterior ventriculostomy catheter tip terminates in the anterior horn of right lateral ventricle. The tip of the most posterior ventriculostomy catheter terminates within the cystic components of the posterior fossa mass.The size of the ventricular system has not significantly changed compared to the prior exam. Stable mild encephalomalacia in the right parieto-occipital region. No new parenchymal lesions are identified. The paranasal sinuses and mastoid air cells are clear. Expected vascular flow-voids are demonstrated.

Output: Since the prior examination, the overall cystic and solid tectal region lesion has decreased in its craniocaudal dimension when compared to the most recent noncontrast head CT dated 4/8/2015. The primarily more posteromedially located enhancing portion of the mass demonstrates some enlargement when compared to the most recent contrast enhanced MRI exam of 3/31/2015.


Instruction: Generate impression based on findings.

Input: Thumb mass Within the thenar eminence is a solid lobulated, ovoid mass which is predominantly hyperintense to musculature on T2 and iso to slightly hyperintense on T1. The mass measures approximately 2 x 1 x 2.9 cm in the greatest transaxial and craniocaudal dimensions. Additionally, more radially and anterior to the thumb are additional subcentimeter foci which demonstrate similar signal characteristics. The dominant mass causes some displacement of the flexor tendons and median nerve and there is a mild amount of surrounding subcutaneous edema. The mass also appears to be discrete from the median nerve.Following contrast administration, there is predominantly heterogeneous enhancement within more focal area distally demonstrating more peripheral enhancement (series 13 image 42/64 and series 16 image 20/36).The remaining muscles and osseous structures are normal in signal and caliber.

Output: Solid lobulated mass within the thenar eminence demonstrates nonspecific imaging characteristics. As a result, both benign and malignant etiologies must be considered including epithelioid sarcoma. This mass would be amenable to ultrasound-guided biopsy.


Instruction: Generate impression based on findings.

Input: Male, 48 years old, with seizures and a brain lesion. Functional MRI is requested for presurgical planning. Sensorimotor cortical activation of the hand maps as expected along the pre- and postcentral gyri. This area of activation is posterior to and contiguous with the margin of the patient's right frontal lobe lesion. In response to foot movement, cortical activation is elicited at the medial most aspect of the pre- and postcentral gyri, right side more than left. Spotty activation is also seen elsewhere in the cerebral hemispheres.Cortical activation related to facial movement is demonstrated at the inferior lateral most aspect of the pre- and postcentral gyri. On the right, this area of activation is posterior and inferior to the lesion margin.

Output: Sensorimotor cortical activation is elicited identifying the pre- and postcentral gyri bilaterally.


Instruction: Generate impression based on findings.

Input: HgbSS (on hypertransfusion protocol at La Rabida) and poorly controlled epilepsy (refractory to multiple AEDs) secondary to left MCA stroke in 2007 (with residual right sided weakness), who presents with worsening generalized weakness and gait changes over the past 4 weeks. The study is limited by patient motion.MRI: There is unchanged extensive encephalomalacia in the left frontal, left parietal and to lesser extent left temporal lobes, with Wallerian degeneration of the left brainstem. However, there is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, with ex vacuo dilatation of the left lateral ventricle. The orbits are grossly unremarkable. There is diffuse low T1 and T2 signal in the bone marrow and findings related to Dyke Davidoff Masson on the left side. EEG leads are in place on the scalp. MRA: There is unchanged severe steno-occlusive disease of the left supraclinoid internal carotid artery. The proximal left anterior and middle cerebral arteries appear to be diffusely narrowed as well. There is a paucity of cortical vessels overlying the areas of left cerebral hemisphere encephalomalacia. There also appears to be narrowing of the supraclinoid right internal carotid artery, which is more pronounced than previously, and minimal collateral vessel formation in the region. The vertebral, basilar, and posterior cerebral arteries are intact. There is no evidence of cerebral aneurysms.

Output: 1. Chronic extensive left middle cerebral artery territory infarction related to sickle cell disease, without evidence of acute infarction.2. Severe steno-occlusive disease of the left supraclinoid internal carotid artery, proximal left anterior and middle cerebral arteries stenoses are also unchanged, with associated moyamoya. Stenosis involving the right supraclinoid internal carotid artery is more pronounced, although this might be artifactual. 3. The appearance of the skull is likely related to sickle cell disease.


Instruction: Generate impression based on findings.

Input: Retro-orbital pain left greater than right. Postnasal drip. Bony density inferior exam is within normal limits. Small retention cysts within dependent portion of bilateral maxillary sinuses is noted. The ostiomeatal units of the maxillary sinuses are patent bilaterally. Small retention cyst within one of the right posterior ethmoid air cells. The rest of the paranasal sinuses are well pneumatized and unremarkable. Images through the orbit demonstrate normal appearing retro-orbital fat, extraocular musculature and optic nerves. Increased density in a linear fashion is noted overlapping the right upper quadrant of the right globe. There may be some increased density also within the right lacrimal gland. This finding may represent hemorrhage or heavy calcification. Please correlate with history and follow-up with an MRI examination.

Output: 1.Small retention cysts within the bilateral maxillary sinuses and right posterior ethmoid as detailed.2.Unremarkable suture paranasal sinuses otherwise.3.Patent bilateral ostiomeatal units the maxillary sinuses.4.Linear increased density overlapping the outer lateral quadrant of right globe which may represent calcification or blood product. Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Low grade glioma of the left temporal region status post biopsy followed by XRT. There are post-treatment findings in the left temporal region with unchanged confluent, mildly expansile area of T2 hyperintensity in the left temporal lobe with punctate foci of enhancement and susceptibility effect. There is also an unchanged subcentimeter non-enhancing focus of T2 hyperintensity in the right superior cerebellar hemisphere. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. No evidence of left temporal lobe tumor progression.2. UNchanged subcentimeter right cerebellar hemisphere lesion.


Instruction: Generate impression based on findings.

Input: 27-year-old female with history of Hodgkin's disease. Status post auto stem cell therapy about day 30.IMAGE ACQUISITION: Contrast enhanced CT of the head and soft tissue neck was performed. 60 mL of Omnipaque 350 was injected intravenously. CT HEAD:No acute intracranial abnormality is evident. Specifically, there is no evidence for focal mass lesion, edema, midline shift, hydrocephalus, or abnormal enhancement. Gray white matter differentiation is preserved. The ventricles are normal in size and configuration. No abnormal fluid collections seen.A focal lucent lesion in the left frontal bone with sclerotic margins is noted, previously characterized by MRI and was felt to likely represent a benign process such as hemangioma.The visualized paranasal sinuses demonstrate a right maxillary retention cyst.CT NECK:There is no cervical lymphadenopathy based on CT imaging. The reference right level 2 lymph node measures 0.8 x 0.6 cm (image 35 demonstrates 4), previously measuring 1.2 x 0.8 cm. No new or enlarging lymph nodes are identified. No neck mass or fluid collection is seen. The aerodigestive tract is unremarkable without evidence for exophytic mass or effacement. The paraspinal soft tissues and musculature are within normal limits. The submandibular, parotid, and thyroid glands are within normal limits. The orbits are unremarkable.The carotid and jugular vessels are patent. Right anterior chest port.Limited views of the lung apices demonstrate no significant abnormality, however please refer to the dedicated CT of the chest report for complete details.

Output: 1. No CT evidence for lymphadenopathy in the neck. Slight interval decrease in size of reference node with measurements as above.2. No intracranial mass lesion. Sclerotic lesion in the left frontal bone, characterized on prior MRI and felt to represent a benign process such as hemangioma.


Instruction: Generate impression based on findings.

Input: Preoperative MR examination prior to clival biopsy. There is motion limiting the T2 sequence images. Within this limitation, the lobulated high T2/low T1 signal, nonenhancing lesion which extends from the right lateral aspect of the clivus to involve the Petrus apex at the petro-clival junction is again demonstrated. This has a nonaggressive appearance on CT demonstrating a sclerotic rim and thinning of the bone which separates it from the CP angle posteriorly (difficult to assess for breakthrough given the progressed thinning ) and anteriorly where it is closely opposed to the posterior aspect of the carotid artery. There is no associated flow void and aneurysm is felt to be unlikely. This measures up to 3.2 by 1.2 x 2.2 cm (previously 2.9 x 1.4 by 2.1 cm in similar dimension). There is no associated mass effect on adjacent structures.Intracranially, there is no other visualized mass, fluid collection, hemorrhage or hydrocephalus. The midline is intact. Limited views of the orbits are unremarkable. Paranasal air sinuses, including the sphenoid, are unremarkable.

Output: Demonstration of the nonaggressive appearing intra-osseous lesion at the right petro-clival junction which, given features such as remodeling of bone, absence of matrix and signal characteristics most likely represents a cephalocele. Differential considerations could include cholesteatoma, neurenteric cyst, or possibly cystic fibrous dysplasia.


Instruction: Generate impression based on findings.

Input: BRAIN: There are no significant white matter T2 signal abnormalities in the supratentorial or infratentorial brain to suggest demyelinating disease. There is no suspicious intracranial enhancement, acute infarct, mass effect or midline shift. Although this exam is not tailored to evaluate the trigeminal nerves specifically, there is no discrete mass or abnormal enhancement involving the cisternal segments of the trigeminal nerves, cavernous sinuses, or Meckel's cave. There is partially empty sella of incidental note. Brain MRI is otherwise unremarkable for age. There is a right maxillary sinus mucus retention cyst.CERVICAL: There is normal alignment of the cervical spine. The osseous marrow is benign. Artifact slightly limits evaluation however no convincing T2 signal abnormality within the cervical cord is appreciated. No abnormal enhancement within the cervical cord. The cord caliber is within normal limits. There are mild degenerative changes, individual levels as below.C2-3: Small central disk protrusion with no central spinal canal or neural foraminal stenosis.C3-4: There is mild left neural foramina narrowing related to left-sided facet arthropathy. No significant spinal canal or right neural foramina stenosis. C4-5: No disk/endplate degenerative changes, significant central spinal canal or neural foraminal stenosis.C5-6: Small disk osteophyte complex and mild bilateral uncovertebral hypertrophy with no significant spinal canal stenosis. There is minimal left and mild right neural foramina narrowing.C6-7: Small disk osteophyte complex with no significant neural foraminal stenosis or central spinal canal stenosis.C7-T1: No significant neural foraminal stenosis or central spinal canal stenosis.The imaged upper thoracic spine shows no evidence of significant disk herniation or spinal canal/neural foraminal stenosis.

Output: 1.No evidence of demyelinating disease in the brain or cervical spine. 2.Minimal cervical degenerative changes without significant central spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. EPIC Note: He has had 3 total biopsies for elevated PSA (3/2014, 1/2013, 10/2010) all of which were negative. Pt's last DRE was 4/2015 and states he has never had an abnl DRE. He is here today for a PSA that continues to rise in light of negative bx for MRI prior to URONAV bx this PM. PSA trend: 10/2011 - 3.07 2/2014 - 6.27 3/2015 8.49 5/2015 9.95 PELVIS:PROSTATE:Prostate Size: 2.9 x 4.6 x 5.3 cm.Peripheral Zone: Within the far right anterior peripheral zone and the transition zone at the mid gland there is an approximately 1.8 x 1.0 cm (series 1101/20) poorly marginated T2 weighted hypointense lesion with restricted diffusion with arterial enhancement and washout, there is extension to the level of the fibromuscular stroma.Central Gland: Benign prostatic hyperplasia. Median lobe hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The lesion bulges the anterior margin of the prostate.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.8 cm lesion within the far right anterior peripheral zone and the transition zone at the mid gland extending to the level of the anterior fibromuscular stroma suspicious for prostatic carcinoma. This is amenable to MRI/ultrasound fusion biopsy. The lesion bulges the anterior margin of the prostate raising the possibility of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Status post craniotomy for left insular tumor resection. Evaluate postoperative changes. There are expected postsurgical changes from a left frontotemporal craniotomy and gross total resection of the enhancing portion of a left insular mass. No residual suspicious enhancement appreciated. Again seen is infiltration of nonenhancing tumor involving the left anterior and medial temporal lobes. There is mild local mass effect, including on the left cerebral peduncle and adjacent sulci. There is also mild effacement of the left lateral ventricle. On DWI imaging, there is minimal thin rim of restricted diffusion involving the margin of the surgical cavity which is consistent with blood products and some element of cytotoxic edema. Expected postsurgical changes include left frontotemporal extra-axial fluid collection mixed with air which causes mild mass effect on the adjacent sulci. There is mild expected postsurgical enhancement of the left-sided dura.

Output: 1.Expected postsurgical changes from a left frontotemporal craniotomy with gross total resection of the enhancing component of a left insular tumor, presumably high-grade glioma.2.Infiltrative nonenhancing tumor involving the medial and anterior left temporal lobe again seen.


Instruction: Generate impression based on findings.

Input: 73-year-old male with worsening pain, edema, heat, s/p amputation (5/27/2015) left 2nd toe. There are postoperative findings related to first digit transmetatarsal amputation with interval amputation of the second digit through the tarsometatarsal joint. There is decreased T1 signal with corresponding increased T2 signal of the head of the second metatarsal. Similar intensity pattern affects the navicular bone as well as the partially imaged talus. These findings are compatible with osteomyelitis. There is marked soft tissue swelling along the dorsum of the foot with a complex fluid collection extending from the second metatarsal head proximally and laterally towards the ankle extending beyond the proximal margin of the image. The largest component of the fluid collection measures 5.3 cm x 2.5 cm.

Output: Note that this is a limited study as described above. Within these limitations, the following observations are made: 1. Findings compatible with osteomyelitis of the 2nd metatarsal head as well as the navicular bone and partially imaged talus. 2. There is marked soft tissue swelling along the dorsum of the foot with a complex fluid collection extending from the second metatarsal head proximally and laterally towards the ankle extending beyond the proximal margin of the image. This may represent an abscess although evaluation of the fluid collection is limited due to lack of postcontrast sequences.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of prostate cancer, on active surveillance. Fusion biopsy to follow. Gleason 6 in the right base. PELVIS:PROSTATE:Prostate Size: 4.2 x 4.5 x 5.9 cm.Peripheral Zone: There is mild intrinsic T1 signal in the mid gland peripheral zone. There is a nonspecific focus of T2 hypointensity in the right lateral peripheral zone (series 1001, image 15) measuring 6 x 7 mm. There is no corresponding low ADC signal. Central Gland: Severe degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No credible targetable lesion for biopsy. Focus of T2 hypointensity in the right lateral peripheral zone without corresponding low ADC signal is nonspecific.


Instruction: Generate impression based on findings.

Input: 56 year old with right nipple discharge Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.There is a linear non mass enhancing lesion in the central aspect of right breast, measuring 24 x 6 x 6 mm (AP x LR x CC), extending anteroposteriorly. This lesion is connecting to a mildly dilated duct toward the nipple. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Suspicious linear non mass enhancing lesion in the central aspect of right breast. MR-directed ultrasound study is recommended. If sonographic correlation is detected, ultrasound guided biopsy can be performed.2. No MR evidence for malignancy in the left breastBIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Further evaluate cervicothoracic junction for enhancement of the anterior epidural space. Evaluate the lumbar disc as well. Cervical spine:Again seen is patchy marrow replacement involving many of the vertebral bodies of the cervical and visualized thoracic spine concerning for diffuse metastatic disease. However, there is no significant loss of vertebral body height. Again seen at the C5-6 and C6-7 level there is substantial T2 hypointensity matching that of the disc within the ventral epidural space which causes displacement and compression of the spinal cord. There is persistent evidence of a small amount of age-indeterminate cord signal abnormality at the C7 level which is confirmed on the recent previous outside hospital MRI exam of the spine. The T2 signal hypointensity and overall lack of enhancement pattern involving the ventral epidural space at the C5-6 and C6-7 level is compatible with disc extrusion. Infiltration by metastatic disease is thought to be unlikely given the lack of pathologic contrast enhancement in the anterior epidural space. C2-3: Mild left greater than right disc osteophyte complex with a small central disc protrusion is without significant central spinal canal or neural foraminal stenosis.C3-4: Disc osteophyte complex and minimal disc extrusion but no significant central canal stenosis or neural foraminal narrowing.C4-5: Mild facet and uncovertebral hypertrophy left greater than right which causes mild bilateral neural foraminal stenosis. No significant central canal stenosis.C5-6: Moderate facet and uncovertebral hypertrophy as well as a large central disc herniation with extrusion superiorly and inferiorly. As discussed above, this causes moderate to severe central spinal canal and moderate right and mild left neural foraminal stenosis.C6-7: Disc herniation with central disc protrusion which causes moderate bilateral neural foraminal stenosis and moderate central canal stenosis.C7-T1: Mild central disc protrusion but no significant spinal canal or neural foraminal stenosis.Lumbar spine:Patchy marrow replacement involving many of the vertebral bodies of the cervical and visualized thoracic spine concerning for diffuse metastatic disease. The vertebral body heights are preserved. Prominent lordotic curvature of the lumbar spine. The conus medullaris on sagittal imaging is grossly intact.T12-L1 through L3-4: No disc bulge. No significant neural foraminal or central spinal canal stenosis.L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Minimal disc bulge but no significant neural foraminal or central spinal canal stenosisL5-S1: Severe disc disease with prominent right greater than left disc herniation at the L5-S1 level causes moderate central spinal canal stenosis. No significant neural foraminal stenosis.

Output: 1.Redemonstration of patchy marrow replacement involving much of the cervical and lumbar spine indicating osseous metastases. There is no evidence of abnormal pathologic enhancement within the epidural space to indicate epidural spread of tumor within either the cervical or lumbar spine.2.No pathologic enhancement of the low T2 intensity signal material matching signal of disc in the anterior epidural space at the C5-6 level compatible with disc herniation with superior and inferior extrusion. It is unlikely to represent metastatic epidural spread of tumor given the lack of enhancement and the lack of epidural disease elsewhere in the spine.3.No change in the moderate to severe central spinal canal stenosis at the C5-6 level. 4.Degenerative changes in the lower lumbar spine, most prominent at the L5-S1 level, where there is a prominent central, right greater than left, disc herniation which causes moderate central spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with neck pain, left upper extremity pain and weakness, low back pain, bilateral thigh pain and right outer calf pain. Cervical:A slight reversal of the cervical lordosis is seen. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No marrow replacement or marrow edema is detected. The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No epidural abnormalities are detected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Tiny central disc protrusion. No significant spinal canal stenosis or neuroforaminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation asymmetric to the left with slight effacement of the ventral thecal sac but no significant spinal canal stenosis. Mild left foraminal narrowing. C5-6: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Lumbar:Trace anterolisthesis of L4 relative to L5 is seen. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No marrow replacement is seen. Mild endplate degenerative edema is noted at L5-S1. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Minimal disc bulging. No spinal canal or foraminal stenosis. L3-4: Mild facet arthropathy and ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L4-5: Moderate facet arthropathy and ligamentum flavum thickening. Mild disc bulging. No significant spinal canal stenosis. Mild right foraminal narrowing. L5-S1: Moderate facet arthropathy. Disc bulging with a small left paracentral protrusion. No significant generalized spinal canal stenosis. Mild left foraminal narrowing.

Output: Relatively mild degenerative findings are seen in the cervical and lumbar spine with no areas of high-grade spinal canal stenosis, severe foraminal narrowing or obvious nerve root impingement.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with sensation of band around chest and coronary problems. Assess for multiple sclerosis, assess for interval change. Brain:A 4 mm focus of T2 hyperintensity within the right globus pallidus is unchanged. No new focal parenchymal lesions are detected. Diffusion-weighted images are within normal limits. No evidence of parenchymal edema or mass effect is seen. No abnormal extra-axial fluid collections are detected. Ventricular size and morphology are within normal limits.C-spine:Spinal cord signal intensity and morphology are within normal limits. No focal cord lesions are detected. No intracanalicular or epidural abnormalities are seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema or concerning marrow replacement is seen.The intervertebral discs demonstrate normal height and morphology. Minimal posterior disc-osteophyte complex formation is seen at C3-4. At no level is there any significant spinal canal or neuroforaminal stenosis.Incidental is made of a 14 mm right thyroid nodule.T-spine:The thoracic spinal cord demonstrates normal signal intensity and morphology. No focal cord lesions are detected. No intracanalicular or epidural abnormalities are seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema or concerning marrow replacement seen.Very small central disc protrusions are present at T6-7 and T7-8. At no point is there any significant spinal canal or neuroforaminal stenosis.Incidental note is made of a nonspecific subcentimeter cystic lesion within the left kidney.

Output: 1.A nonspecific 4 mm focus of signal abnormality within the right globus pallidus is unchanged.2.No additional specific abnormalities are detected in the brain.3.No focal spinal cord lesions are detected. No spinal canal or neuroforaminal stenosis is evident at any level.4.Incidentally noted are a right thyroid nodule and a left renal cystic lesion.


Instruction: Generate impression based on findings.

Input: Pituitary macroadenoma. There is an enhancing pituitary mass that measures up to 16 mm in craniocaudal dimension. The mass abuts the optic apparatus, without significant mass effect. The tumor also extends into the cavernous sinuses bilaterally. The internal carotid artery flow voids are intact. The pituitary infundibulum is deviated to the left.

Output: A pituitary mass that measures up to 16 mm in craniocaudal dimension is compatible with a macroadenoma.


Instruction: Generate impression based on findings.

Input: History of right L5 nerve sheath tumor. Assess for schwannomas. CERVICAL SPINE:There is partial straightening which may relate to patient position. Sagittal alignment is otherwise anatomic. The vertebral bodies are preserved in height. There is moderate disc height and T2 signal loss at C6-C7 associated with degenerative endplate disease. There is mild disc desiccation but no significant height loss at the other levels. Very shallow ventral indentations of the thecal sac by the disc-osteophyte complex is present at C6-C7 and to lesser extent at C4-C5. At C6-C7, there is mild-to-moderate right and mild left neural foraminal stenoses by uncovertebral and, to a lesser extent, facet arthropathy. Neural foramina at the other levels are preserved. The cervical spinal cord shows normal signal and shape. Following contrast injection, there is no abnormal enhancement in the spinal cord or the cervical nerve roots. Included posterior fossa is unremarkable.THORACIC SPINE:Of note, the patient has atypical segmentation with only 11 ribs, assuming ribless T12. Thoracic spinal alignment is anatomic. The vertebral bodies are preserved in height. Marrow signal is heterogeneous, in part because of fat-containing lesions involving the T6, T7 T10, and T11 vertebrae, which probably represent hemangiomata, in addition to type 2 degenerative signal in the marrow subjacent to the endplates at T8-T9 anteriorly. There is no suspicious marrow lesion. Small intravertebral disc herniations (Schmorl nodes) are present at T7-T8. There is no significant posterior bulging or osteophytosis and the spinal canal is preserved. There is mild proliferative right T10-T11 facet arthropathy resulting in very mild neural foraminal stenosis. The other foramina are preserved. The thoracic spinal cord also shows normal signal and shape. Following contrast injection, there is no abnormal contrast enhancement within the thecal sac.Lungs show dependent changes. Well-circumscribed T1-hypointense, T2-hyperintense, noncontrast enhancing liver lesions likely represent cysts but are not completely assessed.LUMBAR SPINE: Of note, the patient has atypical segmentation with only 11 ribs. Assuming ribless T12, there are only 4 lumbar vertebrae. There is no significant malalignment. The vertebral bodies are preserved in height. There is disc desiccation at L2-L3, L3-L4 and L4-L5 associated with small bulges. There is mild height loss at L3-4. Degenerative facet arthropathy is present at these 3 levels but is more pronounced at L4-L5 and L3-L4, which is associated with small effusions and edema and enhancement in the marrow and adjacent soft tissues but only mild left neural foraminal stenosis. The left L3-L4 facet is also associated with a small dorsal cyst. There is abnormal contrast enhancement in the L2-L3 interspinous ligament with associated remodeling of the spinous processes, compatible with Baastrup disease. Mild similar changes are present at L1-L2 as well.The conus has normal shape and signal. The tip of the conus is at upper L1 level. There is no abnormal contrast enhancement within the thecal sac.There is a well-circumscribed, T1-hypointense, T2-hyperintense, contrast-enhancing just anterior to the first right sacral foramen (L5 by the above described level nomenclature), which measures up to 3.5 cm.

Output: 1.Cervical: No schwannoma, ependymoma or meningioma. Mild degenerative disease at C6-C7 as described above.2.Thoracic: No schwannoma, ependymoma or meningioma. Mild degenerative disease of the right T10-T11 facet and the anterior T8-T9 endplate. Of note, the patient has atypical segmentation with only 11 ribs. Assuming ribless T12, there are 4 lumbar vertebrae. Incidental, incompletely assessed probable liver cysts are present.3.Lumbar: While there is no abnormal contrast enhancement in the spinal canal, a 3.5 cm Contrast-enhancing mass anterior to the right first sacral foramen (right L5 nerve root by the above-described level nomenclature) would be most compatible with isolated nerve sheath tumor, such as schwannoma or neurofibroma. Otherwise, there is multilevel lower lumbar facet arthropathy associated with effusions and marrow/adjacent soft tissue edema. There is also Baastrup disease at L2-L3.


Instruction: Generate impression based on findings.

Input: 64 years Male (DOB:8/5/1951)Reason: Evaluate for ischemia History: Transient RUE weakness x 2 episodesPROVIDER/ATTENDING NAME: JAMES J WALTER HELENE G RUBEIZ MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. The left A1 segment is larger than the right A1 segment. The LVA is smaller than the RVA.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is no evidence for intracranial hemorrhage or intracranial mass to explain the patient's right upper extremity weakness.2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for extracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: Male, 24 years old. Left knee crepitance, suspicion for chondromalacia of patella. Left knee pain with running MENISCI: There is poorly defined globular intermediate signal intensity within the periphery of the medial meniscus at the junction of the body and posterior horn and abutting the tibial articular surface, suspicious for an undersurface fraying/tearing in the red zone. We see no fluid signal intensity within the meniscus, and therefore it is possible that this represents a healed tear. The remainder of the medial meniscus appears normal. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: Articular cartilage appears normal as does the bone marrow.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Intermediate signal intensity within the periphery of the medial meniscus as described above suggesting undersurface fraying/tearing. Please note that this may be chronic and not necessarily of current clinical significance.2.Normal appearing articular cartilage.3.Small Baker's cyst.


Instruction: Generate impression based on findings.

Input: Ovarian cancer. Rising CA-125. 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: Left pelvicaliectasis, unchanged. RETROPERITONEUM, LYMPH NODES: Right retrocrural lymphadenopathy extending above the diaphragm into the lower chest, measures 2.5 x 1.8 cm (series 901, image 32), previously 2.5 x 1.9 cm.Multiple other prominent retroperitoneal and porta hepatis lymph nodes best seen on DWI sequences, not significantly changed.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Fatty marrow infiltration in the lumbar spine, likely due to post-radiation effect.OTHER: No significant abnormality noted.

Output: Stable right retrocrural and retroperitoneal lymphadenopathy with no new sites of disease.


Instruction: Generate impression based on findings.

Input: Altered mental status. Evaluate for acute stroke. There is a punctate focus of diffusion restriction in the right thalamus. There is no evidence of intracranial hemorrhage or mass effect. There is mild parenchymal volume loss. There are scattered areas of abnormal T2 hyperintensity within the periventricular white matter, consistent with chronic small vessel ischemic changes. There is no midline shift or herniation. There is opacification of the right maxillary sinus and to a lesser degree left maxillary sinus with low T2 signal and remodeling of the right medial maxillary sinus wall. There is deformity of the right lamina papyracea, likely from prior blowout fracture. The skull and extracranial soft tissues are otherwise unremarkable. Incidentally noted is a partially empty sella. There are bilateral lens implants.

Output: 1. Acute right thalamic microinfarct.2. No evidence of intracranial hemorrhage or mass effect.3. Opacification of the bilateral maxillary sinuses. Based on comparison to an MRI from 6/6/2003, this most likely represents inspissated secretions and is chronic. Please correlate with patient's clinical history and symptoms.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is blunting and maceration of the posterior horn and body of the medial meniscus. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss of the lateral femoral condyle posteriorly at the level of the posterior horn of the meniscus. This is superimposed upon mild diffuse thinning of the articular cartilage. Full-thickness cartilage loss and degeneration of the medial compartment is also noted particularly along the posterior aspect of the femoral condyle. There is near complete cartilage loss of the femoral trochlea with degeneration and partial thickness loss of the patellofemoral articulation.LIGAMENTS: There are surgical changes relating to ACL repair. The ACL graft is intact as is the PCL and medial/lateral collateral ligaments. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Maceration of the medial meniscus. Although the morphology may in part be related to prior meniscectomy, superimposed complex tearing is likely.2. Multiple areas of tricompartmental full-thickness cartilage loss further detailed above.3. ACL repair with intact ACL graft.


Instruction: Generate impression based on findings.

Input: 52 year old female with paroxysmal atrial fibrillation and premature ventricular contractions here for cardiac evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 97 ml/m2 (normal range: 65+/-11), the LVEDV is 159 ml (normal range 109+/-23), the LV end systolic volume index is 42 ml/m2 (normal range 18+/-5), the LVESV is 69 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native T1 times are normal.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 100 ml/m2 (normal range 69+/-14), the RVEDV is 165 ml (normal range 110+/-24), the RV end systolic volume index is 50 ml/m2 (normal range 22+/-8), and the RVESV is 82 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.RU 17x14 mmLU 12x16 mmRL 15x16 mmLL (small vessel) 11x13 mmPulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal biventricular size and systolic function.2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 58-year-old male with multiple myeloma. Patient has renal insufficiency. Evaluate myeloma lesions. Evaluation of the proximal femora, bilaterally, is limited due to metallic susceptibility artifact related to orthopedic fixation. Given this limitation, we see no bone marrow signal abnormality. Evaluation of the hip joints is limited but there appears to be at least moderate osteoarthritis of the hips. The sacroiliac joints are unremarkable. The pubic symphysis is unremarkable. There is relatively fatty atrophy of the gluteus medius and minimus musculature on the right, but we see no muscular edema or soft tissue masses. There is a Foley catheter within the decompressed bladder. We see no abnormal enhancement following contrast administration.

Output: Metallic susceptibility artifact resulting from orthopedic fixation of the proximal femora, bilaterally, slightly limits the examination, but we see no discrete myelomatous lesions.


Instruction: Generate impression based on findings.

Input: 33 year-old female with a history of epigastric pain with fatty replacement of the pancreas and reportedly patulous appearing common bile duct on CT examination. ABDOMEN:LIVER, BILIARY TRACT: There is no intra- or extrahepatic biliary ductal dilation. No focal mass lesion identified. No gallstones are seen.SPLEEN: No significant abnormality noted.PANCREAS: The distal pancreatic body and tail are not well seen, which may represent severe fatty atrophy/replacement. The remainder of the pancreas also appears atrophic. Although assessment for calcifications would be better performed by CT examination, no definite signal abnormality is identified to suggest calcification. The main pancreatic duct is normal in size and appearance. No dilation or irregularity is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Severe atrophy of the pancreas consistent with the stated history. No pancreatic or biliary ductal dilatation. If there is continued clinical concern, further evaluation with ERCP or MRI with administration of secretin recommended.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42]. MRI BRAIN: There are a few scattered foci of T2 hyperintensity in the subcortical and periventricular white matter. The brainstem and cerebellum appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA BRAIN: There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: 1. No evidence of acute infarction. A few scattered foci of T2 hyperintensity in the subcortical and periventricular white matter are nonspecific, but may represent chronic small vessel ischemic disease. 2. No evidence of significant cerebral artery steno-occlusive 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: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is global parenchymal volume loss which is appropriate for patient's age. No hydrocephalus. No extra-axial collections. There is patchy T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter, which is nonspecific, but compatible with moderate chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Minimal mucosal thickening in the paranasal sinuses. Paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits. CERVICAL SPINE

Output: 1. Moderate of chronic small vessel ischemic changes. MRI of the brain is otherwise unremarkable for age.2. No abnormal cord signal. Mild degenerative changes without high-grade spinal canal or neural foraminal stenosis in the cervical or thoracic spine.3. Abnormal enhancement involving the dorsal epidural space at the L1-L2 level as well as subtle enhancement involving the dorsal paraspinous soft tissues as well; finding may represent sequela of prior lumbar puncture or epidural injection. There is also a disc extrusion which is present extending from the T12-L1 level to the mid L2 level. These findings along with ligamentum flavum thickening and facet arthropathy result in mild to moderate degree of spinal canal stenosis at the L1-L2 level.4. Moderate to severe spinal canal stenosis at L4-L5. There is also moderate bilateral neural foraminal stenosis at this level which may be impinging on the bilateral L4 nerve roots.5. Please note post gadolinium images of the cervical and thoracic spine were not obtained as patient did not want to complete these sequences.


Instruction: Generate impression based on findings.

Input: A 62 year old female with history of extra-cardiac sarcoid, right lung cancer (treated with surgical resection and radiotherapy). Recently she suffered from a transient ischemic attack (TIA) and mild-to moderate left ventricular function was found in an echocardiography. Referred to cardiac MRI to assess cardiac sarcoid and coronary artery disease. MEDICATIONS: Aspirin, Atorvastatin, Clonazepam, Fluticasone, Lanzoprazole, Zolpidem First Pass PerfusionDuring hyperemia, a small, moderate severity perfusion defect present in the basal anterolateral wall. The overall ischemia burden is 2 out of 32 and 6% of the myocardium is ischemic.Viability/ Myocardial ScarThere is no clear cut late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. There is, however, a borderline increase in signal intensity in a small area of the basal anterolateral wall which I believe is an imaging artifact.Left VentricleThe left ventricle is normal in size with mild systolic dysfunction. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 107 ml (normal range 109+/-23), the LV end systolic volume index is 35 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 36 g/m2, and the LV mass is 61 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 48 ml/m2 (normal range 69+/-14), the RVEDV is 81 ml (normal range 110+/-24), the RV end systolic volume index is 23 ml/m2 (normal range 22+/-8), and the RVESV is 38 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsConsolidation is noted in the lower lobe of the right lung; no significant change in size compared to this finding in the Chest CT from 12/6/2011. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. A small, moderate severity perfusion defect/ "ischemia" is present in the basal anterolateral wall.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 45%) without obvious evidence of underlying myocardial fibrosis, inflammation, or infiltration. If there is a high clinical suspicion of cardiac sarcoidosis, consider repeat cardiac MRI in 6-12 months to reassess the above described increased signal intensity involving the basal anterolateral wall. 4. Normal RV size and systolic function (RVEF 54%).5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 46-year-old female with history of cervical cancer and brain metastases status post WBRT. The patient is status post right frontal craniotomy for removal of a right middle frontal gyrus metastasis with interval evolution of the blood products in the treatment bed. There is a more prominent focus enhancement in the anterior margin of the treatment bed that measures up to 10 mm and a new nodular focus of enhancement along the posterolateral margin of the treatment bed that measures up to 7 mm. There is persistent surrounding vasogenic edema. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild frontal sinus mucosal thickening, as well as patchy mucosal thickening involving the anterior ethmoid air cells. The orbits, skull, and scalp soft tissues are unchanged.

Output: Post-treatment findings in the right frontal lobe with a more prominent focus enhancement in the anterior margin of the treatment bed that measures up to 10 mm and a new nodular focus of enhancement along the posterolateral margin of the treatment bed that measures up to 7 mm. These may represent tumor progression and/or treatment effects.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: focal abnormalities History: new onset seizure, focal onset on EEG There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are normal in size and configuration. There is a cystic lesion which follows CSF signal which appears to originate in the quadrigeminal plate cistern measuring 2.2 x 2.0 cm. This lesion causes leftward displacement of the pineal gland and internal cerebral veins. A small cavum vergae is noted. The hippocampi are symmetric without evidence of atrophy or abnormal signal. No heterotopic gray matter. Midline structures are intact. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable.

Output: 1.Cystic lesion in the region of the quadrigeminal plate cistern likely represents an arachnoid cyst. The relevance of this finding to the patient's presenting clinical symptoms is uncertain.2.Normal appearing hippocampi without abnormal signal or atrophy. No other specific lesions are seen which would account for seizures.


Instruction: Generate impression based on findings.

Input: 69-year-old male patient with history of right kidney mass status post CT RFA on 10/22/2014. Follow-up examination. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. Stable T2 weighted hyperintense hepatic lesions, likely representing cysts. SPLEEN: No significant abnormality noted.PANCREAS: Two non-enhancing cystic foci within the distal pancreatic body/tail measuring 8 x 6 mm (image 5, series 7) and the pancreatic head measuring 9 x 7 mm (image 15, series 7) are unchanged in size and likely represent side branch IPMNs. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Post-ablation treatment changes of the midpole of the right kidney with an ablation defect and stable peri-ablation changes. Intrinsic T1 weighted hyperintensity along the medial margin of the defect without enhancement is compatible with blood products/proteinaceous material, unchanged. Additional bilateral renal cysts and a T1 hyperintense, likely proteinaceous/hemorrhagic cyst, lesion are stable. 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.Stable appearance of the right kidney status post ablation without evidence of recurrence.2.Stable bilateral renal cysts.3.Stable appearing probable sidebranch IPMNs.4.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: SLE with urinary incontinence and poor memory. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a punctate nonspecific focus of T2 hyperintensity in the isthmus of the left parietal lobe. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are prominent arachnoid granulations in the occipital bone. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There is a posterior disc-osteophyte complex that impinges upon the spinal cord at T10-11. There is also associated mild bilateral neural foraminal stenosis at this level. There is no evidence of spinal cord signal abnormality, however. The cauda equina nerve roots are intact. There are multiple lower cervical and lower thoracic intravertebral disc herniations, but the vertebral body heights are otherwise preserved. There is no spondylolisthesis. The vertebral bone marrow signal is unremarkable throughout. There are left paraspinous cysts at L4 and L5.

Output: 1. A punctate nonspecific focus of T2 hyperintensity in the isthmus of the left parietal lobe may represent a chronic ischemic lesion. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Compression of the spinal cord by a T10-11 posterior disc-osteophyte complex.3. No evidence of inflammatory spinal cord lesions.Discussed with Dr. Trotter at 4:40 PM on 1/29/16.


Instruction: Generate impression based on findings.

Input: Cystectomy for bladder cancer with transient episodes of blurred vision and left eye facial droop; please evaluate for TIA. There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse predominantly periventricular cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. A 3 mm wide right parafalcine structure may represent a meningioma. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are bilateral maxillary sinus retention cysts.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Mild diffuse predominantly periventricular cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: 83 yo s/p a distal pancreatectomy/splenectomy 12/2010 for a IPMN. New NIDDM, needs surveillance MRCP 5/2015 History: new DM ABDOMEN:LIVER, BILIARY TRACT: Nonvisualization of the main portal vein with cavernous transformation, unchanged. No suspicious focal hepatic lesion.Status post cholecystectomy. Mild intra and extrahepatic biliary ductal dilatation with the common bile duct measuring up to 9 mm, not significantly changed.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. Stable linear nonenhancing focus in the mid pancreas. The remaining pancreatic parenchyma demonstrates normal signal intensity and enhancement.There are multiple T2 hyperintense cystic structures in the resection margin the largest of which measures up to 6 mm which are not well seen on the previous examination but overall appear decreased in size compared to the 7/31/2014 examination. The 3 mm cystic lesion within the uncinate process described on the previous examination is not well visualized. The pancreatic duct is not dilated.Mildly prominent peripancreatic lymph nodes appear similar to prior.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts, some of which are hemorrhagic, without associated enhancement.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.Multiple subcentimeter cystic lesions within the pancreas overall slightly more prominent than 5/7/2015 (which may be due to technique) but less prominent than 7/31/2014. No definite new lesions are identified.2.Stable portal vein thrombosis with cavernous transformation.


Instruction: Generate impression based on findings.

Input: Patient with intermittent right greater than left arm and forearm pain, wrist pain and intermittent paresthesias of the both hands, right greater than left and intermittent neck pain, evaluate for cervical disc disease and nerve impingement. Alignment is anatomic. Vertebral body heights and intervertebral disc spaces are preserved. No cord signal abnormality is identified. No significant abnormalities noted in the paraspinal soft tissues. Bone marrow signal is benign.Individual levels as below:C2-C3: No significant spinal canal or neural foraminal stenosis.C3-C4: No significant spinal canal or neural foraminal stenosis.C4-C5: No significant spinal canal or neural foraminal stenosis.C5-C6: No significant spinal canal or neural foraminal stenosis.C6-C7:There is small left foraminal disc protrusion with minimal narrowing of the left neural foramen. No spinal canal or right neural foraminal stenosis. C7-T1: No significant spinal canal or neural foraminal stenosis.T1-T2: No significant spinal canal or neural foraminal stenosis.

Output: Small left foraminal C6-C7 disc protrusion with minimal narrowing of the left neural foramen. There is otherwise no significant disc disease, spinal canal, or neural foraminal stenosis in the cervical spine. No cord signal abnormality.


Instruction: Generate impression based on findings.

Input: 35 year old with history atrial flutter s/p ablation and palpitations presenting for cardiac evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 90 ml/m2 (normal range: 65+/-11), the LVEDV is 169 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 76 ml (normal range 31+/-10), the LV mass index is 33 g/m2 (normal range 67+/-11), and the LV mass is 62 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 88 ml/m2 (normal range 69+/-14), the RVEDV is 164 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 55%).There is no late gadolinium enhancement. 2. The right ventricle is normal in size and systolic function (RVEF 63%).


Instruction: Generate impression based on findings.

Input: 68-year-old male with elevated PSA (5.3 in September 2016). PELVIS:PROSTATE:Prostate Size: 5.3 x 3.3 x 4.5 cm.Peripheral Zone: Linear T2 hypointense appearance throughout the peripheral zone limits the evaluation and could represent a background of chronic prostatitis. At least 2 rounded discrete foci of T2 and ADC hypointense foci measuring up to 4 mm are also identified in the left anterior-lateral peripheral zone (series 508 image 224, series 901 image 13). Central Gland: In the mid gland anterior transitional zone, there is a 1.5 x 1.3 cm T2 and ADC hypointense focus suspicious for a dominant lesion (series 508 image 224, series 901 image 14). This lesion extends to the anterior fibromuscular stroma and slightly crosses the midline to the left.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant lesion in the anterior transitional zone measuring 1.5 x 1.3 cm, best characterized as PI-RADS 5.2.Additional rounded discrete foci of T2 hypointense signal also noted in the left anterolateral peripheral zone, suspicious for additional neoplastic foci.


Instruction: Generate impression based on findings.

Input: History of multifocal prostate cancer. Patient presents for focal laser ablation of the 3+3 cancer in the left side of the prostate Patient used prophylactic antibiotics before and after the procedure asprescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500 mg bidstarting the night before the procedure. He took 2 tablets of Ciprofloxacin 500 mg beforethe procedure and will take two tablets after the procedure. Following the discussion ofthe risks, benefits, and alternatives of the procedure, informed consent was obtained forthe research study. The procedure was performed under moderate conscious sedation.MRI focus in the left base, mid-gland and apical peripheral zone suspicious for patient's known cancer waslocalized with T2 weighted MR images. Following sterile preparation, Medtronic's laserablation template was placed in the perineum on the patient and localized on MR images andregistered to the MR images where prostate lesion could be visualized.Following local anesthesia with lidocaine, 14-gauge MR- compatible needles were insertedinto the left side of the prostate to stabilize the prostate. Upon confirmation of thetip of the needle on the left side close to the known lesion, a total of5 laser ablationswith 30-W, 90 % power was performed within the left mid-gland and apical peripheral zone of theprostate zone. The patient tolerated the procedure well without any immediate complications.Pre-and postcontrast axial MR images are obtained before and after administration of 20 ccMultiHance, upon completion of the procedure. On MR images of ablation defect was notedwithin and around the ablated region. COMPLICATIONS: No immediate complications.BLOOD LOSS: < 10 ml

Output: MR guided laser ablation of the left base mid-gland and apical peripheral zone of theprostate.PLAN: Patient was sent to the post-procedural area for observation to ensure voiding. Will follow-up with urology.


Instruction: Generate impression based on findings.

Input: History of metastatic head and neck cancer with single brain metastasis status post resection. Please evaluate for radiosurgery. A small surgical resection cavity is evident at the junction of the right temporal and occipital lobes. The cavity is mildly hemosiderin stained. The margins of the cavity demonstrate thin rim enhancement. At the upper margin of the cavity, however, an area of more nodular enhancement is seen with a small ring-enhancing component.No new enhancing lesions are seen. No evidence of edema or mass effect is detected. A small focus of susceptibility is demonstrated along the left temporal horn.

Output: Limited sequences for treatment planning demonstrate a surgical resection cavity at the junction of the right temporal and occipital lobes. The margins of the cavity enhance thinly which may be postoperative, though there is an area of more nodular/ring enhancement along its superior margin which is nonspecific.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Mucosal thickening is present within the right maxillary sinus as well as a few scattered bilateral ethmoid air cells. Remaining paranasal sinuses and mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Brain MRV:There is normal venous flow demonstrated within the internal cerebral veins, vein of Galen, straight sinus, superior sagittal sinus and within the bilateral transverse and sigmoid sinuses. No dural venous sinus thromboses or occlusions are identified.

Output: 1.Mucosal thickening is present within the right maxillary sinus as well as a few scattered bilateral ethmoid air cells. Otherwise negative MRI of the brain including gadolinium enhancement.2.Negative MRA of the brain.3.Negative MRV of the brain.


Instruction: Generate impression based on findings.

Input: 77 year old woman with recent increasing shortness of breath with exertion and possible diagnosis of hypertrophic cardiomyopathy presents for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. There is asymmetric septal hypertrophy (septal wall thickness: 16 mm, posterior wall 8mm) with flow acceleration in the outflow tract and associated systolic anterior motion of the mitral valve. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 67 ml/m2 (normal range: 74+/-15), the LVEDV is 121 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 43 ml (normal range 47+/-19), the LV mass index is 85 g/m2 (normal range 85+/-15), and the LV mass is 153 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is an atypical pattern of late gadolinium enhancement involving the basal inferior and inferolateral walls and the LV apex which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The overall burden of late gadolinium enhancement is 5-10% of the myocardial mass. Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 112 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 51 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 at least mild mitral regurgitation. There is evidence of systolic anterior motion of the mitral valve.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 upper limits of normal in size (29 mm)Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. There is mild amount of pericardial fat present.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (65%)2. There is asymmetric septal hypertrophy (septal wall thickness: 16 mm, posterior wall: 8mm) with flow acceleration in the outflow tract and associated systolic anterior motion of the mitral valve. 3. There is an atypical pattern of late gadolinium enhancement to suggest the presence of an underlying fibrosing process, which involves only 5-10% of the myocardial mass. 4. The right ventricle is normal in size and systolic function (54%)5. Taken together, these findings support the diagnosis of hypertrophic cardiomyopathy and no high risk features of sudden cardiac death/ adverse cardiac remodeling are identified. Atypical patterns of late gadolinium enhancement are present in approximately two-thirds of individuals with hypertrophic cardiomyopathy. The presence of 15-20% late gadolinium enhancement burden is considered higher risk for sudden cardiac death and adverse cardiac remodeling.


Instruction: Generate impression based on findings.

Input: Evaluate right thigh opacity seen on CT. History of psoas abscess status post drainage by IR. History of pancreatic cancer and falling hemoglobin. There is a complex rim-enhancing fluid collection involving much of the quadriceps musculature extending along nearly its entire length with sparing of the rectus femoris. The collection consists of multiple pockets of nonenhancing fluid/tissue that we suspect intercommunicate. Proximally, the collection extends along the posterior margin of the greater trochanter as well as into the adductor musculature of the hip and the iliopsoas muscle. The collection is of heterogeneous signal intensity on T2-weighted images with components that are both hyperintense and isointense relative to skeletal muscle. There is also heterogeneity on T1-weighted images with curvilinear foci of hyperintensity. This heterogeneity raises the possibility of blood products of varying ages and perhaps myonecrosis although we cannot exclude an abscess.There is edema of the adjacent musculature and the surrounding subcutaneous fat. The bone marrow signal is normal without evidence of osteomyelitis. There is a small knee joint effusion. There is no hip joint effusion. A few small inguinal lymph nodes are noted.Note is made of a filling defect in the right femoral vein at the level of the subtrochanteric femur, representing partially occlusive thrombus.

Output: Complex rim-enhancing collection involving much of the quadriceps musculature along its length extending into the adductor musculature of the hip, the iliopsoas muscle, and posterior to the greater trochanter. Heterogeneity of signal on the T1 and T2 images suggests the possibility of blood products of varying ages and possibly myonecrosis but an abscess cannot be excluded.These findings were communicated to Dr. Khattak by telephone at 9:30 AM on 9/28/2016.


Instruction: Generate impression based on findings.

Input: Dysphagia, rule out neck mass. There is no abnormal enhancement or discrete mass appreciated involving the oral cavity, pharyngeal, or parapharyngeal soft tissues. There is mild prominence of the bilateral palatine and lingual tonsillar tissue with partial effacement of the vallecula. No suspicious underlying mass. Laryngeal structures are unremarkable.Small scattered cervical lymph nodes are seen which are not significant by size criteria. There is a 7 mm nodule involving the right thyroid lobe. Thyroid gland and remainder of the salivary glands appear unremarkable. Minimal mucosal thickening is seen in the partially imaged maxillary sinuses.Mild degenerative changes are seen in the cervical spine without high-grade spinal canal or neural foraminal stenosis at any level. No suspicious osseous lesions.

Output: 1. No suspicious neck masses. No cervical lymphadenopathy. 2. Mild nonspecific prominence of the palatine and lingual tonsillar tissue without discrete underlying lesions.


Instruction: Generate impression based on findings.

Input: Knee pain, lupus MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a heterogeneous appearance of the marrow signal likely representing hematopoietic marrow reconversion. Otherwise the articular cartilage is intact.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No evidence of internal derangement.


Instruction: Generate impression based on findings.

Input: 73 year old female. Right shoulder pain/weakness. Evaluate for rotator cuff pathology. ROTATOR CUFF: Supraspinatus: Complete tear of the supraspinatus tendon from its insertion on the greater tuberosity with retraction to the level of the glenohumeral joint. There is moderate fatty atrophy of the supraspinatus muscle.Infraspinatus: There is a near complete to complete tear of the infraspinatus tendon with similar retraction. Moderate to severe fatty atrophy of the infraspinatus muscle.Teres minor: The tendon and muscle are intact.Subscapularis: Apparent thickening and mild increased signal intensity of the subscapularis tendon, likely represents a combination of tendinosis and redundancy as a result of internal rotation of the humerus. The subscapularis muscle appears intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint with spurring of the anterior aspect of the acromion process. A small amount of fluid in the subacromial/subdeltoid bursa is noted. The humeral head is high riding with narrowing of the acromiohumeral interval to 1 mm.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is severe osteoarthritis of the glenohumeral joint with areas of full-thickness cartilage loss and there is signal abnormality in the medial aspect of the humeral head that is likely degenerative in etiology. The humeral attachment of the anterior aspect of the inferior capsule is indistinct and may be partially torn. There is a small amount of fluid in the glenohumeral joint. The labrum is attenuated, likely reflecting degenerative tearing.BICEPS TENDON: The biceps tendon is not well seen in the rotator cuff interval, and a tear cannot be excluded.ADDITIONAL

Output: Massive rotator cuff tear and severe rotator cuff arthropathy, as described above.


Instruction: Generate impression based on findings.

Input: Childhood radiation and a nerve sheath tumor of the right skull base. Denies headaches, voice or swallowing changes. Neck: There is no significant interval change in the well-defined lobulated, enhancing mass that measures up to approximately 42 mm within the right post-styloid parapharyngeal space, with extension into prevertebral space and widened C1-occipital neural foramen, with associated remodeling of the right lateral C1 arch. The mass protrudes slightly into the epidural space, but does not compress the spinal cord. The mass displaces the carotid artery anteromedially and abuts and possibly encases the right vertebral artery. The mass also compresses the internal jugular vein, which is displaced posteriorly. The pharyngeal mucosal space is intact. There is no significant cervical lymphadenopathy. The salivary gland and thyroid are unremarkable. There is multilevel degenerative cervical spondylosis.Brain: There is an unchanged subcentimeter well-defined T2 hyperintense, enhancing lesion within the right cerebellomedullary angle. The left medial temporal lobe cavernous malformation and associated developmental venous anomaly are unchanged. There is a small right superior frontal gyrus developmental venous anomaly. A few scattered punctate foci of white matter T2 hyperintensity are unchanged and nonspecific. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation.

Output: 1. No significant interval change in the mass that measures up to approximately 42 mm within the right post-styloid parapharyngeal space, with extension into prevertebral space and widened C1-occipital neural foramen. 2. A subcentimeter lesion within the right cerebellomedullary angle is unchanged. These lesions likely represent peripheral nerve sheath tumors.3. The left medial temporal lobe cavernous malformation and associated developmental venous anomaly are unchanged.


Instruction: Generate impression based on findings.

Input: 16-year-old female with cavernous malformation. Status post resection. Decreased mental status. Please evaluate for ventriculomegaly and increased intracranial pressure. Postoperative changes of suboccipital craniectomy is again identified. The cerebellum and the fourth ventricle remain normal. A small CSF density at the level of the quadrigeminal plate and right cerebral peduncle is again identified and no interval change. This finding has the appearance of an extra axial date cyst. There are no prior MRI examinations to compare. This finding all were was noted in all prior CT exams.Images through supratentorial brain parenchyma demonstrates shunted lateral ventricles which are small and non-Hydrocephalic.A small extra-axial fluid attenuation on the left is again identified and shows no definitive evidence of enlargement.

Output: Stable CT examination of brain.