Instruction: Generate impression based on findings.

Input: There is redemonstration of postoperative changes from prior left posterior temporal parietal lobe mass resection. The resection cavity appears similar in configuration, with marginal susceptibility likely relating to chronic postoperative hemosiderin deposition. There is no associated pathological enhancement. T2/FLAIR hyperintensity surrounding the posterior and medial margins of the resection cavity is again noted, with similar appearance to more recent comparisons, although slightly more posteriorly extending compared back to the June 2013 exam. There is again mild ex vacuo dilatation of the left ventricular trigone.There is redemonstration of numerous punctate foci of susceptibility throughout the cerebral hemispheres especially posteriorly and along the brainstem margins, with slight interval progression. These are are nonspecific but favored to represent posttreatment changes.Ventricles and sulci are prominent, consistent with moderate global volume loss. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The right cerebellar tonsil is slightly more low lying than the left.

Output: Stable postoperative and posttreatment changes without evidence of recurrent tumor. Slight posterior progression of marginal FLAIR hyperintensity when compared to remote exams which may relate to evolving posttreatment changes.


Instruction: Generate impression based on findings.

Input: Female, 20 years old, with excruciating upper back pain. Outside report of a T2 lesion and retroperitoneal/mediastinal lymphadenopathy. A compression deformity of the C7 vertebral body results in 60% loss of height, while a compression deformity of the T2 vertebral body results in 70% loss of height. Both vertebral bodies demonstrate pathologic marrow T2 hyperintensity and enhancement. A T2, there is very mild thickening of the ventral epidural soft tissues. This, along with mild retropulsion of the vertebral body, results in a mild spinal canal narrowing. No significant stenosis or cord impingement is suspected. Cord signal characteristics remain normal. The adjacent neural foramina also remain patent.The vertebral bodies of the cervical spine are slender but except as above demonstrate normal morphology and signal characteristics. The vertebral bodies of the thoracic and lumbar spine are unremarkable with no areas of pathologic marrow replacement or enhancement. There is a mild scoliotic curvature of the thoracolumbar spine. Spinal alignment is otherwise unremarkable.The spinal cord demonstrates normal morphology and signal characteristics throughout. No pathologic leptomeningeal or intramedullary enhancement is detected. The conus tip terminates at the L1 level which is normal. No intradural masses are seen.A bulging disk is evident at L5-S1 which results in minimal spinal canal narrowing. The neural foramina are patent. No other significant degenerative disk disease, spinal canal or neuroforaminal stenosis is seen.Views of the paraspinal tissues are notable for the presence of bulky retroperitoneal, and to a lesser degree mediastinal, adenopathy.

Output: Compression deformities of the C7 and T2 vertebral bodies are noted. The presence of diffuse abnormal marrow signal and enhancement at these levels, in the context of significant adenopathy, raises suspicion for pathologic fracturing.Likely etiologies would include both lymphoma and metastatic disease.There may be minimal ventral epidural extension of the disease process at T2. This, along with retropulsion of the T2 vertebral body, results in a mild spinal canal stenosis at this level but without evidence of spinal cord compression.


Instruction: Generate impression based on findings.

Input: The examination is limited by motion artifact. The cervical lordosis is preserved. There is minimal anterolisthesis of C4 over C5 and C5 over C6 as well as minimal retrolisthesis of C6 over C7. The vertebral body and disk heights are well-maintained. There is an approximately 1.4 cm hemangioma visualized in the T2 vertebral body. Within the limitations of motion artifact, spinal cord demonstrates normal caliber and signal. There is no pathological enhancement.C2-C3: There are mild facet and ligamentum flavum hypertrophic degenerative changes, otherwise no significant abnormalities appreciated. Specifically there is no evidence for disc herniation, neuroforaminal stenosis, or central spinal stenosis.C3-C4: There is a diffuse disc bulge with uncovering of the disc as well as mild bilateral posterior facet and ligamentous hypertrophic degenerative changes causing mild left neuroforaminal stenosis and mild spinal canal stenosis without right neuroforaminal stenosis.C4-C5: There is uncovering of the disc with a diffuse disc bulge and left greater than right posterior facet degenerative changes without neuroforaminal or central spinal stenosis.C5-C6: There is a diffuse posterior disc osteophyte complex causing moderate left and mild right neuroforaminal stenosis without spinal canal stenosis at this level. There may be impingement of the exiting left sixth nerve root.C6-C7: There is a diffuse posterior disc osteophyte complex as well as hypertrophy of the ligamentum flavum and posterior facets causing severe bilateral neural foraminal stenosis and mild spinal canal stenosis.C7-T1: No spinal canal stenosis or neuroforaminal stenosis is noted at this level.T1-T2: There is a diffuse disc bulge causing mild bilateral neuroforaminal stenosis.T2-T3: There is a small amount of linear ventral epidural signal at this level which may represent an extrusion migrating 4 mm both cranially and caudally, causing only mild indentation of the ventral thecal sac.

Output: 1. At C5-C6 there is a diffuse posterior disc osteophyte complex causing moderate left and mild right neuroforaminal stenosis without spinal canal stenosis. There may be impingement of the exiting left sixth nerve root.2. There is severe bilateral neuroforaminal stenosis and mild central spinal stenosis at C6-C7 secondary to a diffuse posterior disc osteophyte complex and hypertrophy of the posterior facet/ligamentum flavum.3. Possible small disc extrusion at the T2-3 level causing mild indentation of the ventral thecal sac.4. There is minimal anterolisthesis of C4 over C5 and C5 over C6 as well as minimal retrolisthesis of C6 over C7.


Instruction: Generate impression based on findings.

Input: Lateral ankle pain. Check peroneal tendon TENDONS: No significant abnormality noted. Specifically the peroneal is intact and normal throughout its course and attachment.LIGAMENTS: No significant abnormality noted. Specifically the ligaments are intact and well visualizedARTICULAR SURFACES AND BONE: Unremarkable osseous structures other than minimal degenerative changes and a small punctate mid calcaneal focus suggesting a small enchondroma. Specifically no evidence of acute fractures or findings to suggest malalignment.ADDITIONAL

Output: Intact ligaments and tendons as described. No specific findings to suggest a source of patient's pain.


Instruction: Generate impression based on findings.

Input: 40-year-old male with a history of neurofibromatosis type I, evaluate margins of neurofibromas deep within the buttocks. Several sequences are limited by patient motion artifact.There are several subcutaneous masses overlying the gluteus maximus compatible with small nerve sheath tumors appearing similar to those seen on the prior study. No large tumor along the expected course of the proximal sciatic nerve or elsewhere deep within the buttocks.Small nerve sheath tumors are noted along the right S3 and S4 nerve roots appearing similar to the prior study. There are tiny nerve sheath tumors anteriorly and within the pelvis.There is mild poorly-defined edema type signal within the lateral portion of the gluteus maximus muscle at the level of the proximal femur. The signal is nonspecific and could represent a mild strain. Of note, a similar finding was present in retrospect on the prior study.Bone marrow signal intensity is normal. Mild osteoarthritis affects both hips with what appears to be bilateral CAM deformities. Mild signal abnormality in the acetabular labra bilaterally, which may reflect tearing. The hamstring tendons appear normal.

Output: 1. Multiple small nerve sheath tumors compatible with patient's stated diagnosis of neurofibromatosis type I. However, no dominant deep buttock lesion is identified.2. Mild edema type signal within the gluteus maximus laterally, as described above, is nonspecific and could represent a strain. However, similar findings were present on the prior study.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: There is marked dilatation of the lateral ventricles with absence of septum pellucidum. The ventricular size is unchanged since the previous study. The cerebral aqueduct is not well visualized and most likely stenosed. The floor of the third ventricle is thin in some areas, but no clear evidence of a gap or perforation is seen, similar to prior. The positioning of the sagittal CSF flow sequence is slightly to the right of the midline of the third ventricle. Given flow imaging was acquired as a 10 mm imaging slab, however, the midline is probably covered. Given this, no flow is detected across the floor of the third ventricle, also similar to prior.

Output: 1. Unchanged size of the ventricles since previous study.2. No flow detected across of the floor of the third ventricle. No evidence to indicate patent ventriculocisternostomy.


Instruction: Generate impression based on findings.

Input: Right hip pain, prior orthopedic pinning for SCFE Evaluation of the right hip is limited secondary to metallic artifact from the presence of an orthopedic screw. ACETABULAR LABRUM: Within the limits of the exam, there is no evidence of labral tear. There is questionable mildly increased globular signal of the anterior labrum as seen on the radial sequences which may be artifactual in nature but otherwise there is no discrete contrast entering the intrasubstance of the labrum.ARTICULAR CARTILAGE AND BONE: Orthopedic screws are identified through the femoral head neck junction bilaterally. Note that evaluation of the alpha angle and center edge angle is limited on MRI particularly in the presence of susceptibility artifact and the patient position. Within these limits, the alpha angle measures approximately 55-60 degrees and the coronal center edge angle measures 13 degrees.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1. Limited examination secondary to susceptibility artifact from orthopedic screws. Within these limits, there is no evidence of a discrete labral tear or other specific findings to account for the patient's pain.2. Evaluation of the alpha angle and coronal center edge angle is limited given the susceptibility artifact and patient positioning. Within these limits, the alpha angle measures approximately 55-60 degrees suggesting a mild CAM deformity and the coronal center edge angle measures 13 degrees suggesting some acetabular dysplasia. Note, however, that the accuracy of these measurements is questionable given the limitations described above and dedicated radiographs of the hip can be obtained for more accurate quantification.


Instruction: Generate impression based on findings.

Input: 69Yrs-old male status post PVC ablation via endocardial and epicardial access, here for MRI evaluation of scar formation Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 67%. The LVEDV is 166 ml (normal range 142+/-34), the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVESV is 56 ml (normal range 47+/-19) and the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9). The LV mass is 166 g (normal range 164+/-36) and the LV mass index is 69 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. . There is a focused area of late gadolinium enhancement in the basal anteroseptal region of the left ventricle, suggesting myocardial scarring and correlating with the anatomical ventricular summit. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and mildly reduced function. The overall RV ejection fraction is 43%. The RVEDV is 204 ml (normal range 142+/-31), RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVESV is 115 ml (normal range 54+/-17), and the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal sized.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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. Left ventricle is normal in size and function. The overall LV ejection fraction is 67%.2. Right ventricle is normal in size with mildly reduced function. The overall RV ejection fraction is 43%.3. There is a focused area of late gadolinium enhancement in the basal anteroseptal region of the left ventricle, suggesting myocardial scarring and correlating with the anatomical ventricular summit.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67 year old female pre-vertebroplasty procedure scan There is normal lumbar spine lordosis. Examination again shows mild collapse of the L5 vertebral body with sclerotic change, more prominent on the left side. Axial images show soft tissue density intra-osseous mass on the left with posterior extension to the left hepatic lobe and transverse process, and extending into the neural foramen and adjacent paraspinal space (axial image 60/105, sagittal image 28). There is vacuum phenomenon at L5-S1 intervertebral disk space.There is no vertebral body destruction in the residual lumbar spine. No bony destruction is identified in other segments of posterior elements.Disk bulge is noticed at L2-3, L3-4 and L4-5 level. Please refer to the dedicated lumbar spine MRI examination for more details on degenerative change findings.

Output: L5 vertebral column metastatic lesion as detailed above.


Instruction: Generate impression based on findings.

Input: Cerebral infarction due to embolism of unspecified cerebral artery [I63.40], Reason for Study: ^Reason: stroke History: l hemiparesis Brain MRIThere is restricted diffusion lesion on the right internal capsule posterior limb as well as part of the right basal ganglia. On gradient echo images, there are multiple susceptibility lesions on bilateral thalami as well as right basal ganglia indicating either parenchymal calcification or chronic petechial hemorrhagic lesions. Among them, the lesion on the right basal ganglia is more likely on the external capsule aspect, therefore, this does not represent evidence of hemorrhage transformation. Without evidence of hemorrhage transformation of acute ischemic lesion.Underlying brain shows multiple patch bihemispheric periventricular white matter high signal intensity on FLAIR and T2-weighted images indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate possible focal luminal stenosis on the right MCA proximal M1 segment and right vertebrobasilar junction. Since MRA can exaggerate the degree of luminal stenosis, CTA can be considered for further imaging evaluation if clinically indicated.Bilateral distal ICAs and basilar artery appear to be slightly ectatic which represent atherosclerotic changes.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Again bilateral CCAs and extracranial ICAs show ectatic changes with tortuosity indicating atherosclerotic changes.

Output: 1. Acute ischemic infarction on the right internal capsule posterior limb and globus pallidus without evidence of hemorrhagic conversion.2. More than 50% luminal stenosis of the right MCA proximal M1 segment and right vertebrobasilar junction as described above. CTA can be considered for further imaging evaluation.3. No evidence of extracranial arterial luminal stenosis. 4. Atherosclerotic changes of both intracranial and extracranial arterial system.


Instruction: Generate impression based on findings.

Input: 37-year-old male with anterior instability of the left shoulder. ROTATOR CUFF: Intermediate proton density signal and thickening of the supraspinatus tendon near its insertion site, compatible with tendinopathy. However, there is no rotator cuff tear given that gadolinium stays within the glenohumeral joint and does not communicate with the subacromial/subdeltoid bursa. No evidence of rotator cuff atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Cleft of gadolinium entering the anterior labrum at the 3:00 position is compatible with an isolated normal variant sublabral foramen. No evidence of labral tear.BICEPS TENDON: The biceps tendon is intact and demonstrates normal anatomic course.ADDITIONAL

Output: 1.Supraspinatus tendinopathy without evidence of rotator cuff tear.2.Normal variant sublabral foramen. No acute labral pathology.


Instruction: Generate impression based on findings.

Input: Female, 27 years old, with metastatic HER-2 positive breast cancer with known CNS metastases. Evaluate brain metastases and compare to outside MRI from July. Eight to ten enhancing lesions are evident within both cerebral hemispheres and the right cerebellum. Most are situated along the periphery of the brain and most demonstrate a rather curvilinear or gyriform pattern of enhancement. Lesions within the right cerebellum are elongated and tend to follow the cerebellar fissures. The largest lesion is found in the inferior right cerebellum and measures 23 x 5 mm.Some of the lesions induce minimal surrounding edema and some induce none. No evidence of significant generalized mass effect is seen. No abnormal extra-axial fluid collections are detected. There are no findings to suggest acute intracranial hemorrhage,and the above-mentioned lesions do not appear to be hemorrhagic themselves. No pathologic enhancement of the visualized cranial nerves is seen. The ventricles are normal in size.

Output: Numerous (8-10) enhancing lesions are seen in both cerebral hemispheres and the right aspect of the cerebellum compatible with metastases. These lesions are situated peripherally along the brain surface and are relatively gyriform in morphology or they follow the cerebellar fissures suggesting involvement of the subarachnoid space. Please note that no comparison examination is available at the time of this interpretation. If the prior examination can be made available, we will be happy to make a comparison and addend this report.


Instruction: Generate impression based on findings.

Input: Lesions on head CT. There are scattered bilateral cerebral hemisphere punctate foci of T2 hyperintensity with mildly restricted diffusion in a watershed distribution. A few lesions in the left occipital lobe cortical region demonstrate mild enhancement and susceptibility effect. There is no evidence of large intracranial hemorrhage or mass. 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 an unchanged polypoid lesion in the anterior left nasal cavity and a small retention cyst in the right maxillary sinuses. The orbits and skull are grossly unremarkable. There is a nonspecific subcentimeter left frontal scalp lesion.

Output: 1. Scattered bilateral cerebral hemisphere punctate subacute ischemic lesions in a watershed distribution.2. No evidence of intracranial metastases. Discussed with Physician: DANIEL V CATENACCI at 9:20 AM on 12/9/15.


Instruction: Generate impression based on findings.

Input: Headache No evidence of acute ischemic or hemorrhagic lesion.Retention cyst on the right maxillary sinus.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Brain MRVNoncontrast enhanced coronal acquisition MIB was obtained.3-D MIP reconstruction shows focal signal drop on the right side mid transverse sinus as well as right sided internal jugular vein. However, robust signal enhancement was seen on the left side transverse sinus, sigmoid sinus and internal jugular vein, therefore, the right transverse sinus signal drop is more likely congenital hypoplasia.There is no evidence of venous congestive encephalopathy.Major deep and superficial venous drainage channels appear to be normal.Conclusion: No evidence of occlusion or venous congestive encephalopathy on this scanNormal brain MRVC-spine MRI:Noncontrast enhanced the C-spine MRI was performed.Cervical spine appears to be straightened. However other cervical spine alignment is anatomic.The cranial-cervical junction is normal. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate decreased T2 intensity and height with minimal disc bulging at the level of C67 indicating disc desiccation. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: no neuroforaminal narrowing or spinal stenosis. C4-C5: no neuroforaminal narrowing or spinal stenosis. C5-C6: no neuroforaminal narrowing or minimal disc bulging. C6-C7: no neuroforaminal narrowing or minimal disc bulging, decreased T2 signal intensity of intervertebral disc with a slightly decreased disc height indicating disc desiccation. Minimal spinal canal stenosis at this level.. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan in the brain.2. Normal brain MRV, possible hypoplastic right transverse sinus and internal jugular vein which could be normal variation.3. Minor loss of normal cervical spine lordosis. Disc desiccation with minimal spinal canal stenosis at the level of C6-7 as described above.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [M62.81] / Malignant neoplasm of right kidney, except renal pelvis [C64.1], Reason for Study: ^Reason: h/o T8 corpectomy, assess for for new cord compression or hematoma (on therapeutic anticoagulation) History: s/p T8 corpectomy.66 years Male (DOB:8/29/1950)Reason: h/o T8 corpectomy, assess for for new cord compression or hematoma (on therapeutic anticoagulation) History: s/p T8 corpectomy, metastatic renal cell carcinoma w/ L leg pain and weaknessPROVIDER/ATTENDING NAME: HEDY L KINDLER Post corpectomy of T9 vertebral body with posterior fusion from T7 to T11 with the screws and interconnecting rods, unchanged.There is no evidence of abnormal signal intensity or spinal cord compression on the scan provided with limited exam due to metallic artifacts.There is no evidence of additional vertebral body metastatic lesion.Paravertebral soft tissues appear to be unremarkable.

Output: 1. Limited exam due to metallic artifacts.2. Post T9 corpectomy status with external fixation from T7 to T11, unchanged since prior scan.3. No evidence of spinal canal compromise aeration or abnormal spinal cord signal intensity.


Instruction: Generate impression based on findings.

Input: Diagnosis: LumbagoClinical question: rule foraminal compression in the L-spineSigns and Symptoms: Anterior thigh radicular symptoms Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There are 4 non-rib bearing vertebra present and L5 appears to be sacralized. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.Patient is status post lower lumbar spine surgery at L4 -- 5 and L3-4.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is status post surgery. Some soft tissue is present along the lateral recess bilaterally which displayed contrast enhancement on the prior exam which mas more on the right versus the left side. The fat at the lateral recess is bilaterally effaced. There is also loss of disk space height, disk desiccation and a disk bulge at this level. There is effacement of the fat of the lateral recesses bilaterally at this level as well as at bilateral facet hypertrophy and bilateral laminotomies with removal of ligamentum flavum. Overall, the thecal sac appears stable compared to the preoperative exam.At L3-4 there is is effacement of the fat of the lateral recesses bilaterally at this level as well as at bilateral facet hypertrophy and bilateral laminotomies with removal of ligamentum flavum. There is a Schmorl's node at this level. There is redemonstration and no change of effacement of the fat surrounding the right exiting nerve roots at this level and milder narrowing of the left neural foramen. Overall, the thecal sac appears larger on the current exam versus the preoperative exam.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is redemonstration of a minor disk bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Please note that L5 is partially sacralized. This affects enumeration of the lumbar vertebra2.The patient is status post lumbar spine surgery at L3-4 and L4-5 with laminotomies and removal of a ligamentum flavum.3.There is soft tissue present at the lateral recesses at L4-5 surrounding the nerve roots at the right lateral recess right more than left and at the L3-4 lateral recess bilaterally. The possibility that this represents some scar formation at the site is suggested. This has not changed substantially since the prior exam. Please note that contrast enhanced exams are more sensitive in evaluating for scar formation. Please correlate with clinical symptoms.4.There is mild to moderate encroachment of the right exiting nerve roots at the L4-5 level within the neural foramen.5.A note by the technologist indicates that the axial T2 continuous images were omitted by error. The technologist in DCAM indicated that he would contact the patient and offer this additional sequence to the patient.


Instruction: Generate impression based on findings.

Input: 59-year-old male to evaluate for stroke. Additionally obtained clinical history indicates left-sided numbness. There is no evidence of intracranial hemorrhage, mass or edema. There is no definite evidence of cortical stroke. The ventricles are midline, with normal volume and morphology. There is minimal crowding of the foramen magnum, raising the possibility of tonsillar ectopia/herniation. This may be further evaluated by MRI if clinically indicated.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of acute intracranial hemorrhage or cortical stroke.2. Possible mild crowding of the foramen magnum, raising the possibility of tonsillar ectopia/herniation. This may be further evaluated by MRI if clinically indicated.Findings were discussed with Dr. M. Sih at the time of dictation.


Instruction: Generate impression based on findings.

Input: Moyamoya, migraines. Any strokes or clots or other vascular abnormalities. Few tiny nonspecific foci of T2/FLAIR hyperintensity in the bilateral frontal white matter, greater on the right, are again seen. No new lesion is identified. No intracranial mass, hemorrhage or restricted diffusion to suggest acute infarct is seen. Ventricles and basal cisterns are symmetric and appear within normal limits. Cerebellar tonsils are low measuring up to 6 mm below the foramen magnum with preserved rounded morphology. No abnormal parenchymal or meningeal enhancement.MRA images again demonstrate diminished caliber of the intracranial internal carotid arteries, worse on the left than the right and are occluded bilaterally similar to prior. Bilateral anterior and middle cerebral arteries are not also well visualized and consistent with severely diminished flow. These findings demonstrate no significant interval change. The surgical anastomoses of the superficial temporal arteries and middle cerebral arteries appear patent. Posterior circulation also demonstrates no significant change with good flow in the right vertebral and basilar arteries and poorly visualized left vertebral and right worse than left posterior cerebral arteries.There is deformity involving the right medial orbital wall with medial herniation of fat and compatible with chronic blowout fracture, new since prior. Small mucus retention cyst in the left maxillary sinus is again seen.

Output: 1. Compared to 10/28/2011, no significant change in tiny foci of T2/FLAIR hyperintensities in the frontal white matter which are nonspecific but may be related to prior ischemia. No evidence of new infarcts.2. MRA images also demonstrate no significant change included occluded distal bilateral intracranial internal carotid arteries and diminished flow of the anterior circulation of the circle of Willis. Diminutive left vertebral and posterior cerebral arteries also appear similar to prior. The STA-MCA bypass appear patent bilaterally.3. Cerebellar tonsils measure up to 6 mm below the foramen magnum compatible with a mild Chiari I. There is however preserved rounded morphology of the tonsils and absence of significant crowding at the foramen magnum.


Instruction: Generate impression based on findings.

Input: 63 years Female (DOB:4/5/1953)Reason: evaluate for cervical disc disease vs radiculopathy History: numbness in hands bilaterally, leg fatiguePROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI SERVICES ANCILLARY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is a right lateral recess disc protrusion at this level which encroaches on the right-sided exiting nerve roots right lateral recess and the right neural foramen. This associated with uncovertebral osteophytes.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is a right lateral recess disc protrusion at C3-4 which encroaches on the right-sided exiting nerve roots and is associated with osteophytes.2.No abnormal lesions are appreciated within the cervical spinal cord


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate intracranial hemorrhage, cerebral edema. Signs and symptoms: Worsening hepatic encephalopathy. Unenhanced CT of brain:Patchy areas of periventricular and subcortical low attenuation although nonspecific could represent small vessel disease of indeterminate age. Considering provided clinical data all hepatic encephalopathy these findings may represent edematous changes from hepatic encephalopathy. There is no evidence of any associated mass-effect with his findings. Prior examination from 6 -- 2 -- 2010 was performed with a helical CT and imaging quality was not as good as the current exam and precise comparison is difficult.There is no evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. Follow up would and MRI can significantly improved the assessment.

Output: Diffuse patchy areas of subcortical and periventricular low attenuation with no associated hemorrhage, mass-effect or midline shift as detailed. Please see above comments.


Instruction: Generate impression based on findings.

Input: Note that the lack of intravenous contrast limits evaluation. There is skin thickening and edema in the posterior upper cervical subcutaneous soft tissues, right greater than left. Edema extends to the right parotid gland and to the level of the neck muscles without deeper extension into the spine. There are no measurable discrete fluid collection. There are areas of diffusion restriction in the previous identified discrete ovoid areas of soft tissue density, which are consistent with phlegmon or early abscess formation. The right parotid gland is mildly enlarged which may be reactive. There are scattered prominent lymph nodes. Nasopharynx, oropharynx, and hypopharynx are patent. The submandibular glands are normal in appearance. There are no thyroid masses. There is layering frothy material in the bilateral sphenoid sinuses with mild mucosal thickening. Minimal mucosal thickening is also noted in the bilateral maxillary sinuses. The bilateral mastoid air cells are partially opacified. Bilateral lens prostheses noted.Limited evaluation of the brain parenchyma demonstrates a focus of increased T2 signal in the left anterolateral thalamus which may be related to prior ischemic injury. There are multilevel degenerative changes in the cervical spine with disc bulge and moderate spinal canal narrowing at C4-C5. Expected vascular flow voids are present demonstrating patency.

Output: 1.As seen on recent CT, there are extensive inflammatory changes in the soft tissues of the posterior neck which on the right extend to the level of the right parotid gland. These findings are consistent with extensive cellulitis. Multiple areas within the superficial soft tissues demonstrate restricted diffusion which may be related to phlegmon or early abscess formation. No discrete drainable fluid collection is demonstrated although the lack of contrast limits evaluation. Inflammatory changes extend to the posterior paraspinous musculature without deeper extension into the spinal canal.2.Mild paranasal sinus disease.3.Degenerative changes in the spine with moderate spinal canal narrowing at C4-C5.


Instruction: Generate impression based on findings.

Input: 56-year-old female with facial droop; evaluate for CVA There is no evidence of acute intracranial hemorrhage, mass or edema. Multiple foci of hypoattenuation are seen in the periventricular and subcortical white matter which may represent small vessel ischemic disease of indeterminate age. Mild asymmetry is seen in the temporal lobes which may be artifactual. Right posterior cerebellar wedge shaped hypodensity is seen which may represent acute / subacute infarct versus artifact. Recommend MRI of the brain for further evaluation. The gray-white matter differentiation is grossly preserved. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are normally pneumatized.

Output: No acute intracranial hemorrhage. Wedge-shaped right cerebellar hypodensity which may represent acute or subacute infarct versus artifact. Small vessel ischemic disease of indeterminate age. Given the absence of prior study for comparison, acute infarcts cannot be excluded. Recommend MRI of the brain for further evaluation.


Instruction: Generate impression based on findings.

Input: Reason: back pain History: metastatic breast cancer Again noted is abnormal marrow signal involving T4, T6, T7 vertebral bodies with associated enhancement and now slightly ill-defined margins. Disease again extends into the right T4 pedicle, transverse process, and and pars interarticularis, with subtle progression of the anterior and posterior extent of abnormal signal although portions of the are now predominantly low signal compatible with sclerosis. Additional posterior element involvement is seen at T6 and T7 on the right. There is also minimal involvement on the left at T6 and T7. Findings appear very minimally progressed at all these levels. In addition, there is emerging abnormal enhancement involving the majority of the T2 vertebral body as well as the upper T3 vertebral body although there is no definite abnormal signal at this time.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are stable. The spinal cord is of normal caliber and signal.There is redemonstration of mild to moderate left T5-T6 and T6-T7 narrowing secondary to facet arthropathy. There is no significant central spinal canal stenosis at any level.There is partial visualization of bilateral breast implants. There is presumed pleural parenchymal scarring at the right lung apex. There is a prominent T2 hyperintense oval lesion within the left lobe of the thyroid gland with enlargement of the left lobe of the finding measures up to 1.6 cm. There are trace right greater than left pleural effusions.

Output: 1. Slight further progression of scattered osseous metastatic disease along the upper to midthoracic spine, with additional areas of abnormal emergent enhancement identified in T2 and T3 vertebra. No acute compression deformities appreciated.2. Stable mild to moderate left foraminal narrowing at T5-T6 and T6-T7 on the left secondary to facet arthropathy.


Instruction: Generate impression based on findings.

Input: There are no fractures. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no MRI findings of ligamentous injury.C2/3: Posterior osteophyte disc complex, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is mild central and moderate to severe bilateral neural foraminal stenosis.C3/4: Mild posterior osteophyte disc complex and ligamental flavum thickening. There is minimal central stenosis. There is slight flattening of the anterior cord surface without intrinsic cord signal abnormality.C4/5: Trace retrolisthesis C4 on C5, posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. Redemonstrated is a small focus of T2 hyperintensity within the left hemicord, not significantly changed, consistent with myomalacia. There is minimal central and moderate bilateral neural foraminal stenosis. There is slight flattening of the anterior cord surface without intrinsic cord signal abnormality.C5/6: Trace retrolisthesis C5 on C6, posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild to moderate central and moderate to severe bilateral neural foraminal stenosis. There is slight flattening of the anterior cord surface without intrinsic cord signal abnormality.C6/7: Trace retrolisthesis C6 on C7, posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.C7/T1: Left facet hypertrophy results in mild left neural foraminal stenosis.

Output: 1.C2/3: Mild central and moderate to severe bilateral neural foraminal stenosis.2.C3/4: Minimal central stenosis. There is slight flattening of the anterior cord surface without intrinsic cord signal abnormality.3.C4/5: Redemonstrated is a small focus of T2 hyperintensity within the left hemicord, not significantly changed, consistent with myomalacia. There is minimal central and moderate bilateral neural foraminal stenosis.4.C5/6: Mild to moderate central and moderate to severe bilateral neural foraminal stenosis.5.C6/7: Mild central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.6.C7/T1: Mild left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Male, 14 years old. Hip pain for weeks to months with football ; reinjured with limp. Evaluate for avulsion versus stress fracture. BONE MARROW: Cortical irregularity and marrow edema at the left anterior superior iliac spine with surrounding soft tissue T2 hyperintensity, compatible with an avulsion injury at this location. Cortex and marrow signal is normal elsewhere.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Findings compatible with avulsion injury of the left anterior superior iliac spine.


Instruction: Generate impression based on findings.

Input: History of cystic fibrosis status post bilateral lung transplant in 2005, status post cholecystectomy last month now with abdominal pain and elevated alkaline phosphatase ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No focal hepatic lesions. Mild intrahepatic biliary ductal dilation noted with areas of mild narrowing. Status post cholecystectomy. The common bile duct measures up to 5 mm in diameter. No evidence of stones or mass.SPLEEN: No significant abnormality noted.PANCREAS: Fatty replacement of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.No evidence of choledocholithiasis. The common bile duct is normal in diameter. 2.Mild intrahepatic biliary ductal dilation with areas of narrowing of uncertain etiology.


Instruction: Generate impression based on findings.

Input: Female, 75 years old, with lytic bone lesions and concern for malignancy in the right maxillary sinus/nasal cavity. The bony walls of the right maxillary sinus are thickened and the sinus itself is completely opacified by a combination of peripheral mucosal thickening and central fluid or secretions. As noted on prior CT, a combination of mucosal thickening and secretions projects through the widened ostium into the right nasal cavity. That portion of the tissue which projects into the nasal cavity is markedly hypointense on T2-weighted images (see image 29 series 41), and of intermediate intensity on T1-weighted images. The presumed secretions within the sinus are mildly diffusion restricting, but the thickened mucosa and the intranasal tissue are not. Patchy opacification is seen involving the ethmoid air cells and the right frontoethmoidal recess. Evidence of extensive prior ischemia is seen in the partially visualized intracranial space.

Output: Findings are seen compatible with likely long-standing inflammation of the right maxillary sinus. The sinus is completely opacified by a combination of peripheral mucosal thickening and central inspissated secretions. Thickened mucosa and secretions project through a widened maxillary ostium into the nasal cavity. The tissue occupying the right nasal cavity demonstrates marked T2 hypointensity which can be an indication of fungal elements. This constellation of findings may therefore represent chronic allergic fungal sinusitis with polyp formation. The possibility of a sinonasal malignancy is considered much less likely.


Instruction: Generate impression based on findings.

Input: Worsening right knee pain Due to the patient's body habitus the patient's knee could not fit in the dedicated knee coil, and the torso coil was used instead resulting in suboptimal image qualityMENISCI: The posterior horn of the medial meniscus is not visualized likely due to extensive chronic tearing and fragmentation. There is also attenuation and abnormal signal intensity within the body of the medial meniscus indicating additional degeneration and tearing. The anterior horn of the meniscus is also attenuated likely reflecting chronic attritional tearing.There is marked attenuation of the anterior horn and anterior aspect of the body of the lateral meniscus indicating extensive chronic tearing and fragmentation. The posterior horn of the lateral meniscus is relatively preserved.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the knee, particularly the medial compartment, with areas along the medial femoral condyle and medial tibial plateau devoid of articular cartilage and associated with edema like signal in the underlying marrow.There is also full-thickness degeneration of the articular cartilage along the lateral femoral condyle above the posterior horn of lateral meniscus and moderate degeneration of the articular cartilage along the posterior aspect of the tibial plateau.There is moderate to severe degeneration of the articular cartilage of the patellofemoral joint.Tricompartmental osteophytes are also noted.A lobulated focus of abnormal signal intensity within the distal femoral metaphysis likely reflects a benign enchondroma.LIGAMENTS: The ACL is not visualized, presumably due to a chronic tear. The PCL is intact. The medial collateral ligament is bowed medially by underlying osteophytes but is otherwise intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Severe osteoarthritis of the right knee particularly affecting the medial tibiofemoral compartment with extensive tearing of the menisci.2. Nonvisualization of the ACL indicating a chronic tear.


Instruction: Generate impression based on findings.

Input: 66-year-old with history of HCV cirrhosis, evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with increased reticular T2 signal indicating fibrosis. In segment 5 of the liver (13/452) there is a subcentimeter nonenhancing T2 hyperintense lesion compatible with a simple cyst. No focal lesion or abnormal focus of enhancement is identified.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is nondilated. There is no focal parenchymal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. No focal renal lesion.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver without suspicious focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: Female 33 years old Reason: Possible OCD lesion left distal femur MENISCI: Anterior horn of the medial meniscus is diminutive without discrete tear. The lateral meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness osteochondral defect in the lateral aspect of the medial femoral condyle measuring 6 mm in coronal dimension and 15 mm in AP dimension, with subchondral cyst formation. In the joint space there is a loose body adjacent to this defect measuring 12 mm in coronal dimension. There is T2 hyperintense bone marrow edema in the medial femoral condyle and medial tibial plateau. There is a large band of low signal corresponding to sclerosis on radiograph in the femoral diaphysis most likely representing an unusual enostosis and is unlikely to be of any clinical significance. There is a focal partial-thickness defect in the medial facet of the patella.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Osteochondral defect with adjacent loose body in the lateral aspect of the medial femoral condyle.2.Focal partial-thickness defect in the medial facet of the patella. 3.Moderate joint effusion.4.Band of low signal corresponding to sclerosis on radiograph in the femur, most likely representing an unusual enostosis, unlikely of any clinical significance.


Instruction: Generate impression based on findings.

Input: Limited examination secondary to motion artifact.There is marked dilatation of the lateral ventricles with a moderately dilated third ventricle and only a thin mantle of cerebral cortex, although distinct lobes are identified. A portion of the medial left posterior lateral ventricle herniates inferiorly into the posterior fossa along the medial margin of the left tentorium cerebelli. A thin septation or minimal debris is present in the inferior aspect of the left lateral ventricle extending towards midline (series 801, image 13). The fourth ventricle is normal in size. On available thin section parasagittal images, there is soft tissue fullness involving the tectal plate and the cerebral aqueduct is not well seen, concerning for obstruction.The thalami are present and appear unfused. The septum pellucidum is absent. The corpus callosum is not well assessed, but may be present perhaps significantly thinned by the enlarged ventricles. The intraorbital optic nerves are present and appear grossly unremarkable. The optic chiasm is suboptimally evaluated secondary to the diminished suprasellar cistern from the enlarged third ventricle, although is likely present as well. The pituitary gland is identified and appears within normal limits for age.No areas of diffusion restriction are seen to suggest acute or subacute ischemia. No areas of gradient susceptibility are demonstrated to suggest intracranial hemorrhage. The flow voids of the intracranial vasculature grossly unremarkable as well.Along the lower cervical cord, the sagittal T1W images of the brain appear to suggest trace T1 hypointensity centrally. The sagittal thin section images in the midline appear to suggest diminished caliber of the visualized upper thoracic cord, especially as compared to the cervical cord caliber.

Output: 1. Findings are most compatible with severe chronic hydrocephalus with concern for soft tissue prominence along the tectal plate, which may be obstructing the cerebral aqueduct. Further evaluation with CSF flow study and thin section sagittal midline 3D T2 images is recommended. Holoprosencephaly is considered unlikely given absence of fused thalami; septo-optic dysplasia is felt to be unlikely given that the pituitary gland is unremarkable and optic nerves are present. 2. Questioned trace syrinx in lower cervical cord and diminutive caliber of the upper thoracic cord, although incompletely evaluated. MRI of the cervical spine and thoracic spine recommended for a full evaluation.


Instruction: Generate impression based on findings.

Input: Cerebral aneurysm, nonruptured [I67.1] / Migraine without aura, intractable, without status migrainosus [G43.019], Reason for Study: ^Reason: daily HA question of ACOM aneurysm History: Daily HA Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 2.2mm x 1.5mm sized posteriorly and slightly right laterally direction luminal bulge arising from the left ACA A1-A2 junction which likely represent an anterior communicating artery aneurysm.No other aneurysm is seen.Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. About 2mm x 1.5mm sized left side Acom aneurysm. Comment: head CT angiography can be considered for more precise anatomical evaluation of the aneurysm.


Instruction: Generate impression based on findings.

Input: 44-year-old female with history of stage IIB cervical cancer s/p chemoradiation. Evaluate disease status. CHEST:LUNG BASES: Stable diffuse right posterior basilar pleural thickening. No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is no evidence of obstruction or intraperitoneal free fluid. Thickening of the rectosigmoid with surrounding submucosal fatty infiltration of the rectum is again seen, consistent with post-radiation changes.The visualized appendix is filled with contrast. Mild thickening of the appendiceal wall is noted at the distal tip of the appendix. However, in the absence of periappendiceal inflammatory changes and complete opacification of the appendix with contrast, appendicitis is very unlikely. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Nodular masses in the uterus are again noted and unchanged, likely leiomyomas. Heterogeneous appearance of the cervix is again noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Thickening of the rectosigmoid with surrounding submucosal fatty infiltration of the rectum is again seen, consistent with post-radiation changes. The prerectal collection seen on the 12/21/2010 MRI exam has resolved. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: Interval resolution of pre-rectal collection. No local recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: Right vestibular schwannoma. History of SRS complete 9/2016. There is an enhancing right cerebellopontine angle cistern tumor with extension into the internal auditory canal that measures up to 22 mm, which is not significantly changed. The tumor contains small areas of cystic change and susceptibility effect likely replated to prior hemorrhage. There is mild mass effect upon the right middle cerebellar peduncle, but the brain parenchyma otherwise appears unremarkable. There is no evidence of 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.

Output: No significant interval change in the right vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: 75 year old male with a history of PVCs, syncope and cardiomyopathy. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarMotion artifacts on this study limit image interpretation. There was no clear areas of late gadolinium enhancement noted suggesting no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%. The LVEDV is 249 ml (normal range 142+/-34), the LV end diastolic volume index is 104 ml/m2 (normal range: 74+/-15), the LVESV is 119 ml (normal range 47+/-19) and the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9). The LV mass is 120 g (normal range 164+/-36) and the LV mass index is 50 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. The native T1 myocardial relaxation time is <1100 ms suggestive of absence of underlying diffuse fibrosis or infiltration.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%. The RVEDV is 189 ml (normal range 142+/-31), RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVESV is 77 ml (normal range 54+/-17), and the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mild-moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial to mild 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 measures 37 mmVenous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are 2 cyst-like lesions in the liver; one in the superior mid right lobe and one in the posterior aspect of the right lobe. Imaging artifact is noted in the left chest from the implantable loop recorder. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.No perfusion defects/ "ischemia" present during hyperemia.2.No prior myocardial infarction. Motion artifacts limited interpretation of late gadolinium enhancement images. No definitive areas of late gadlinium enhancement. The entire myocardium is viable.3.Normal LV size with low normal systolic function (LVEF 52%).4.Normal RV size with normal systolic function (RVEF 59%).5.Biatrial dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Chronic tension-type headache, not intractableClinical question: mass lesion causing new onset headaches and left arm weaknessSigns and Symptoms: HA, left arm weakness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this level.At C4-5 there is no significant compromise to the spinal canal. There is a disc bulge present this level associated with some uncovertebral osteophytes with mild encroachment ofAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a mild disc bulge present at this level. There is mild ligamentum flavum hypertrophy at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a mild disc bulge present at this level. There is mild ligamentum flavum hypertrophy at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is a hyperintense T1 focus present in the T2 vertebral body measuring 8 mm in diameter most likely representing a vertebral body hemangioma.

Output: 1.There are degenerative changes present in the cervical spine without significant compromise to the spinal canal or exiting nerve roots.2.There is no evidence for intracranial mass lesion or cerebral infarction.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with epilepsy, surveillance scan. Image quality is somewhat motion degraded. Posttreatment findings are again seen compatible with left mesial temporal laser ablation including T2 hyperintensity and volume loss which affects the left anterior hippocampus and surrounding tissues. Postcontrast images are not included on this examination. Elsewhere no significant parenchymal signal abnormality is seen. No abnormal extra-axial collections are detected. Ventricular size and morphology are within normal limits.

Output: Redemonstration of post ablation findings in the left anterior medial temporal lobe. No new lesions are seen.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The pituitary gland is not enlarged. The cerebellar tonsils are above the foramen magnum. The skull and extracranial soft tissues are unremarkable.

Output: No acute intracranial abnormality or mass-effect.


Instruction: Generate impression based on findings.

Input: A 57 year old male with personal history of acute leukemia treated with stem cell transplant and chemotherapy (doxorubicin and mitoxantrone) in 2012 who was recently diagnosed with left heart failure and the echocardiography showed a severely decreased systolic function. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 148 ml/m2 (normal range: 74+/-15), the LVEDV is 313 ml (normal range 142+/-34), the LV end systolic volume index is 122 ml/m2 (normal range 25+/-9), the LVESV is 260 ml (normal range 47+/-19), the LV mass index is 83 g/m2 (normal range 85+/-15), and the LV mass is 176 g (normal range 164+/-36). There is a mid-wall stripe pattern of late gadolinium enhancement in the septum most suggestive of underlying myocardial fibrosis. This pattern of late gadolinium enhancement is classically seen in dilated cardiomyopathy. The pattern is atypical for prior myocardial infarction. Native myocardial T1 relaxation values are generally within normal range; however, in the basal to mid inferoseptum, they are mildly elevated consistent with the above described fibrosis. No myocardial iron overload.No intracavitary thrombus was seen.Left AtriumThe left atrium is mildly dilated (115ml). Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 39%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 181 ml (normal range 142+/-31), the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9), and the RVESV is 111 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is 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. The left ventricle is severely dilated with severely reduced systolic function, the LVEF is 17%. There is a mid-wall stripe of late gadolinium enhancement in the septum most suggestive of underlying myocardial fibrosis in a pattern that is classically described for dilated cardiomyopathy. No evidence of prior myocardial infarction or infiltrative cardiomyopathy.2. The right ventricle is normal in size with moderately reduced systolic function, the RVEF is 39%. 3. Mild biatrial enlargement. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is no evidence for intracranial hemorrhage or diffusion-weighted abnormalities. There are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter which is nonspecific but compatible with chronic small vessel ischemic disease. There is more focal signal abnormality involving the left insular cortex, subinsular white matter, and left frontal operculum compatible with chronic ischemia. There are no masses, mass effect or midline shift. The ventricles and sulci are normal in size. There are no intraaxial or extraaxial fluid collections. Flow voids are present within the major vessels indicating patency. There is right maxillary mucous retention cyst and left maxillary sinus mucosal thickening. Scattered opacification of ethmoid air cells. Mastoid air cells are clear. Orbits are unremarkable.

Output: 1.No acute infarct.2.Moderate chronic small vessel ischemic changes. More focal signal abnormality involving the left insular cortex, subinsular white matter, and left frontal operculum also compatible with chronic ischemia.


Instruction: Generate impression based on findings.

Input: 33-year-old female with elevated LFTs, ANA positive. Evaluate for biliary stricture, dilatation, or underlying hepatic etiology. ABDOMEN:LIVER, BILIARY TRACT: Suspected flash-filling hemangioma of hepatic segment 8/5 (series 10013 image 231). Otherwise, normal hepatic parenchyma. Patent vasculature. No intra or extrahepatic biliary ductal dilatation. The gallbladder is collapsed, and the 3 mm suspected polyp noted on the prior ultrasound is not clearly visualized.SPLEEN: No significant abnormality noted.PANCREAS: Normal parenchymal enhancement. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Normal caliber of the biliary tree. No evidence for biliary stricture.2.Flash-filling hemangioma of hepatic segment 8/5.


Instruction: Generate impression based on findings.

Input: 86-year-old female history of HCV cirrhosis. ABDOMEN:LUNG BASES: Large right pleural effusion with layering cellularity and associated atelectasis. Masslike restricted diffusion in the right perihilar region may represent a primary lung malignancy.LIVER, BILIARY TRACT: Interval development of innumerable lesions scattered throughout the liver parenchyma demonstrating increased T2 signal abnormality with no appreciable enhancement. These lesions are compatible with metastatic disease.Cirrhotic liver morphology. Cholelithiasis. No intra or extra hepatic biliary ductal dilatation. The portal vein, hepatic vein, and hepatic arteries are patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is not well visualized due to motion artifact.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: There are retroperitoneal nodules present bilaterally with reference right retroperitoneal lesion measuring 18 x 12 mm (image 21 series 601).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Innumerable osseous metastases.OTHER: Moderate volume ascites.

Output: Interval development of innumerable hepatic, osseous, and retroperitoneal lesions, most likely metastatic in etiology. Given the presence of a right perihilar masslike area of restricted diffusion and large right pleural effusion, the constellation of findings suggest a primary lung malignancy, probably adenocarcinoma. Dedicated chest CT is recommended.The liver lesions would be amenable to ultrasound guided biopsy.


Instruction: Generate impression based on findings.

Input: 64 year old male with prostate cancer PELVIS:PROSTATE:Prostate Size: 3.7 x 4.1 x 4.6 cmPeripheral Zone: There is a focus of T2 hypointensity in the right base peripheral zone measuring 10 x 12 mm with possible corresponding diffusion restriction. There is suggestion of neurovascular bundle involvement as evidenced by slight retraction of the capsule and probable extracapsular extension.Central Gland: Moderate benign prostate hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Probable extracapsular extension in the right peripheral zone base.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.Right peripheral gland base lesion with probable neurovascular bundle involvement as described above.


Instruction: Generate impression based on findings.

Input: 43 year old female with unspecified rotator cuff tear or rupture of right shoulder, not specified as traumatic. ROTATOR CUFF: There is fluid signal intensity along the distal aspect of the supraspinatus tendon anteriorly with discontinuation of the fibers compatible with a small full-thickness tear spanning 5 mm. Intermediate signal intensity within distal distal subscapularis tendon is compatible with tendinosis. The teres minor and infraspinatus tendons appear normal. The rotator cuff muscles appear normal with no evidence of fatty infiltration or atrophy.SUPRASPINATUS OUTLET: There is subacromial spur formation present.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate degenerative changes affect the glenohumeral joint and acromioclavicular joint. There is a small amount of fluid within the glenohumeral joint communicating with the long head of the biceps tendon within the bicipital groove. There is trace fluid within the subacromial subdeltoid bursa. The glenoid labrum appears normal.BICEPS TENDON: The long head of the biceps tendon appears normal with small amount of fluid within the tendon sheath communicating with the glenohumeral joint.ADDITIONAL

Output: 1. Small full-thickness tear of the supraspinatus tendon anteriorly.2. Tendinosis of the subscapularis tendon with no evidence of tear.3. Mild to moderate degenerative changes affect the glenohumeral and acromioclavicular joints with subacromial spur formation present.


Instruction: Generate impression based on findings.

Input: 13-year-old male with headaches for one month. Please evaluate for mass. There is no evidence of intracranial hemorrhage, mass or edema. A small focus of hypodensity within the left occipital white matter on a single image without associated edema or hemorrhage is of nonspecific etiology. Further evaluation with MRI is recommended, if clinically warranted.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The mastoid air cells are normally pneumatized. Left ethmoid fluid collection, likely due to sinus disease. The remainder of the visualized paranasal sinuses are normally pneumatized.

Output: Small focus of hypodensity, as described above, is of nonspecific etiology. Further evaluation with MRI is recommended, if clinically warranted.


Instruction: Generate impression based on findings.

Input: Right parietal anaplastic astrocytoma, status post RT and surgery 2012. There are stable post-treatment findings in the right temporo-occipital region with confluent T2 hyperintensity surrounding the resection cavity and an area of enhancement and susceptibility effect along the posterior margin of the resection cavity that measures up to 10 mm. There is no evidence of acute infarct. There is unchanged mild ex vacuo dilatation of the right lateral ventricle trigone. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Post-treatment findings in the right temporo-occipital region without evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Male, 60 years old, with multiple sclerosis. Numerous, likely more than 20, foci of T2 hyperintensity are seen within the subcortical and periventricular white matter of the bilateral cerebral hemispheres. The heaviest lesion burden is seen in the right periventricular region where some lesions demonstrate a radial orientation with respect to the ventricle.None of the above-mentioned lesions demonstrates any associated enhancement, and indeed, no pathologic enhancement is seen intracranially. There is no evidence of parenchymal edema or mass effect. No restricted diffusion is seen. No significant intracranial hemorrhage or any abnormal extra-axial fluid is suspected. The ventricular system is within normal limits in size and morphology.

Output: Numerous white matter lesions are seen compatible with the stated history of demyelinating disease. None of these lesions shows evidence of enhancement on the present study.


Instruction: Generate impression based on findings.

Input: Knee pain Note that metallic susceptibility artifact overlies the medial and anterior soft tissues of the knee which represents the radiopaque foreign body seen on prior radiographs.MENISCI: Note that the anterior horn of the medial meniscus is obscured secondary to the susceptibility artifact. The visualized portion of the anterior horn is otherwise intact and there is no evidence of medial or lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: There is a diffuse intermediate signal intensity of the marrow on T1 sequences reflecting chronic changes of sickle cell disease. The articular cartilage of the medial, lateral, and patellofemoral compartments is preserved. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No evidence of internal derangement of the knee. Note that the anterior horn of the medial meniscus is obscured due to susceptibility artifact from known foreign body but within these limits, there is no discrete meniscal tear.


Instruction: Generate impression based on findings.

Input: 13-year-old female with history of pelvic rhabdomyosarcoma. Evaluate for possible relapse. PELVISUTERUS, ADNEXA: Flow voids seen within the anterior vaginal wall is unchanged. No focal lesion visualized in the uterus. BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic or inguinal lymphadenopathy.BOWEL, MESENTERY: Unchanged focus of fluid signal intensity along the descending colon, likely fluid in the paracolic gutter.BONES, SOFT TISSUES: There has been interval improvement in high T2 signal seen in the marrow of the pubic symphysis. Again noted is T2 hyperintensity in the vaginal introitus and labia bilaterally. Additionally, there is new linear enhancement of the vagina (series 801, image 29). No mass or masslike enhancement is identified.OTHER: Small amount of free fluid in the pelvis.

Output: 1.New linear enhancement of the vagina is most likely secondary to vaginitis. This is a very unlikely appearance for disease recurrence.2.Persistent nonspecific T2 hyperintensity of the vaginal introitus and bilateral labia.3.Interval improvement in bone marrow signal abnormalities as above.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: There is extensive cyst formation adjacent to and within the supraspinatus muscle with extension of these cysts into the suprascapular notch. The fibers of the supraspinatus tendon can be traced to its insertion upon the greater tuberosity although there is diffuse thickening of the tendon likely representing chronic attritional tearing. A more focal full-thickness defect of the supraspinatus tendon is noted at the apex of the humeral head. There is moderate to severe fatty atrophy of the remaining supraspinatus muscle.There is moderate to severe fatty atrophy of the infraspinatus muscle although the tendon itself can be traced to its insertion on the greater tuberosity. The atrophy of the muscle may be secondary to compression of the nerve within the suprascapular notch. The teres minor tendon and muscle are intact. There is mild tendinosis and minimal fatty atrophy of the subscapularis tendon and muscle respectively.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. The humeral head is high riding and there is a small amount of fluid/inflammation within the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is severe osteoarthritis of the glenohumeral joint with bone-on-bone apposition and extensive subchondral cystic changes. There is diffuse degenerative tearing of the labrum. There is a small joint effusion present, possibly with a component of mild synovitis, and multiple loose bodies are noted within the axillary and subscapular recesses.BICEPS TENDON: The biceps tendon appears slightly attenuated but is otherwise intact.

Output: 1. Severe osteoarthritis of the glenohumeral joint with multiple loose bodies.2. Cystic replacement of the supraspinatus muscle with extension of these cysts into the suprascapular notch. This likely results in impingement upon the nerves supplying the infraspinatus and supraspinatus muscles leading to fatty atrophy. There is also thinning of the supraspinatus tendon likely reflecting chronic attritional tearing with what appears to be a more focal full-thickness defect at the apex of the humeral head.3. Additional findings further detailed above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Abnormality of gait. Dizziness and giddinessClinical question: Episodes of imbalance, vertigo; evaluate cerebellum MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple punctate foci of signal hypointensity in the left periventricular white matter (one adjacent ot the occipital horn and one adjacent to the body of the lateral ventricle) on susceptibility imaging which most likely represent microhemorrhages.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk dessication present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal . There is encroachment of the right exiting nerve roots due to right facet hypertrophy and uncovertebral osteophytes associated with disk material.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is a 13x8mm axial dimension T2 hyperintense and T1 hypointense well circumscribed lesion in the posterior and inferior aspect of the right parotid gland.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating arteries is not readily identified. There is fetal origin of the left PCA. The right vertebral artery is larger than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The LVA originates from the aortic arch.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related and likely of little clinical significance.2.A couple microhemorrhages in the periventricular white matter in isolation are likely of little clinical significance.3.There is encroachment of the right sided exiting nerve roots at C4-5 due to degenerative changes.4.There is no evidence for carotid or vertebral dissection.5.There is not evidence for intracranial or extracranial cerebrovascular occlusive disease.6.A right parotid gland lesion is present which has a relatively benign appearance. Please correlate with clinical exam. If appropriate follow-up imaging may be helpful. This is an incidental finding.


Instruction: Generate impression based on findings.

Input: Clinical question: Recent cerebellar stroke? Signs and symptoms: Headache and gait instability. Pre-and post-enhanced brain MRI:Diffusion-weighted images demonstrate a small focus of restricted diffusion measuring at 5 x7 mm in transaxial dimension involving the lingula of vermis without evidence of hemorrhage. This finding demonstrate enhancement and likely representing subacute state of the stroke. This finding is also well identified on T2 and flair images.Diffuse periventricular and to a lesser degree subcortical small foci of flair hyperintensity consistent with chronic small vessel ischemic strokes demonstrate no convincing evidence of interval change. Similar signal changes are also present in bilateral basal ganglia (left greater than right) as well as bilateral thalami and extensively in the pons all consistent with advanced chronic lacunar infarcts without evidence of hemorrhagic signal changes or significant interval change in the extent.Multiple foci of flair hyperintensity in bilateral cerebellar hemispheres consistent with prior chronic cerebellar strokes demonstrate no significant change since prior exam. Note should be made that precise comparison for interval change is difficult due to extent of disease.Post-enhanced images demonstrate above-mentioned enhancement of min ischemic stroke and negative otherwise.The signal void of major intracranial arterial branches are identified.The signal intensity or intracranial venous sinuses are within normal and mid normal pattern of enhancement.

Output: 1.Enhancing subacute ischemic stroke of the lingula of vermis as detailed above.2.Extensive chronic nonhemorrhagic small vessel ischemic strokes in periventricular and subcortical white matter, extensive chronic nonhemorrhagic lacunar infarcts of bilateral basal ganglia, thalami and extensively of the pons without convincing evidence of interval change. Multiple bilateral cerebellar chronic ischemic strokes without significant change.3.Unremarkable post-enhanced images other than the above detailed enhancing vermian stroke.


Instruction: Generate impression based on findings.

Input: New diagnosis of lung cancer. Evaluate for brain metastasis. There is a well-circumscribed 11 mm pineal region mass which shows solid contrast enhancement. There is minimal cerebral white matter T2 hyperintensity. The brain parenchyma and pituitary gland appear unremarkable. Otherwise, there is no evidence of brain parenchymal enhancing lesions, intracranial hemorrhage, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal maxillary sinus mucosal thickening. There is also minimal fluid within the left mastoid air cells.

Output: 1.A pineal mass with solid enhancement that measures up to 11 mm may represent a perineal parenchymal tumor versus an isolated lung cancer metastatic lesion. Follow-up imaging is recommended to confirm stability.2.Minimal cerebral white-matter T2 hyperintensity is nonspecific, but may reflect chronic microvascular ischemia.3.No evidence of intracranial hemorrhage or acute infarct.


Instruction: Generate impression based on findings.

Input: 64-year-old female with right hip pain. Evaluate for right hip fracture. Evaluation is limited secondary to motion artifact.ACETABULAR LABRUM: The acetabular labrum is not visualized likely secondary to severe degenerative changes as described below.ARTICULAR CARTILAGE AND BONE: There are serpentine areas of low T1 and high STIR signal intensity in the femoral heads bilaterally, right greater than left, most compatible with avascular necrosis. There are secondary degenerative changes with mild collapse of the right femoral head, joint space narrowing and degenerative changes in the adjacent acetabulum. No evidence of acute fracture.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Bilateral femoral head avascular necrosis, right greater than left, with mild collapse of the right femoral head and secondary degenerative changes as described above. No acute fracture is evident


Instruction: Generate impression based on findings.

Input: 42-year-old female with a history of a right mastectomy for IDC/DCIS in 2011. She has a family history of breast cancer in her paternal grandmother diagnosed in her 80s and paternal aunt diagnosed in her 60s. Screening MRI. Mild parenchymal enhancement is noted in the left breast. There is scattered fibroglandular tissue in the left breast. Stable post-surgical changes are noted with no suspicious enhancement in the right reconstruction. No suspicious enhancement is seen in the left breast. The left retroareolar focus is stable. No abnormal axillary lymph nodes are identified in either axillary region. Post-surgical change is again noted in the right axilla.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Slurred speech [R47.81], Reason for Study: ^Reason: eval for acute infarct, assess lesion burden History: stroke/tia (see MRA order) Brain MRINo evidence of acute ischemic or hemorrhagic lesion on this scan.Multiple scattered high signal intensity lesions on periventricular white matter, centrum semiovale and bilateral external capsule indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal various degree intracranial arterial luminal stenosis including distal right ICA and bilateral MCA M1 and M2 segments indicating atherosclerosis. Some of stenosis degree appear to be more than 50%, however, since the TOF MRA can exaggerate the degree of stenosis, if precise evaluation of the degree of stenosis is necessary, CT angiography can be considered.There is no evidence of intracranial major arterial branch occlusion or intracranial arterial aneurysm on this scan.Bilateral PCAs are fetal origin and Acom artery is patent.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Intracranial atherosclerotic changes of multifocal various degree arterial luminal narrowings as described above. No aneurysm was seen.


Instruction: Generate impression based on findings.

Input: 68-year-old female with grade 2 endometrioid adenocarcinoma on endometrial/cervix biopsy now with pelvic pain and bleeding. PELVIS:UTERUS, ADNEXA: There is a large circumferential mass in the lower uterine segment/cervix measuring 6.5 x 6.2 x 5.8 cm. Fluid distends the endometrial canal. The lesion appears to extend beyond the cervix and involve the parametrium, more convincingly on the left, without involvement of the pelvic sidewall. There is mild indistinctness of the right perimetrium (5/34). The mass abuts and obliterates the fat plane between the uterus and bladder and uterus and rectum although there is no evidence of gross invasion.BLADDER: No significant abnormality noted.LYMPH NODES: Small scattered pelvic lymph nodes are noted, nonspecific. There is a 7 mm lymph node along the right external iliac chain.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large circumferential mass in the lower uterine segment/cervix with parametrial invasion as described above. Small scattered lymph pelvic lymph nodes.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified rotator cuff tear or rupture of right shoulder, not specified as traumatic Other shoulder lesions, right shoulder Other cervical disc degeneration, unspecified cervical region Other cervical disc displacement, unspecified cervical regionClinical question: eval for disc herniationSigns and Symptoms: neck pain for years on and off now new left arm weakness and tingling hand and scapular dyskinesis The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal cervical curvature present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is mild loss of disc space height, disc desiccation, endplate reactive changes and a diffuse disc bulge associated with small uncovertebral osteophytes. The endplate reactive changes are bright on T1-weighted imaging. There is no significant compromise to the spinal canal at this level.At C5-6 there is mild loss of disc space height, diffuse disc bulge as well as endplate and uncovertebral osteophytes with encroachment of the left-sided exiting nerve roots within the neural foramen due to a left lateral recess disc extrusion associated with some uncovertebral osteophytes. There is no significant compromise to the spinal canal. Compared to the prior exam from 2013 encroachment of the left-sided exiting nerve roots has not significantly changed.At C6-7 there is loss of disc space height, diffuse disc bulge and a left lateral recess disc protrusion which extends into the left neural foramen and encroaches on the left-sided exiting nerve root. There are endplate reactive changes present at this level which are high signal on T2 STIR predominantly located adjacent to the left side of the disc space. Compared to the prior exam from 2013 the endplate reactive changes were not in the subacute stage and there wasn't a significant disc protrusion.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion redemonstrated at this level.The left vertebral artery is not readily identified. This is stable since the prior exam.

Output: 1.Since the prior exam patient developed a new left lateral recess disc protrusion at C6-7 which encroaches on the left-sided exiting nerve roots. There are endplate reactive changes adjacent to the left lateral recess disc protrusion which are at a subacute stage.2.There is redemonstration of encroachment of left-sided exiting nerve roots at C5-6 related to a disc protrusion.3.There are multilevel degenerative changes present in the cervical spine. 4.The left vertebral artery is not readily identified. This is a chronic finding.


Instruction: Generate impression based on findings.

Input: 29-year-old male with history of NF1, known plexiform tumor in the pelvis. Evaluate plexiform neurofibroma. Again seen are innumerable masses of high signal intensity on STIR images, many having a target appearance, within the skin as well as within the subcutaneous and deep soft tissues of the pelvis compatible with nerve sheath tumors and the known history of neurofibromatosis type I. Plexiform neurofibromas involve the lumbar and sacral nerve roots as well as both sciatic nerves, extending beyond the field-of-view of this study. There are also plexiform neurofibromas involving both femoral nerves, slightly prominent on the right. Additional neurofibromas are noted within the pelvis as well as the surrounding musculature but there is no single dominant lesion to suggest malignancy, within the limitations of this noncontrast examination. Previously referenced lesion along the lateral aspect of the right abductor musculature is not included in its entirety on the current study, however is not significantly changed measuring 2.2 x 1.1 cm, previously 2.2 x 1.3 cm (series 301, image 24). Additional previously referenced lesion within the left rectus femoris muscle belly measures 0.8 x 0.8 cm, previously 0.8 x 0.8 cm (series 301, image 20). The bone marrow signal intensity is within normal limits. The hip joints, sacroiliac joints and pubic symphysis are unremarkable.

Output: Findings compatible with neurofibromatosis with plexiform neurofibromas overall stable in size.