Instruction: Generate impression based on findings.

Input: Female 66 years old with history of papillary thyroid cancer metastatic to lung, bone, and liver and history of psychogenic seizures, concern for brain metastasis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. Mild ventricular and sulcal prominence is consistent with age-related volume loss, while mildly increased T2/FLAIR signal within the subcortical and periventricular white matter consistent with chronic small vessel ischemic changes. There is no midline shift or herniation.Nonenhancing oval T2 hyperintense and T1 hypointense left parotid lesion measuring 12 x 16 mm with possible single thin septation noted on coronal images, has increased in size from prior remote measurements of 8 x 6 mm (10/18/2012). It appears similar in overall size when compared to the more recent CTs. The lesion causes mild localized mass effect on the adjacent parotid tissue and demonstrates a small area of apparent increased signal in the anterior aspect on early postcontrast images; however, the signal is not present on delayed post contrast images and is thus likely artifactual in nature. Overall, the parotid glands have a nodular appearance, which is nonspecific and may be posttreatment or autoimmune in nature. A asymmetrically prominent tubular structure is noted along the anterolateral aspect of the right masseter, which may represent asymmetric prominence of the duct.Symmetric prominence of the superior ophthalmic veins incidentally noted. The major cerebral flow voids are intact. Left anterior frontal T1 and T2 hypointense marrow lesion with minimal thin peripheral enhancement, which corresponds to a sclerotic lesion on CT, and appears unchanged when compared to baseline exam in 10/21/2002 and is likely a benign bone island. T2 hypointensity corresponding to an area of hyperattenuation on prior CT within the right anterior frontal scalp, which probably represents an area of scarring. The orbits and paranasal sinuses are grossly unremarkable.

Output: 1) No definite intracranial metastases identified.2) Redemonstration of oval left parotid lesion, which has doubled in size from prior remote exam dated 10/18/12, and may represent a non-aggressive primary parotid lesion such as a pleomorphic adenoma or Warthin tumor, although developmental cyst remains in the differential, as does necrotic metastatic disease but less likely given slow change.3) Asymmetric right parotid duct of uncertain clinical significance, correlate for recent inflammatory or obstructive pathology.4) Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Ventriculomegaly possible hydrocephalus. There is a redemonstration of a large ventricles with extensive loss of cortical mantle. The left lateral ventricle is massively enlarged relative to the right lateral ventricle which is also enlarged. There is a septation within the left lateral ventricle and this could also represent porencephaly. The general appearance is is similar to prior exams. A ventriculostomy tube courses through the left frontal bone into the left lateral ventricle. At the level of the top of the right lateral ventricle the diameter of a left-sided ventricle measures and 67 mm in diameter and on the prior MRI exam measured 42 mm in diameter, however, the head is significantly larger currently than on the prior exam and probably related to interval growth of the infant . At the level of the foramina of Monroe the right lateral ventricle measures 29 mm in diameter on the current exam and it measured 20 mm in diameter on the previous MRI exam the left lateral ventricle at this level measures 50 mm on the current exam and 35 mm on the prior exam the third ventricle is also enlarged and measures 22 mm in diameter; on the prior MR it measured 17 mm in diameter. The fourth ventricle is not dilated.In general the left calvarium appears larger than the right calvarium. On the current exam and the angled dimensions of the skull at the level of the top of the thalami are 172 x 132 mm and on the exam of 311/08 they were 85 x 120 mm and on the 8/7/08 exam they were 129 by 109 mm.

Output: Marked enlargement of lateral ventricles and third ventricle left lateral ventricle more than right. Since the previous examination the lateral ventricles and third ventricle have enlarged however so has the head.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, with metastatic thyroid cancer, follow-up exam. Thoracic:An enhancing lesion within the left aspect of the T5 vertebral body continues to measure approximately 13 x 9 mm and shows no significant interval change from the prior exam. Lesions within the left transverse process and pars interarticularis of T5 and T6 are also unchanged.Anterior instrumented fusion of T10-T12 is again seen with partial corpectomy at T11 and placement of a strut graft. The residual T11 vertebral body continues to show diffuse abnormal marrow signal without significant change. Kyphotic angulation of the thoracic spine is seen centered at T11.No new marrow space lesions are seen. No significant epidural disease is suspected. No significant spinal canal stenosis is seen.Fatty marrow replacement in the lower thoracic spine likely represents postradiation change. Failure of fat suppression is also seen in the lower thoracic spine on postcontrast fat-suppressed images.Lumbar:Enhancing lesions on the right at L2, on the left at L3, and on the left at L5 show no significant interval change. For reference, the L5 lesion continues to measure 18 x 16 mm.The background marrow remains fatty replaced compatible with prior radiation. No new lesions are seen. No significant epidural disease extension is detected. The spinal canal remains patent.Facet hypertrophy develops at lower lumbar levels becoming severe at L4-5. There is a bulging disc at L4-5 with a right far lateral annular fissure, unchanged. There is a bulging disc at L5-S1 with a small central protrusion, unchanged.

Output: Stable scattered metastatic lesions in the thoracic and lumbar spine with no evidence to suggest any new or growing metastatic disease.


Instruction: Generate impression based on findings.

Input: There are postsurgical findings related to right paramedian frontal lobe tumor, with diffuse nodular enhancement along the resection cavity, more prominent anteriorly. There is trace leptomeningeal enhancement along the marginal branch of the right cingulate sulcus, which is unchanged. Extensive T2 hyperintensity that likely represents vasogenic edema in much of the upper right cerebral hemisphere white matter persists. There is no evidence of acute infarction. There is slight midline shift to the left. There is a small right cerebellar hemisphere developmental venous anomaly. The skull and extracranial structures appear to be unchanged.

Output: Postoperative findings with persistent abnormality along the right paramedian frontal lobe, which is suspicious for residual tumor. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Concern for seizure activity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, brainstem, cerebellum, and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Mildly low-lying cerebellar tonsils, but display rounded contours.


Instruction: Generate impression based on findings.

Input: Evaluate for cord compression, history of kyphoplasty: sudden onset tingling, numbness, poor rectal tone. There is a metastasis within the T10 vertebral body associated with a pathologic fracture previously treated with kyphoplasty, as evidenced by cement that manifests sa low T1 and T2 signal. The tumor compresses the spinal cord, which appears to contain mild high T2 signal at the T10 level. The tumor also bulges into the paraspinal soft tissues at the T10 level and there is neural foraminal narrowing at the T9-10 and T10-11 levels bilaterally. There is a metastatic lesion that occupies much of the T5 vertebral body, where there is superior endplate concavity, but no retropulsion into the spinal canal. There is a subcentimeter T1 hypointense and T2 hyperintense lesion in the posterior T1 vertebral body. There is a hemangioma in the T6 vertebral body. There is advanced degenerative spondylosis at the L4-5 level, where there is disc space narrowing, fatty endplate marrow signal alterations, and disc bulge with superimposed eccentric left extrusion that results in severe bilateral neural foraminal stenosis, and mild spinal canal stenosis. There is also a focus of high T2 signal in the posterior L4 vertebral body more superiorly.

Output: 1. A metastasis arising from the T10 vertebral body associated with a pathologic fracture previously treated with kyphoplasty compresses the spinal cord. 2. A metastatic lesion that occupies much of the T5 vertebral body, where there is superior endplate concavity. 3. Probable small metastasis within the posterior T1 vertebral body.4. Advanced degenerative spondylosis at the L4-5 level with severe bilateral neural foramen stenosis and signal abnormality in the posterior L4 vertebral body that may be related to the degenerative process, although an underlying metastasis is not excluded.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for sinus disease/infection. Signs and symptoms: 55-year-old female with MDS and severe facial pain. Concern for invasive sinusitis. Non-enhanced CT of paranasal sinuses:Frontal sinuses, worsening of frontal sinus disease since prior study.Sphenoid sinus, worsening of sinusitis since prior exam.Ethmoid sinuses, significant worsening of the left ethmoid sinus disease since prior exam. Minimal new right posterior ethmoid sinus disease.Maxillary sinuses demonstrate significant interval worsening of left maxillary sinus disease with near complete opacification on the current exam. Complete occlusion of left ostiomeatal unit. Unremarkable right maxillary sinus and with patent right ostiomeatal unit which has remained stable since prior exam.There is thinning of the posterolateral wall of left maxillary sinus with a suspect a small area of bony defect. There is also effacement of fracture plane in the left infratemporal fossa and including the left retromaxillary fat pad. There is also effacement of fascial planes between the masticator muscles at this site. There is edematous changes of the musculature. Comment a follow-up with an enhanced MRI exam for further evaluation.There is no detectable retro-orbital space abnormality on the left however the edematous changes of the left infratemporal fossa extends into the left inferior orbital fissure.Images through nasal cavity demonstrate increased soft tissue density in the posterior aspect of left nasal cavity.Visualized mastoid air cells and middle ear cavities are unremarkable.Above findings were discussed at the time of interpretation with Dr. Scott Siglin pager number 2953.

Output: Interval worsening of sinusitis in particular on the left with extension of edema/inflammatory changes into the left infratemporal fossa with effacement of fascial plane which also extends into the left inferior orbital fissure. Follow up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Male, 3 months old, ex-36 week gestation, with history of ECMO, evalute for neurologic damage. No evidence of acute ischemia is seen. No findings are demonstrated to suggest acute intracranial hemorrhage. No focal parenchymal lesion, edema or mass effect is detected. The pattern of white matter myelination is probably appropriate for gestational age. However, there does appear to be some periventricular white matter volume loss resulting in prominence of the ventricular system. No abnormal extra axial collections are detected.

Output: 1.No acute intracranial abnormalities.2.Periventricular white matter volume loss.


Instruction: Generate impression based on findings.

Input: Known right frontal ICH, further imaging investigation to see any underlying lesion. Redemonstration of evolving right frontal ICH and IVH with the surrounding edema and minimal midline shift towards left side. Comparing to the most recent head CT scan, no significant interval change of the degree of midline shift.There is no evidence of new acute ischemic or hemorrhagic lesion on the scan.There is no evidence of abnormal enhancement.There is no evidence of ventriculomegaly although the right lateral ventricle frontal horn appeared to be slightly compressed which again do not show any significant interval change since prior head CT scan. The cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Redemonstration of evolving right frontal ICH, no change of size, extent of surrounding edema and degree of minimal midline shift towards left side since prior exam.No evidence of abnormal enhancement.No evidence of new ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Left knee pain. Left knee lateral meniscus tear? MENISCI: There is extensive complex tearing of the body and posterior horn of the lateral meniscus, with portions of the meniscus macerated to the point of being almost nonexistent. The anterior horn of the lateral meniscus is relatively intact. There is poorly defined band-like increased signal intensity within the posterior horn of the medial meniscus that extends to the femoral articular surface suggestive of a degenerative horizontal tear, but the true clinical significance of this is uncertain.ARTICULAR CARTILAGE AND BONE: There is full-thickness loss of articular cartilage along the posterior aspect of the lateral femoral condyle and posterior aspect of the lateral tibial plateau with degenerative edema-type signal in the underlying subchondral bone. There are also prominent osteophytes arising from the lateral femoral condyle and lateral tibial plateau. The articular cartilage of the medial and patellofemoral compartments appears relatively preserved.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Maceration of the lateral meniscus with severe osteoarthritis affecting the lateral tibiofemoral compartment and other findings as described above.


Instruction: Generate impression based on findings.

Input: Metastatic germ cell tumor: headache. There is an enhancing lesion in the occipital bone, which measures up to 10 mm. There is also an enhancing lesion in the right parietal bone. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable. There are small bilateral maxillary and left frontal sinus retention cysts.

Output: Small skull lesions likely represent metastases. Otherwise, no evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: History of SLE and chronic low back pain assess for disk disease On sagittal reconstructed images there is disk space narrowing with vacuum disk phenomena at the L4-5 disk space.The remainder of the visualized levels demonstrate preservation of disk height. Vertebral bodies are within normal limits in height.Axial images through the L1-2 level demonstrate minimal facet hypertrophic changes no significant central or foraminal stenosis.At the L2-3 level there is no significant central or foraminal stenosis. Incidental note is made of a stent within the left renal artery at this level.At the L3-4 level mild facet hypertrophic changes with mild bulge of the disk causing minimal effacement of ventral thecal sac but no significant central or foraminal stenosis.At L4-5 there is a diffuse bulging disk as well as ligamentous hypertrophy and facet joint hypertrophic changes. These result in a mild to moderate degree of central canal stenosis as well as mild bilateral foraminal narrowing.At the L5-S1 level central bulging disk is present with mild effacement of ventral thecal sac but no significant central canal stenosis.

Output: Degenerative changes of the lumbar spine which are most severe at L4-5 where there is disk space narrowing and vacuum disk phenomena. Diffuse bulge of the disk is present which in conjunction with ligamentous hypertrophy and facet hypertrophic changes causing mild to moderate degree of central canal stenosis and mild bilateral foraminal narrowing. These findings are without significant change in comparison to the prior study.At the L5-S1 level small central disk protrusion is present without significant confines of the central canal or neural foramen.


Instruction: Generate impression based on findings.

Input: Acute on chronic liver failure and respiratory failure requiring mechanical ventilation with progressive development of ARDS in setting of parainfluenza infection with likely secondary Aspergillus and MSSA pneumonia and probable cystic fibrosis. There appear to be two contiguous lesions in the right occipital lobe with peripheral T1 hyperintensity and extensive susceptibility effect and central restricted diffusion, the largest of which measures up to approximately 25 mm. There is surrounding vasogenic edema and overlying sulcal T2 hyperintensity and enhancement. In addition, there are punctate (1 to 3 mm diameter) enhancing lesions in the left frontal lobe periventricular white matter and in the grey-white matter junctions of the left postcentral gyrus, left inferior parietal lobule, and right middle frontal gyrus. There are punctate foci of susceptibility effect in the left cerebellar hemisphere. There is no evidence of acute infarct. There is no midline shift or herniation. The ventricles are unchanged in size and configuration. The major cerebral flow voids are intact. There is fluid signal in the bilateral mastoid air cells. There is diffuse mucosal thickening and enhancement, as well as secretions within the pneumatized portions of the paranasal sinuses. There is a partially-imaged right nasoenteric tube. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. The lesions in the right occipital lobe may represent abscess, either pyogenic or fungal, with superimposed hemorrhage and regional cerebritis and meningitis and/or superimposed subarachnoid hemorrhage. Metastatic disease is nevertheless an imaging differential consideration.2. A few scattered punctate enhancing lesions in the bilateral cerebral hemispheres may represent septic emboli. Similarly, punctate foci of susceptibility effect in the left cerebellar hemisphere may represent hemorrhagic microabscesses or chronic aseptic microhemorrhages related to the underlying coagulopathy. Metastatic disease is nevertheless an imaging differential consideration.3. Apparent inflammatory changes in the paranasal sinuses are suggestive of acute sinusitis, perhaps related to cystic fibrosis.4. Effusions within the bilateral mastoid air cells may represent mastoiditis or may be related to intubation.


Instruction: Generate impression based on findings.

Input: Left hyperacusis, dizziness. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is a hypoenhancing subcentimeter lesion in the right pituitary lobe. There is a prominent perivascular space in the left temporal stem. There are also minimal scattered T2 hyperintense foci in the cerebral white matter, which are nonspecific. There is no evidence of acute infarction.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. A hypoenhancing subcentimeter lesion in the right pituitary lobe likely represents a microadenoma.


Instruction: Generate impression based on findings.

Input: Male 68 years old with metastatic follicular carcinoma of the thyroid to the brain s/p stereotactic radiosurgery to left cerebellar lesion 3 months ago, evaluate for new metastasis/progression Enhancing mass within the left cerebellum measuring approximately 14 x 12 x 11 mm, slightly decreased from prior 15 x 14 x 14 mm. The lesion again contains a minimal focus of susceptibility artifact, which may be related to minimal blood products. Surrounding area of T2/FLAIR hyperintense signal with minimal mass effect noted, which also appears decreased from prior exam. No new enhancing lesions identified.Mild age-related volume loss with prominence of the ventricles and sulci. Minimal foci of T2/FLAIR cerebral white matter signal similar to prior and compatible with minimal chronic small vessel ischemic changes. There is no evidence of acute intracranial hemorrhage or acute infarct on diffusion imaging. The pituitary gland appears unremarkable. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Mild interval decrease in size of metastatic left cerebellar lesion. There is also mild decrease in surrounding vasogenic edema. No new lesions.


Instruction: Generate impression based on findings.

Input: Paresthesia. Diagnosed with multiple sclerosis since 2010. Prior MR examinations are not available for direct comparison. Brain:Limited brain sequences were obtained as per the demyelinating disease protocol. There are more than 10 cerebral white-matter T2-hyperintense lesions, many of which are oriented perpendicular to the long axis of the lateral ventricles as well as involving the corpus callosum consistent with known demyelinating disease. Some of the lesions are T1-hypointense. There is no definite involvement of the brainstem and cerebellum. There is no space-occupying brain lesion or mass-effect. There is no midline shift or brain herniation. Overall brain volume is very minimally decreased. The major intracranial vascular flow voids are preserved. The orbits show no gross abnormality. There is no destructive skull lesion.Cervical spine:There is extensive T2-hyperintense signal throughout the cervical spinal cord, which is more focal at C2, C5-C6 and C6-C7 levels. This is associated with areas of volume loss/cord thinning such as at the dorsal C6-C7 and right dorsal at C5-C6. An additional smaller right central lesion is present on the cervicomedullary junction. There is an incidental small right thyroid lobe nodule that is T2-hyperintense.

Output: 1.Brain: Multiple cerebral T2/FLAIR hyperintense lesions are compatible with the given diagnosis of multiple sclerosis. There is mild-to-moderate burden of T1 hypointense lesions and minimal overall brain volume loss.2.Cervical spine: Multiple cervical spinal cord lesions are present consistent with demyelinating disease. Areas of volume loss in the cord also noted indicating chronicity.3.No prior MRI studies are available for comparison. Addendum can be issued if images are made available for comparison.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: paresthesias. Brain: There are multiple, greater than 20, T2 hyperintense lesions within the cerebral white matter, in a periventricular, deep, and juxtacortical distribution. Many of the lesions are also T1 hypointense. There is no evidence of infratentorial lesions. There is no evidence of intracranial hemorrhage, mass, 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a trace posterior disc-osteophyte complex at C6-7, but there is no significant spinal canal stenosis in the cervical or thoracic spine. The paravertebral soft tissues are unremarkable.

Output: 1. Multiple demyelinating lesions in the brain do not appear to be significantly changed, accounting for differences in technique. 2. No evidence of demyelinating lesions in the spinal cord.


Instruction: Generate impression based on findings.

Input: Metastatic prostate cancer presenting with LE weakness and collapse concerning for spinal mets causing cord compression. There is diffuse abnormally low T1 and T2 signal bone marrow signal throughout the vertebrae. There may be slight epidural extension of tumor at C3-4. There also appears to be epidural extension of tumor at multiple levels of thoracic spine, without definite associated spinal cord compression, although assessment is limited by the lack of intravenous contrast. There are disc-osteophyte complexes and facet hypertrophic changes at C3-4 and C4-5, as well as 5 mm of retrolisthesis at C3-4 with associated moderate to severe narrowing of the spinal canal, as well as pronounced neural foraminal narrowing at C2-3 though C4-5 bilaterally. There are milder degenerative changes at C5-6 and C6-7, without significant narrowing of the spinal canal at these levels. The spinal cord displays normal signal characteristics. The vertebral body heights are intact. The paravertebral soft tissues and partly imaged intracranial structures are grossly unremarkable.

Output: 1. Diffuse abnormal bone marrow signal throughout the vertebrae is likely related to metastatic disease. Furthermore, there may be slight epidural extension of tumor at C3-4. There also appears to be epidural extension of tumor at multiple levels of the thoracic spine, without definite associated spinal cord compression, although assessment is limited by the lack of intravenous contrast.2. Degenerative spondylosis at C3-4 and C4-5, as well as 5 mm of retrolisthesis at C3-4 with associated moderate to severe narrowing of the spinal canal, as well as pronounced neural foraminal narrowing at C2-3 though C4-5 bilaterally.


Instruction: Generate impression based on findings.

Input: Clinical question: Right-sided numbness, poorly controlled hypertension concerning for TIA/stroke. Signs and symptoms: As above. Nonenhanced brain MRI:Examination demonstrates a focus of restricted diffusion in the left thalamus measuring at 4 x 10 mm in transaxial dimensions and consistent with an acute nonhemorrhagic lacunar infarct.FLAIR and T2-weighted images demonstrate several punctate foci of hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and including above mentioned acute lacunar infarct. Findings are consistent with small vessel ischemic changes of mild degree. There is no detectable cortical signal abnormality and images through the basal ganglia, pons and cerebellar hemispheres remain within normal on all MRI sequences. The cortical sulci, ventricular system as well as the CSF spaces remain within normal for stated age. Signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are unremarkable.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.

Output: 1.Acute nonhemorrhagic left thalamic lacunar infarct measuring 4 x 10 mm in transaxial dimensions.2.Mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter as detailed.3.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Reason: R posterior thigh mass in hamstring region History: Right posterior thigh mass. Markers were placed along the posterior aspect of the mid to distal thigh, presumably denoting the site of the patient's palpable mass. Deep to these markers, there is focal prominence of the semimembranosus muscle, posteriorly, perhaps representing an anomalous bundle. It does not appear to be herniating through the deep peripheral fascia and there is no abnormal signal intensity or enhancement of the musculature. We otherwise see no mass. The bone marrow signal intensity of the femur is normal.

Output: Slight asymmetry of the semimembranosus muscle likely due to a small anomalous muscle bundle, but we see no mass.


Instruction: Generate impression based on findings.

Input: Headache, structural brain lesion. Brain parenchyma appears within normal limits. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Examination is within normal limits. Specifically, no intracranial mass or mass effect.


Instruction: Generate impression based on findings.

Input: Reason: RUE/RLE weakness, eval for CVA History: RUE/RLE weakness, eval for CVA. Brain: There is no restricted diffusion to suggest acute infarct. Again noted are changes compatible with prior suboccipital craniectomy and resection of posterior arch of C1 for posterior fossa decompression, with low-lying cerebellar tonsils which extend to the inferior margin of the anterior arch of C1 not significantly changed since the prior study. The ventricles are normal in size without hydrocephalus. There is prominent volume loss involving the superior cerebellar vermis similar to prior. There is no mass, mass effect, or midline shift. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as the pons, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Postcontrast images demonstrate no abnormal parenchymal or meningeal enhancement. Cervical spine: Again seen is T2 signal abnormality involving the right central and dorsal cervical cord from C2 to the C7 level. There is also a associated prominence of the central canal which extends to the lower T1 level on the axial T2 sequence. Overall appearance of the signal abnormality is unchanged. No abnormal enhancement in the cervical spine.Cervical spine alignment is unchanged with reversal of cervical lordosis and mild retrolisthesis of C4 on C5. Bone marrow signal is benign. The vertebral body heights are preserved. No abnormal enhancement. Degenerative changes are specified by the intervertebral level as follows: C2-C3: Minimal disc osteophyte complex without spinal canal stenosis or neural foraminal compromise is identified. C3-C4: Small disk osteophyte complex with mild narrowing of the spinal canal and effacement of the ventral thecal sac. No significant neural foraminal stenosis.C4-C5: Small disk osteophyte complex with effacement of the ventral thecal sac. Minimal right foraminal narrowing, otherwise no significant neural foramina stenosis. C5-C6: Disk-osteophyte complex without significant spinal canal or neural foramina stenosis.C6-C7: Small disk osteophyte complex without significant spinal canal or neural foramina stenosis.C7-T1: No spinal canal stenosis or neural foraminal compromise.

Output: 1.No evidence of acute infarct. No intracranial mass or mass effect. Postsurgical changes of prior Chiari I decompression without significant interval change in position of the low-lying cerebellar tonsils. 2.No significant change in extensive right cervical cord myelomalacia with small adjacent syrinx.3.Mild multilevel degenerative changes as detailed above with mild spinal canal stenosis at C3-C4 and C4-C5. No high-grade spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Diplopia [H53.2], Reason for Study: ^Reason: Evaluate for abnormality, further evaluate mid-brain lesion History: Blurry vision, intermittent diplopia Multifocal relatively ill defined FLAIR/T2 high signal intensity lesions on bilateral frontal lobes and paramedian upper right midbrain lesions are again seen. They still show subtle restricted diffusion on ADC maps but the MR signal intensity has been decreased since prior scan.Multiple scattered susceptibility lesions are again seen, unchanged.There is no new hemorrhagic or restricted diffusion lesion on today' scan.There is no evidence of abnormal enhancement on this scan.Constellation of above findings indicate the possibilities of infectious or inflammatory lesions would be low and the possibility of neoplastic lesions could also be low. Therefore, these lesions may represent scattered various aged evolving ischemic lesions.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection or abnormal contrast enhancement. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Previously seen multifocal FLAIR/T2 high signal intensity lesions do not show any evidence of enhancement but decreased the degree of restricted diffusion, thus likely represent evolving ischemic lesions. Possibilities of infectious, inflammatory or neoplastic etiologies would be low.2. No evidence of new ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: MS; follow-up progression. Signs and symptoms: Paresthesias. Nonenhanced brain MRI:There is significant technique difference between the current exam performed with dedicated multiple sclerosis protocol with 2 mm slices compared to prior routine brain MRI with 5 mm slices.Within this limitation examination demonstrates a small demyelinating plaque in the inferior right pons similar to prior exam. Unremarkable images through posterior fossa otherwise. Images through the supratentorial space demonstrate mild findings of demyelinating disease in the periventricular and subcortical white matter of cerebral hemispheres without convincing evidence of any new lesions. Questionable subtle interval decreased size of a previously known lesion in the subcortical white matter of the right posterior temporal lobe.Normal size of cortical sulci, ventricular system and patent all CSF spaces similar to prior study.Nonenhanced cervical MRI:Examination at C5-C6 demonstrate a right lateral disc extrusion with resultant subtle flattening deformity of the ventral aspect of the cord and mild central spinal stenosis. There is a small focus of T2/T2 STIR hyperintensity of the anterior aspect of the cord at this level (sagittal T2 STIR series 1201 image 8 and 9) which is suspected for a a focus of myositis secondary to disc herniation, however considering patient's history of demyelinating disease possibility of the lesions representing a demyelinating plaque cannot be entirely excluded.There are tiny additional suspected foci of T2 hyperintensity within the cord on axial T2 series 1301 on image #30 in the right posterior cord at C2 level, left posterior cord on image 27 at C3 level, image 24 on the right at C3-C4 level, left posterior on image 22 at C4 level.The caliber of the cord remains within normal.Minimal degenerative changes at other levels however without evidence of spinal canal or neural foraminal compromise.Upper most visualized thoracic cord and thoracic spine T3 level are unremarkable.

Output: 1.Mild supratentorial findings of demyelinating disease without definitive change since prior exam and a single right inferior pontine lesion as well as noted on prior study.2.MRI of cervical spine demonstrate a right lateral disc extrusion at C5-C6 level with resultant subtle flattening deformity of the ventral aspect of the cord on the right and mild central spinal stenosis. Small focus of T2 hyperintensity of the anterior cord at the level of disc extrusion which could represent a focus of myelitis however possibility of a demyelinating plaque cannot be entirely excluded. Multiple tiny additional foci of T2 hyperintensity of the cord as detailed or level above and suspected of demyelinating disease. Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: 52 years, Female, Reason: h/o thryoid ca, liver mets, compare to previous, measurements pls, eval response to tx. History: none. ABDOMEN:LUNG BASES: Cardiomegaly.LIVER, BILIARY TRACT: Innumerable hepatic metastases are overall decreased in size from the prior exam. Reference T2 hyperintense lesion identified on prior exams is not identified on this exam, however there are significant remaining rim enhancing lesions throughout the right hepatic lobe likely representing tumor. For reference, a segment 7 conglomerate measures 7.0 x 5.6 cm (13/151), previously is 9.2 x 7.1 cm. A left hepatic cyst is stable.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: Mildly enlarged periportal node is unchanged measuring 1.9 x 1.5 cm (4/25).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild perihepatic ascites is increased.

Output: 1.Decreased hepatic metastases.2.Stable retroperitoneal lymphadenopathy.3.Increased perihepatic ascites.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma status post surgery: surveillance. There has been interval evolution of postoperative findings related to transsphenoidal surgery for debulking of a pituitary macroadenoma. There is ano significant interval change in size of the mass that measures up to approximately 25 mm centered in the left sella with extension into the left cavernous sinus with partial encasement of the left internal carotid artery, which is not significantly changed. There also appears to be invasion of the left clivus and persistent enhancement within the bone marrow of the right planum sphenoidale. There is high T2 signal and perhaps mild volume loss of the optic chiasm. However, there is no discernible mass effect upon the optic apparatus by the pituitary mass. There are secretions and mucosal thickening within the sphenoid sinuses. There are multiple nasopharyngeal mucus rentention cysts.

Output: Evolution of postoperative findings related to transsphenoidal surgery for debulking of a pituitary macroadenoma with no significant interval change in size of the residual tumor with associated extension into the left cavernous sinus and partial encasement of the left internal carotid artery.


Instruction: Generate impression based on findings.

Input: Seizure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is diffuse paranasal sinus mucosal thickening. The orbits, skull, mastoid air cells, and scalp soft tissues are unremarkable, aside from a focally prominent posterior condylar vein.

Output: No evidence of seizure foci.


Instruction: Generate impression based on findings.

Input: 68-year-old female with right upper extremity shoulder pain, evaluate for muscle tear ROTATOR CUFF: There is partial thickness articular surface tearing of the supraspinatus tendon at its insertion and an associated intramuscular ganglion at the myotendinous junction. The remaining tendon has high signal on T2, indicating a tendinopathy. There is also mildly increased T2 signal within the infraspinatus tendon suggesting tendinopathy with a smaller amount of surrounding T2 signal which also likely represents an intramuscular ganglion. Teres minor is intact. Subscapularis is intact. There rotator cuff muscles are small, likely normal for age. Reactive edema is seen in the greater tuberosity adjacent to the supraspinatus insertion.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Small osteophytes are seen at the glenohumeral joint. The glenoid labrum is intact.BICEPS TENDON: Biceps tendon is intact. ADDITIONAL

Output: Tendinopathy of the infraspinatus and supraspinatus with partial-thickness tearing of the supraspinatus.


Instruction: Generate impression based on findings.

Input: 66 years, Female, upper extremity weakness with the known bone metastases secondary to thyroid cancer. Rule out cord compression.. Brain: There is evidence of intracranial metastatic disease. There is a heterogeneously enhancing lesion involving the left posterior frontal lobe cortex including the precentral gyrus which demonstrates cystic and solid components. There is mild surrounding edema. The lesion measures up to 29 mm in the longitudinal dimension and 12 mm in the AP dimension. There is also a cortical lesion involving the left occipital lobe with similar heterogeneous enhancement and measuring approximately 14 x 14 mm. There is more faint ill-defined enhancement immediately lateral to this lesion with restricted diffusion. There are multiple additional foci of restricted diffusion including the cortex of the bilateral frontal lobe as well as additional scattered foci in the bifrontal periventricular white matter and the left splenium. There is minimal associated enhancement. There is susceptibility associated with the above-mentioned larger left posterior frontal and left occipital lesions compatible with hemorrhagic metastases.There is no midline shift or herniation. No hydrocephalus. Major flow-voids in the brain are preserved. There is a 16 x 12 mm ovoid cystic lesion involving the left parotid gland which is unchanged since prior from 11/24/2015 and larger since CT dated 10/18/2012; differentials again include developmental cyst, low-grade cystic neoplasm, or focal ductal dilatation. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.Cervical spine: Vertebral body heights are normal. There is straightening of the cervical spinal curvature. Alignment is otherwise grossly maintained. No abnormal enhancing foci are appreciated. There is focus of low T1 and low T2 signal involving the right inferior lateral aspect of the C4 vertebral body corresponding to foci of air as seen on prior CT studies and favored to be on a degenerative basis. The spinal cord is of normal caliber and signal. There is no pathological enhancement.Multilevel degenerative changes are seen including disc bulges throughout the cervical spine with mild spinal canal narrowing from C3-C4 to C5-C6. No high-grade spinal canal stenosis is appreciated. Mild to moderate multilevel neural foraminal narrowing is noted related to uncovertebral hypertrophy and facet arthropathy, relatively worse at the left C4-C5 and C5-C6 levels. Small subcutaneous lipoma is incidentally noted in the posterior subcutaneous soft tissues on the left at the C5-C6 level.Thoracic spine: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. Scattered foci of T1 hyperintensity are compatible with small hemangiomas. Image quality is suboptimal due artifact however no obvious cord signal abnormality is appreciated. There is no pathological enhancement. Mild multilevel degenerative changes are present including disc height loss, small multilevel disc bulges, ligamentum flavum thickening, and mild facet arthropathy. No significant spinal canal or neural foraminal stenosis is appreciated.Multiple lung nodules related to metastatic disease are noted and better assessed on recent dedicated chest CT.

Output: 1. Multiple enhancing lesions in the brain, particularly involving the left posterior frontal lobe and left occipital lobe, are most consistent with intracranial metastatic disease. There is evidence of hemorrhage associated with these two larger lesions. There is mild associated edema. No significant intracranial mass effect, midline shift, or herniation. 2. There are multiple foci of restricted diffusion in the brain associated with mild enhancement. Notably there is restricted diffusion in the left occipital lobe just lateral to the enhancing left occipital metastasis described above. These findings suggest infarcts associated with the intracranial metastases and raise suspicion for tumor embolism.3. No evidence of metastatic disease in the cervical or thoracic spine. There is mild spinal canal stenosis in the cervical spine at C3-C4, C4-C5, and C5-C6, which is on a degenerative basis. No evidence of high-grade spinal canal stenosis, cord compression, or cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Female; 29 years old. Reason: 29yo female with ileal Crohn's disease. Evaluate extent of disease History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The distal and terminal ileum demonstrate moderate circumferential wall thickening with resultant stenosis of the lumen, as well as increased wall enhancement, most compatible with active inflammatory bowel disease. This segment is approximately 20 cm in length. No evidence of bowel obstruction. No evidence of abscess or fistula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings most compatible with active inflammatory bowel disease affecting the distal and terminal ileum as detailed above.


Instruction: Generate impression based on findings.

Input: Acute lymphoid leukemia. Altered mental status and right-sided tremor. The study is limited by patient motion. There are patchy areas of FLAIR hyperintensity involving the bilateral subcortical and periventricular white matter. Relatively more prominent of these is seen involving the left posterior frontal centrum semiovale and corona radiata. There are punctate foci of mild restricted diffusion within this area of FLAIR hyperintensity with subtle enhancement. There is also a subtle focus of enhancement in the right cerebellar hemisphere which also shows mild diffusion restriction (better seen on the ADC, then on the limited DWI).The other scattered foci of cerebral white matter abnormality show no diffusion restriction or contrast enhancement and are nonspecific. There is no intracranial mass or mass effect. Ventricles are within normal limits without evidence of hydrocephalus. Mild global parenchymal volume loss is commensurate with age. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: 1.Study is limited by patient motion as described above.2.There are punctate foci of mild restricted diffusion in the left frontal lobe and right cerebellum with enhancement. These are favored to represent subacute infarcts or posttreatment-related injury. There are patchy areas of FLAIR hyperintensity in the left frontal centrum semiovale and corona radiata as well as scattered elsewhere in the white matter which may represent posttreatment and/or chronic ischemic change. Given history of systemic infection, it is also possible the foci of FLAIR hyperintensity and foci of enhancement and restricted diffusion are infection-related (cerebritis); however there is no evidence of intracranial abscess, empyema, or abnormal meningeal enhancement to support this differential. Follow-up MRI to evaluate for evolution and CSF evaluation may be considered as clinically indicated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 11 year old male with right heel pain and previous abnormal MRI. There is minimal patchy edema-like signal and enhancement within the talus and calcaneus, appearing similar to that seen on prior study. Mild patchy edema-type enhancement in the navicular and middle cuneiform appears new when compared to the previous study. A tiny focus of high signal intensity seen within the body of the calcaneus laterally, posterior to the subtalar joint, measures approximately 2mm and shows mild enhancement following gadolinium administration, and is new from the prior study. Note is made of a peroneus quartus, a normal variant. The remaining soft tissue structures appear normal. There is a small amount of fluid in the tibiotalar and subtalar joints. A small amount of fluid also extends outward from the sinus tarsus along the extensor retinaculum. We see no fracture.

Output: Mild patchy bone marrow edema-like signal as described above, new in the navicular and middle cuneiform. This is often a "normal" finding in children and adolescents and may represent relatively active hematopoietic marrow. Stress reactions are considered less likely.


Instruction: Generate impression based on findings.

Input: 65-year-old male patient with history of prostate cancer status post prostatectomy with rising PSA. Evaluate for extent of disease/local recurrence. PSA of 0.25. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Status post prostatectomy.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: Normal-appearing inguinal lymph nodes.BONES, SOFT TISSUES: Mottled bone marrow throughout the pelvis. Refer to bone scan performed the same day.OTHER: There is an small area of T2 hypointensity with linear morphology at the base of the left penis (series 901 image 9).

Output: 1. Postsurgical changes from radical prostatectomy.2. Linear T2 hypointensity at the left aspect of base of penis may be postsurgical in etiology, but recurrence cannot be entirely excluded. Attention should be paid to this area on follow up imaging.3. Mottled bone marrow throughout the pelvis. Refer to bone scan performed the same day.


Instruction: Generate impression based on findings.

Input: Evidence of catatonia, confusion and multiple myeloma. There is no evidence of acute infarct. The focal area of T2 signal abnormality in the left frontal lobe is unchanged. Otherwise, evaluation of the brain parenchyma is not possible due to the limited sequences and artifact from patient motion. The ventricles are stable in size. There is no midline shift. A retention cyst is redemonstrated in the left maxillary sinus.

Output: Unchanged T2 signal abnormality in the left frontal lobe, which may be related to chronic small vessel ischemia, but no definite evidence of acute infarct ir large tumor. However, the exam is very limited due to patient motion artifact and premature termination.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Metastatic lung adenocarcinoma. History of spine metastasis. Evaluate for change and for preoperative planning. Since the previous examination, the posterior fusion hardware has been extended to T3-T7 with bilateral screws at T3, T4, T6 and T7 levels as well as posterior dual rods in addition to T4-T6 laminectomies. Partial corpectomy and and right transversectomy were performed at T5, in addition to previous left costotransversectomy. There is bone cement in the deep/anterior partial corpectomy bed, but also extending outside the corpectomy bed on the left side. There is intensely contrast enhancing tissue filling the remainder of the partial corpectomy bed and costotransversectomy, which is predominantly right sided though a thin rim of the same tissue does wrap around the thecal sac on the left side. This would be most compatible with recurrent tumor and it mildly deforms the spinal canal and thecal sac though with residual CSF around the spinal cord and no spinal cord compression. In the axial plane, this contrast enhancing tissue measures 4.1 cm x 3.2 cm. Craniocaudally, it measures 4.4 cm. It reaches to the right costochondral junction but without definite rib involvement. Most of the left costotransversectomy bed is filled with postoperative change.There is slightly increased thoracic kyphosis across the fused segment compared to the previous examination but this may relate also to patient position. The Cobb angle measured from the superior endplate of T1 to the inferior endplate of T12 is now 72 degrees compared to 66 degrees previously.Accounting for metallic artifact related to the screws and the posterior rods, there is no compression of the spinal cord at the other levels. This artifact also does not allow for accurate assessment of the marrow comment T3-T7 levels. There is also no suspicious marrow abnormality at other levels to indicate the presence of other thoracic spine metastasis.Postoperative changes are present in the back posterior soft tissues at midline. Dependent pulmonary opacities may represent atelectasis and scarring but this study does not allow for diagnostic long assessment.

Output: 1.Compared to the previous examination of June 2015, the posterior fusion has been extended, now T3-T7. Also partial corpectomy and right transversectomy were performed at T5, in addition to previous left costotransversectomy.2.Contrast enhancing tissue that is predominantly left-sided at the T5 corpectomy/costotransversectomy bed is most compatible with recurrent tumor. It mildly compresses the spinal canal but causes no spinal cord compression.3.Other ancillary and postoperative findings are described above.


Instruction: Generate impression based on findings.

Input: Reason: ms progression History: pain, leg weakness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple periventricular white matter lesions which are bright on T2 and flair sequences as well as lesions extending to the corpus callosum at the callosocingulate junction. Punctate lesions are also present in the right thalamus and left thalamus. Comparing to the previous exam the number and distribution of these lesions has not changed. One in particular along the trigone of the left lateral ventricle is less conspicuous on the current exam when compared to the prior examNo 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 partial opacification of the left sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate prolapse of some of the left orbital fat into the maxillary sinus suggestive of a prior left orbital wall which has not changed since the prior exam.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine. There is redemonstration of a lesion which is hyperintense on T2-weighted imaging located along the right posterior and lateral aspect of the spinal cord at the C2-3 level which measures 10 mm superior inferior dimension. There is redemonstration of a lesion which is hyperintense on T2-weighted imaging located in the left hemicord posteriorly measuring 2 x 5 mm axial dimensions and 9 mm superior inferior length. This is also stable compared with prior exam.There is a 10-mm T1 hyperintense lesion within the T1 vertebral body most likely represent a vertebral body hemangioma.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 or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present 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.

Output: 1.There are multiple lesions scattered in the supratentorial brain which are relatively stable when compared to prior exam with the exception of a left periventricular white matter lesion adjacent to the trigone of the left lateral ventricle which has regressed since the prior exam. No new lesions are appreciated. This is compatible with patient's clinical history of demyelinating disorder2.There are couple lesions in the cervical spinal cord which are stable since the prior exam and compatible with patient's clinical history of demyelinating disorder.


Instruction: Generate impression based on findings.

Input: Cerebral cysts [G93.0], Reason for Study: ^Reason: brain lesion; surgical planning History: brain lesion Motion artifacts degraded image quality.Multiple fiducial markers attached on scalp.There is 16.9mm x 15.7mm sized round non-enhancing mass lesion located at the level of foramen of Monroe associated with ventriculomegaly. The lesion shows high signal intensity with subtle central low signal intensity on T2 and low signal intensity on T1 images indicating the possible diagnosis of colloid cyst.Right frontal approach ventriculostomy tube is seen with scalp swelling which is likely represent postoperative change. The tip of the ventriculostomy tube appears to be within the cavum septum pellucidum. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: About 17mm x 16mm sized foramen of Monroe lesion likely represent colloid cyst with hydrocephalus.Right frontal approach ventriculostomy tube was placed and the tip is located in midline, possibly within the septum pellucidum.


Instruction: Generate impression based on findings.

Input: Progressive pain for 3 months. Suspect rotator cuff tear ROTATOR CUFF: There is a partial articular sided tear of the supraspinatus near its insertion. No evidence is seen of retraction. The subscapularis and infraspinatus tendons and muscles are normalSUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Partial articular sided tear of the supraspinatus


Instruction: Generate impression based on findings.

Input: 41 years Male (DOB:12/26/1974)Reason: herniated cervical disc History: herniated cervical discPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG 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.Overall the patient's cervical spinal canal is small and the congenital basis.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is loss of disc space height, disc desiccation and a disc bulge associated with narrowing of the spinal canal and encroachment of the right-sided exiting nerve roots within the neural foramen. There are uncovertebral osteophytes present on the right side more than the left at this level. There is mild encroachment of left-sided exiting nerve roots at this level. Findings at C3-4 are unchanged compared to the prior exam.At C4-5 there is loss of disc space height, disc desiccation and a disc bulge associated with narrowing of the spinal canal. There are uncovertebral osteophytes present on the right side more than the left at this level. There is encroachment of the right-sided exiting nerve roots. Findings at this level are unchanged compared to the prior exam.At C5-6 there is a central disc extrusion redemonstrated which appears to have mildly regressed when compared to the prior exam. There is effacement of spinal fluid ventral but not posterior the spinal cord. There is some mild deformity of the spinal cord anteriorly where there is some mild signal change within the anterior aspect of the spinal cord.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a small broad-based central disc protrusion at this level which has not changed since the prior exam. Findings at this level are unchanged compared to the prior exam.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.Since prior examination a central disc extrusion at C5-6 has mildly regressed. There remains some mild spinal stenosis and some mild cord signal change.2.There are degenerative changes present elsewhere in the cervical spine with encroachment of right-sided exiting nerve roots at C3-4 and C4-5 and to a lesser degree encroachment of left-sided exiting nerve roots at C3-4 which are stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Right foot pain Note that the examination is limited due to inhomogeneous fat saturation on several sequences.Tendons and ligaments: The visualized extensor tendons are intact. The visualized flexor tendons are intact. The peroneal tendons are intact. The Lisfranc ligament is intact. There is no subluxation or dislocation in the tarsometatarsal articulations.Joints: Note is made of a type II accessory navicular. There is edema type signal both within the navicular bone as well as the accessory navicular. The remaining marrow signal of the hindfoot is otherwise normal. There are no osteochondral lesions identified. There is no joint effusion.Alignment: There is normal alignment of the metatarsals. Muscles: The visualized plantar musculature is unremarkable.

Output: Edema within the navicular bone as well as the type II accessory navicular. Findings are consistent with accessory navicular syndrome. The posterior tibialis tendon attaches to the accessory navicular and appears intact.


Instruction: Generate impression based on findings.

Input: Reason: Surviellance imaging following SRS for meningioma History: Surviellance imaging following SRS for meningioma The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 22 x 16 mm sagittal dimension and 16 x 19 mm axial dimension extra-axial mass at the anterior aspect of the falx cerebri adjacent to the right cingulate gyrus and adjacent right superior frontal gyrus. On the prior exam it measured 22 x 16 mm sagittal dimensions and 19 x 16 mm axial dimensions. There is some associated susceptibility effect.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Right parafalcine mass is stable compared to prior exam and most likely represents meningioma.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 19 month old female with a history of 7 prior seizures, 3 within the past 24 hours. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. No abnormality is noted within the white matter. An MRI may be considered to look for findings not evident by CT if clinically indicated.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is opacification of the maxillary sinuses and the ethmoid air cells.

Output: No acute intracranial abnormality. MRI may be considered for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: 65 years Male (DOB:10/28/1950)Reason: assess for cervical radiculopathy and progression of cervical spinal stenosis History: radicular pain in the RUEPROVIDER/ATTENDING NAME: KOUROSH REZANIA KOUROSH REZANIA The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal mass lesions are identified in the cervical spine. The patient status anterior fusion from C4 through C6 using anterior plate and screws.At C2-3 there is a diffuse disc bulge present associated with ligamentum flavum hypertrophy. There is associated effacement of spinal fluid ventral and posterior the spinal cord. This has not changed substantially compared to the previous exam.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 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. There is a disc bulge present at this level which narrows the neural foramina. It is associated with small uncovertebral osteophytes. Overall there is mild encroachment of the exiting nerve roots within the neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level mildly narrowing the neural foramina at this level.The vertebral artery flow voids appear to be intact.

Output: The patient is status post anterior fusion from C4 through C6. There is redemonstration of degenerative changes of the cervical spine associated with spinal stenosis at C2-3 and some narrowing of neural foramina at other levels. These findings are stable compared to the previous exam from 10/17/2015.


Instruction: Generate impression based on findings.

Input: Clinical question: Subacute stroke in the right ICA signs and symptoms: LLE weakness and left facial droop. Nonenhanced brain MRI:Small focus of restricted diffusion in the posterior limb of right internal capsule measuring at 11-mm consistent with an acute or infarct is noted.Flair and T2 weighted images also demonstrate findings suggestive of mild chronic non-hemorrhagic small vessel ischemic strokes in bilateral cerebral hemispheres and including bilateral basal ganglia however without similar findings in the posterior fossa.The cerebral cortex and cortical sulci remain within normal. Mild prominence of lateral ventricles is noted.Unremarkable calvarium and soft tissues of the scalp. Paranasal sinuses demonstrate mild chronic sinusitis.

Output: 1.11-mm acute lacunar infarct of right posterior limb of internal capsule.2.Mild chronic nonhemorrhagic small vessel ischemic strokes.3.Mild chronic sinusitis.


Instruction: Generate impression based on findings.

Input: 9-year-old male with history of perianal abscess. Evaluate size of the abscess. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral mildly prominent inguinal lymph nodes are again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left perianal soft tissue fluid collection measures 0.9 x 0.4 cm (series 401, image 41), previously measuring 1.2 x 0.4 cm. This collection is hyperintense on T2 imaging, hypointense on T1, demonstrates diffusion restriction, and enhancement; findings consistent with an abscess. Adjacent inflammation is identified on T2 imaging involving the drainage catheter tracts.OTHER: No significant abnormality noted.

Output: Decreased size of left perineal abscess with inflammatory changes in the region of the perianal drainage catheter tracts.


Instruction: Generate impression based on findings.

Input: 16-year-old female with tenderness to palpation of the right knee. Evaluate for meniscal tear. MENISCI: Undulation of the free edge of the body of the lateral meniscus appears most consistent with meniscal flounce. The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is slight increased signal abnormality on fluid sensitive sequences within the lateral femoral condyle consistent with a subacute bone contusion. There is anterior translation of the tibia relative to the femur. The femoral trochlea appears shallow superiorly, suggesting a mild femoral trochlear dysplasia. There is slight lateral translation of the patella relative to the femoral trochlea.LIGAMENTS: The ACL is indistinct indicating a tear involving the proximal and mid substance fibers. There is minimal increased signal abnormality on the fluid sensitive sequences suggesting this finding may be subacute in etiology. The PCL appears intact. The MCL and LCL appears intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Subacute tearing/rupture of the ACL.2. Bone contusion of the lateral femoral condyle.3. Nonspecific subcutaneous edema along the anterior aspect of the knee. 4. Small joint effusion.5. Findings suggestive of a mild femoral trochlear dysplasia as described above.


Instruction: Generate impression based on findings.

Input: 64 years, Male, new onset seizure. Examination is limited due to motion degradation and limited sequences could be obtained. There is however no evidence of intracranial mass or mass effect. There is extensive confluent T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter most compatible with advanced chronic small vessel ischemic disease. Multiple bilateral lacunar infarcts are noted including the pons bilaterally, left thalamus, as well as the left frontal corona radiata. Volume loss also noted in the left basal ganglia with ex vacuo dilatation of the left frontal horn, also likely sequela of chronic infarct. There is possible focus of diffusion restriction involving the posterior limb of the left internal capsule which may represent a recent infarct. There is global parenchymal volume loss which is advanced for patient's age. No hydrocephalus. No extra-axial collections. No midline shift or herniation. There is mild scattered paranasal sinus opacification. There is also partial opacification of the mastoid air cells, right relatively greater than left. Phthisis bulbi on the left.

Output: Limited exam as described in the technique and findings. There is no intracranial mass or mass effect. There is evidence of advanced chronic small vessel ischemic disease with multiple chronic supra and infratentorial lacunar infarcts. There is possible focus of restricted diffusion involving the posterior limb of the left internal capsule raising possibility of a recent infarct, although given the aforementioned limitations, artifact remains a possibility.


Instruction: Generate impression based on findings.

Input: Two day old female with apnea. Evaluate for bleeding or ischemia. There is no evidence of intracranial hemorrhage, mass, edema or hydrocephalus. Asymmetric attenuation is present in the right frontal lobe greater than the left which is nonspecific but if there is concern for ischemia MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses are normally pneumatized.

Output: 1. Asymmetric attenuation is present in the right frontal lobe greater than the left which is nonspecific but if there is concern for ischemia MRI may be considered.2. No evidence of intracranial hemorrhage or other acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits without sagittal spondylolisthesis. There is new mild anterior wedging and superior endplate deformity involving the L2 vertebral body. Within the L2 superior endplate, there is a linear band of decreased T1 signal, increased STIR signal compatible with bone marrow edema, and shows Gad enhancement. Constellation of these findings are most compatible with an acute compression fracture. There is no associated retropulsion into the spinal canal. Vertebral body heights are otherwise preserved. A few scattered small Schmorl's nodes and additional mild degenerative endplate changes are present. There are several foci of increased T1 and T2 signal within the lumbar vertebrae, sacral vertebrae, and iliac bones which are favored to represent hemangiomas or focal fat deposition. There is mild loss of disc height at L4-L5. The disks are diffusely desiccated. The spinal cord displays normal signal and morphology. The conus terminates at L1-L2. The paravertebral soft tissues are unremarkable.T12-L1: No significant central canal or foraminal stenosis.L1-L2: Mild disc bulge and facet hypertrophy without significant central canal or foramina stenosis.L2-L3: Mild disc bulge and facet/ligamentum flavum hypertrophy. Mild central canal stenosis. Right greater than left moderate foraminal stenosis.L3-L4: Mild disc bulge and facet/ligamentum hypertrophy. Mild central canal stenosis. Mild left foraminal stenosis.L4-L5: Mild disc bulge and facet/ligamentum flavum hypertrophy. Mild central canal and moderate bilateral foraminal stenosis.L5-S1: Mild disc bulge and facet/ligamentum flavum hypertrophy. No significant central canal or foraminal stenosis.

Output: 1.Findings most compatible with mild acute compression fracture of the L2 vertebral body without retropulsion. No definite source of infection is identified in the lumbar spine. Given history of fevers, recommend evaluation for alternate source of infection. Recommend consultation with the interventional neuroradiology for L2 kyphoplasty for the purpose of back pain reduction. Discussed by Dr. Lee with VERMA, ANSHU at 10:00 a.m. on 9/4/2015. 2.Multilevel degenerative changes as described above including mild central canal stenosis at L2-L3, L3-L4, L4-5 as well as scattered foraminal stenosis.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact. There is a region of restricted diffusion within the left parietal lobe centered within the post central gyrus but also involving the expected location of Wernicke's area in the left posterior superior temporal gyrus. There is no evidence of intracranial hemorrhage. There are no definite areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is minimal paranasal sinus mucosal thickening.

Output: Acute left parietal and temporal infarct involving Wernicke's area and the left post central gyrus.


Instruction: Generate impression based on findings.

Input: 62-year-old male with alcoholic cirrhosis and HCV who presents for hepatocellular carcinoma surveillance. ABDOMEN:LIVER, BILIARY TRACT: Mild cirrhotic morphology. No suspicious hepatic lesions. No intra or extrahepatic biliary ductal dilatation. Hepatic vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lumbar spine curvature and degenerative changes are noted. There are two T2 hyperintense fluid collections in the right iliacus which are noted on the coronal with the larger measuring approximately 3.7 cm (series 8, image 17).OTHER: No ascites.

Output: 1.Mild cirrhotic morphology without suspicious hepatic mass or biliary ductal dilatation.2.Nonspecific right iliacus fluid collections with the larger measuring up to 3.7 cm, correlate with patient's clinical history and symptoms to exclude musculoskeletal injury/inflammation.


Instruction: Generate impression based on findings.

Input: Male 55 years old Reason: history of prostate cancer in focal therapy clinical trial, evaluate for disease PELVIS:PROSTATE:Prostate Size: 4.4 x 2.8 x 5.1 cmPeripheral Zone: Post ablation changes in the apex bilaterally. Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Post ablation changes in the right apex.


Instruction: Generate impression based on findings.

Input: 64 years, Female, Reason: Patient with past stroke history and recent history of unexplained repeated falls History: Recent falls, loss of sensation in hands No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Slightly prominent perivascular spaces are incidentally noted along the superior frontal gyri. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal is within normal limits.

Output: 1. No intracranial mass or mass effect. No hydrocephalus. No evidence of acute infarct or hemorrhage.2. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: There is no evidence of diffusion restriction. No abnormalities are visualized in the susceptibility images.High signal on T2 and FLAIR with low signal on the T1 images and no concerning enhancement is seen in the right frontal region, representing postsurgical changes with encephalomalacia, with no significant changes since the previous study..The two foci of slight high signal on FLAIR and enhancement that were seen in the previous study in the right superior temporal gyrus are still visualized. The most lateral lesion is increased in size from 8 x 5 mm in the previous study to 9 x 6 mm currently. The dominant medial lesion is unchanged in size since the previous study and measures 6 x 5 mm. Two punctate foci of increased enhancement are seen anterior to the medial lesion, with one appearing stable and the other more anterior one not definitely seen previously.In addition, a new enhancing lesion is seen in the right temporal lobe posteriorly in between the 2 previous larger nodular lesions. This lesion measures 6 x 5 mm, with associated new FLAIR hyperintensity.Ventricular size is normal with no evidence of mass effect or bleed. Basal cisterns remain patent. No evidence of acute infarction. No evidence of herniation. There is no midline shift. No evidence of extra-axial fluid collection.There is a globular structure in the upper left maxillary sinus which again demonstrates high signal on T1, T2, and FLAIR with signal loss in fat suppression images. There is an associated orbital floor defect is seen. This represents orbital fat herniation into the left maxillary sinus from a chronic orbital floor fracture.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Please note that MR perfusion imaging could not be post processed due to technical error at this time.

Output: 1. No changes in the surgical cavity of the right frontal lobe since the previous study.2. The two enhancing lesions that were seen in the previous study in the right superior temporal gyrus are still visualized. The lateral lesion is slightly increased in size. New adjacent punctate enhancing lesions noted, concerning for tumor progression versus posttreatment change. Continued follow-up is again recommended.


Instruction: Generate impression based on findings.

Input: 47 years, Female, Reason: solid mass seen in left adnexa on ultrasound PELVIS: FemaleUTERUS, ADNEXA: Anteverted retroflexed uterus. Intramural T2 hypointense lesion within the posterior uterus measuring 1.1 x 1.4 cm (4/23) likely represents an intramural fibroid.There is a minimally complex left adnexal cystic lesion with a single septation measuring 4.8 x 2.6 x 4.4 cm (5/30 and 3/13). There are no enhancing components to this lesion. An ovarian location is favored given the acute angles of the lesion in relation to the ovary and apparent "claw sign." However, a paraovarian cystic structure such as a hydrosalpinx is among the differential considerations. The left ovary is enlarged, likely due to aforementioned cyst, compared to the right measuring 4.6 x 2.6 cm. Additional small follicles are noted.No significant pelvic ascites.BLADDER: No significant abnormality notedLYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted

Output: Minimally complex cystic lesion in the left adnexa with a thin nonenhancing septation and no suspicious solid or enhancing nodular components. An ovarian location is favored given the acute angles of the lesion in relation to the ovary and apparent "claw sign." However, a paraovarian cystic structure such as a hydrosalpinx is among the differential considerations. Correlation with prior ultrasound exams is recommended to assess for interval increase in size.


Instruction: Generate impression based on findings.

Input: There is no territorially restricted diffusion to suggest acute ischemic infarction. There are unchanged postoperative findings related to resection of left posterior temporal and parietal lobe mass. There is unchanged nonenhancing mild T2 hyperintense signal abnormality surrounding the resection cavity. There is mild ex vacuo dilatation of the trigone of the left lateral ventricle. There is no suspicious intracranial enhancement. There are numerous punctate gradient echo hypointense signal abnormalities in the bilateral cerebral hemispheres, surgical cavity, and brainstem appearing similar to the prior study and which may be posttreatment related. The major cerebral flow voids are intact. There is minimal tonsillar ectopia appearing similar to prior study. The orbits and paranasal sinuses appear unremarkable. The calvarium and extracranial soft tissues are within normal limits.

Output: No recurrent intracranial tumor.


Instruction: Generate impression based on findings.

Input: There is redemonstration of left posterior temporal meningioma that measures 9 x 5 mm in transaxial view (1301/95), previously 9 x 5 mm, and 11 mm in the craniocaudal diameter (1302/130), also previously 11 mm. The measurements are not also significantly changed from the MRI dated 11/2/2009.Brain parenchyma appears otherwise unremarkable for age. There is no T2/FLAIR signal abnormality associated with a meningioma. No restricted diffusion is seen. No new lesions. No intracranial mass effect, midline shift, or herniation. Ventricular size is normal. Major flow-voids are preserved.The orbits and paranasal sinuses are within the normal limits.

Output: Stable left posterior temporal meningioma with unchanged size since MRI studies dated 7/13/2013 and 11/2/2009. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Re evaluate for osteomyelitis History: disseminated mycobacterial infection Direct comparison with prior study is limited due to limited field-of-view on prior study and patient refused additional images at the time. Redemonstration of distal ulnar bone marrow signal changes representing osteomyelitis measuring approximately 4.5 cm in length. This lesion appears more prominent compared to prior study indicating progression. There is also surrounding soft tissue inflammatory changes with small fluid collection in the radial aspect of the distal ulnar diaphysis measuring 6 mm x 3 mm with mild rim enhancement.

Output: 1.Previously seen ulnar osteomyelitis is more prominent on current study indicative of progression.2.Small phlegmon adjacent to the distal ulna as above.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute ischemic or hemorrhagic lesion on this scan.FLAIR images show a bit prominent bilateral frontal lobe cortices, however, these findings are likely to be related to 3T machine related artifacts.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal arterial luminal caliber without evidence of intracranial arterial luminal irregularities or aneurysm.Acom artery is patent and bilateral Pcom arteries are patent too.The distal right vertebral artery shows localized fenestration as well as double lumen indicating arterial dissection. (series 501, image 18/200).3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate irregularities of bilateral distal vertebral arteries indicating vertebral arterial dissection bilaterally. In particular, on the right side the C1 arch level right vertebral artery shows focal signal loss with luminal irregularity and on the left side, the left vertebral artery shows long segment irregularity of the vertebral artery from around C4 to C2 vertebral level. There is no evidence of intraluminal filling defects on this MRA.Otherwise bilateral common carotid arteries with bifurcations and all major arch vessels appear to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. MR evidence of bilateral distal vertebral artery dissection without evidence of intraluminal filling defect. The age of these vertebral dissection is undetermined but MRI with axial fat saturated T1 scan may provide some clue for the age of the dissection.Comment: Subclinical angiographic luminal narrowings or irregularities due to craniocervical dissection tends to get angiographic recovery in 30-40 days, therefore, follow up MR angiography of neck in 2 months can be considered if clinically indicated. Above findings and management related issues have discussed with Dr.Kelly at the time of this dictation.


Instruction: Generate impression based on findings.

Input: 73-year-old male with history of left kidney lower pole mass. ABDOMEN:LIVER, BILIARY TRACT: Scattered small cysts and other subcentimeter T2 hyperintense lesions, likely additional cysts. No suspicious hepatic lesions. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal adenoma.KIDNEYS, URETERS: 2.7 cm round, partially exophytic enhancing left lower pole lesion, compatible with renal cell carcinoma and unchanged in size since prior CT (series 11/64). Bilateral simple cysts in both kidneys are stable.RETROPERITONEUM, LYMPH NODES: Scattered small cystic foci in the retroperitoneum, most likely related to benign lymphatic channels.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left kidney lower pole enhancing mass is unchanged in size and compatible with renal cell carcinoma, most likely papillary type.


Instruction: Generate impression based on findings.

Input: Prior ACL repair 16 years ago now with instability. Evaluate ACL graft and meniscus. MENISCI: There is complex tearing of the posterior horn and body of the medial meniscus. Additionally, there is blunting of the anterior horn of the medial meniscus. There is a complex tear of the posterior horn/body junction of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There are postsurgical changes of an ACL reconstruction. The femoral and tibial tunnels appear to be within normal limits of alignment when compared to the MR equivalent of the Blumensaat line.There is heterogeneity of the articular cartilage of the weight-bearing portion and posterior portion of the lateral femoral condyle. No full-thickness chondral defects are identified. The articular cartilage of the medial femoral condyle and extensor compartment are intact.LIGAMENTS: The ACL graft is intact. The posterior cruciate ligament is intact. The collateral ligaments are intact.EXTENSOR MECHANISM: There is a defect within the central portion of the patellar tendon which is presumably related to the ACL graft donor site.ADDITIONAL

Output: 1. Intact ACL graft.2. Complex tearing of the medial and lateral menisci.3. Loose body adjacent to the ACL graft.


Instruction: Generate impression based on findings.

Input: Male 47 years old Reason: evaluate for rotator cuff injury vs bursitis History: left shoulder pain ROTATOR CUFF: Severe tendinosis affects the supraspinatus tendon with a focal full-thickness tear involving its anterior leading edge. Tendon fibers are not retracted.There is no muscle atrophy.Mild tendinosis affects the infraspinatus which is intact. Teres minor and subscapular tendons are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is likely a small tear of the superior glenoid labrum as seen on image 14 of series 1001. There is some mild degenerative changes of the posterior inferior labrum with a possible small palpable labral cyst.There are cystic changes in the greater tubercle representing enthesopathic changes.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Small full-thickness tear of the anterior aspect of supraspinatus.Findings suspicious for a superior and posterior inferior labral tear.


Instruction: Generate impression based on findings.

Input: Waldenstrom's macroglobulinemia status-post stem cell transplant, lumbar pain without radicular symptoms. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is mildly heterogeneous, but predominantly fatty-replaced. At L2-3, there is slight disc bulge with mild bilateral neural foraminal stenosis. At L3-4, there is ligamentum flavum hypertrophy and right greater than left facet joint hypertrophy causing moderate right neural foraminal and right lateral recess stenosis. At L4-5, there is a disc-osteophyte complex and bilateral facet joint hypertrophy causing spinal canal stenosis with apparent compression of the bilateral descending nerve roots and moderate bilateral neural foraminal stenosis. At L5-S1, there is a mild disc bulge with effacement of the right lateral recess with impingement upon the adjacent descending nerve roots, as well as bilateral facet hypertrophy causing moderate to severe bilateral neural foraminal stenosis. There is a subcentimeter sacral perineural cyst. The spinal cord displays normal signal and morphology with the conus medullaris lies at the inferior L1 level. The paravertebral soft tissues are unremarkable.

Output: Multilevel lumbar spondylosis with moderate right neural foraminal stenosis and right lateral recess stenosis at L3-4, moderate bilateral neural foraminal stenosis and spinal stenosis at L4-5 with apparent compression of the bilateral descending nerve roots, as well as moderate to severe bilateral neural foraminal stenosis and effacement of the right lateral recess at L5-S1.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Re-evaluation after stage II resection of olfactory groove meningioma on 2/25/15: 3 month follow up There are postoperative findings related to recent bifrontal craniotomy with areas of susceptibility along the margins of the resection cavity and bilateral anterior frontal lobe encephalomalacia. There is an enhancing mass in the posterior aspect of the resection cavity, adjacent to the anterior cerebral arteries, that measures up to approximately 20 mm. There also appears to be sheet-like enhancement along the left planum sphenoidale that measures up to 10 mm in thickness, adjacent to the left optic nerve. The ventricles are unchanged in size and configuration. There is no evidence of territorial infarction. There is mild scattered paranasal sinus mucosal thickening.

Output: Postoperative findings related to olfactory groove meningioma resection with no significant interval change in size of the residual tumor in the posterior aspect of the resection cavity and perhaps along the left planum sphenoidale.


Instruction: Generate impression based on findings.

Input: Reason: Considering UFE History: Pain and bleeding PELVIS:UTERUS, ADNEXA: There are multiple large uterine fibroids. A left sided subserosal fibroid along the fundus with heterogeneous enhancement measures 9.8 x 8.7 x 10.9 cm (15/160, 9/27). A right-sided intramural fibroid measures 4.3 x 3.8 cm (15/287) with central necrosis. Multiple additional subserosal and intramural fibroids are present, most of which demonstrate enhancement.Nabothian cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple intramural and subserosal fibroids, most of which are enhancing.


Instruction: Generate impression based on findings.

Input: History of multifocal prostate cancer. March 9, 2016 Bx showed multiple cores of prostate cancer, including Gleason 3+4=7 at the right mid lateral and right base lateral, encompassing 15% to 45% of the individual cores. He also was found to have Gleason 6 prostate cancer at the left base lateral, left mid lateral, left apex lateral, and left base, encompassing 8% to 13% of the cores. PELVIS:PROSTATE:Prostate Size: 4.8 x 5.5 x 5.5 cmPeripheral Zone: The peripheral zone is diffusely thinned with linear T2 hypointense signal diffusely. There are several punctate regions of T1 weighted hyperintensity suggestive of hemorrhage/proteinaceous material.Demonstrated again is the right mid gland para medial lesion measuring approximately 1.1 x 0.8 cm (series 603/264) associated with mild decrease in T2 weighted signal intensity.Dominant left anterior apex lesion measuring 1.4 x 1.0 cm (series 603/144).Central Gland: Marked BPH without a discrete lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Redemonstrated multifocal prostatic adenocarcinoma with dominant bilateral lesions as described above. No specific evidence of extraprostatic extension.