Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental statusClinical question: strokeSigns and Symptoms: stroke MRI of the brainThere are multiple foci of diffusion restriction present. As a patchy areas of diffusion restriction involving the cerebellar hemispheres bilaterally. The area involved in the right cerebellar hemisphere measures approximately 44 x 36 mm axial dimensions. The area involving the left cerebellar hemisphere measures 25 x 38 mm in axial dimensions. There are punctate foci of diffusion restriction scattered in the subcortical and periventricular white matter of the supratentorial brain and all lobes. The periventricular lesions appear to be somewhat larger. Additionally there are small foci of diffusion restriction present in the basal ganglia bilaterally. On susceptibility imaging there is signal loss present in the cerebellar hemispheres bilaterally and relatively small regions suggesting either petechial blood or small foci of hemorrhagic conversion.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is triplication of the anterior cerebral artery. The one segments are similar in size. The left posterior communicating artery is medium-sized. The right posterior cerebral artery has fetal origin. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature presentAt 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.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.3.Multiple foci of infarction are present in the periventricular white matter, subcortical white matter, basal ganglia and cerebellar hemispheres. There is a small amount blood associated with the cerebellar lesions which are somewhat larger.4.Findings were discussed with Dr Kramer at the time of the exam.5.There is no compromise cervical spinal canal or exiting nerve roots. There is mild reversal of normal cervical curvature which could be related to patient positioning or muscle spasm.


Instruction: Generate impression based on findings.

Input: 71-year-old female with vaginal cancer status post external beam radiation, prior to internal radiation boost. PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Soft tissue mass measuring 4.8 x 2.4 cm, previously 3.5 x 5.1 cm centered in the deep left pelvis involving the proximal vagina has decreased in size. Lesion involves the left levator ani muscle and abuts the left ischium. The mass extends caudally into the labia.BLADDER: The above mentioned soft tissue lesion abuts the urethra.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Heterogeneous mottled bone marrow signal intensity is nonspecific and not significantly changed since the prior exam.OTHER: No significant abnormality noted.

Output: 1.Interval decrease in size of left vaginal mass as described above.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Myelination is appropriate. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear.Coronal images of the temporal lobes demonstrate the temporal horns, hippocampal formations and parahippocampal gyri to be normal in size and symmetric bilaterally without signal abnormalities or masses identified within the medial temporal lobes on either side. There is no evidence of mesial temporal sclerosis and there are no foci of heterotopic gray matter.

Output: Negative MRI of the brain. Specifically, there are no MRI findings to explain the patient's seizures.


Instruction: Generate impression based on findings.

Input: Female, 46 years old, history of thymoma resection, with giant arachnoid granulation versus venous lake seen on recent CT scan. An area of focal calvarial thinning in the right frontal bone is seen containing CSF signal fluid. The space is in fact contiguous with the adjacent CSF space. No concerning solid or nodular enhancement is demonstrated. This area demonstrates at most minimal peripheral enhancement.Elsewhere in the brain, no significant parenchymal edema or mass effect. No abnormal extra axial fluid collections are seen. Parenchymal enhancement is within normal limits.

Output: An area of focal thinning of the right frontal bone shows imaging features most compatible with a large arachnoid granulation.


Instruction: Generate impression based on findings.

Input: Change in size of pituitary macroadenoma: Chronic left eye visual loss. There are postoperative findings related to prior frontal craniotomy with a large area of encephalomalacia of the anterior left frontal lobe and ex vacuo dilatation of left lateral ventricle. There appears to be slight interval increase in size of the heterogeneous sellar mass with extension into the cavernous sinuses, mass effect upon the optic chiasm, and invasion of the sphenoid sinuses. The tumor measures up to 45 mm in width, 34 mm in height, and 38 mm in length. There is encasement and narrowing of the left cavernous carotid and a small left cavernous carotid aneurysm.

Output: 1. Postoperative findings related to prior frontal craniotomy with a large area of encephalomalacia of the anterior left frontal lobe2. Apparent slight interval increase in size of the heterogeneous sellar mass with extension into the cavernous sinuses, mass effect upon the optic chiasm, and invasion of the sphenoid sinuses. 3. Encasement and narrowing of the left cavernous carotid and a small left cavernous carotid aneurysm.


Instruction: Generate impression based on findings.

Input: History of gunshot wound to right foot with no fracture, concerning for osteomyelitis. Limited examination providing post contrast images to augment 6/22/2015 right foot MRI. In addition to the findings described on the 6/22/2015 MRI, postcontrast images demonstrate a peripherally enhancing collection extending from within the first metatarsal diaphysis through the cortex inferiorly into the plantar soft tissues (image 37 series 501) measuring approximately 9 x 14 mm and compatible with an abscess. There is also additional abnormal contrast enhancement within the medullary cavity of the first metatarsal.

Output: Limited examination consisting of contrast enhanced images to augment 6/22/2015 MRI demonstrate an abscess extending from the first metatarsal into the plantar soft tissues again compatible with osteomyelitis. Please see 6/22/2015 MRI for further details.


Instruction: Generate impression based on findings.

Input: Ms. Hyde is a 56-year-old female with known DCIS in the left breast and enhancing focus in the inferior right breast seen on MRI, presenting for an MRI targeted ultrasound of this region. A targeted right ultrasound was performed for the MRI area of concern. There is retroareolar focal ductal ectasia. Additionally, there are a cluster of small cysts versus a septated cyst in the right breast at the 6:30 position, approximately 2 cm from the nipple, measuring 3 x 3 mm.Additionally, there is a subtle, hypoechoic region in the superficial skin, possibly within the dermis, at the 6:00 position, approximately 1 cm from the nipple which measures 11 x 2 x 4 mm, and may represent an inclusion cyst or a sebaceous cyst.

Output: Small cluster of cysts versus septated cyst in the right breast at the 6:30 position, which likely correlates to the small enhancing focus from recent MRI. Additionally, hypoechoic region within the skin of the inferior right breast likely correlates to the area of superficial enhancement within the skin seen on recent MRI. No sonographic evidence for malignancy.Follow up MRI in 6 months is recommended to confirm stability of the foci seen on MRIBIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Ms. Dazzena is a 60-year-old female with known right breast cancer IDC and metastatic right axillary lymph node. She presents today for MRI #4 per ISPY-2 protocol. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.RIGHT BREAST:There is no residual enhancement identified in the right upper inner breast, at site of biopsy-proven malignancy. Susceptibility artifact from biopsy marker clip is seen within the central aspect of a normal-appearing right axillary lymph node, measuring 1.1 cm, compared to 1.1 cm.LEFT BREAST:No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region. Vascular port identified in the left medial chest wall.

Output: (1) No residual abnormal MR enhancement identified in the right upper inner breast, at site of biopsy-proven malignancy. However, on the same-day diagnostic workup, there are extensive residual pleomorphic calcifications seen in the right upper inner breast, that span approximately 9 cm in maximal dimension. These calcifications extend to within 1 cm from the right nipple base. (2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: There is no bleed, mass effect, or edema. There is no abnormal signal. No enhancing lesions are visualized. There is no midline shift. There is normal gray-white matter differentiation. The ventricles and the sulci are slightly prominent with volume loss, more than the expected for age.The orbits appear normal. Asymmetric enhancing vessel is seen in the left frontal deep white matter, consistent with developmental venous anomaly.Incidentally seen left atrial choroid plexus xanthogranuloma, associated with FLAIR high signal.

Output: Essentially normal MRI of the brain.


Instruction: Generate impression based on findings.

Input: 42-year-old male with right frontal sinusitis. Complains of right pressure in forehead x 8 months. Patient has history of glioma right orbit/temporal. Extensive opacification of right frontal sinus is noted. Priors MRI examination of the brain from 4 -- 11 -- 07 as well as 9 -- 26 -- 06 were also reviewed which also demonstrated presence of inflammatory sinus disease in the right chamber of frontal sinus. Findings are believed to represent chronic sinusitis.The right chamber of the frontal sinus has a multi-loculated appearance due to septation. The rest of the paranasal sinuses demonstrates only minimal ethmoid sinus disease bilaterally. Maxillary sinuses remain unremarkable an osteomeatal units of the maxillary sinuses are patent.

Output: 1.Extensive chronic sinusitis of right chamber of frontal sinus as detailed.2.Minimal bilateral ethmoid sinus disease.3.Unremarkable paranasal sinuses otherwise.


Instruction: Generate impression based on findings.

Input: Adductor strain for two years. Insertional pain. ACETABULAR LABRUM: There is a tear through the anterior superior labrum and tear through the posterior inferior labrum. ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. The alpha angle measures approximately 35 degrees. There is no evidence of femoral acetabular impingement. The bone marrow signal is within normal limits. SOFT TISSUES: No significant abnormality noted. The musculature appears normal. ADDITIONAL

Output: Anterior superior and posterior inferior labral tears.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis, elbow mass Note that this exam was not tailored for evaluation of the internal structures of the elbow.Within the volar and radial soft tissues of the elbow anterior to the brachioradialis and brachialis muscles and along the expected course of the medial nerve is a well-circumscribed mass measuring 2.5 x 2.4 x 3.8 cm in the greatest transverse, AP, and craniocaudal dimensions. The mass is predominantly hyperintense to skeletal muscle on T2-weighted sequences (although contains some internal low signal intensity) and isointense to skeletal muscle on T1 sequences. The mass does not appear to invade the surrounding fat planes and is and otherwise does not demonstrate aggressive features. Following contrast administration, there is central, heterogeneous enhancement. This mass was evident on the comparison examination from 2014 and has increased from that exam when it measured approximately 1.9 x 1.8 x 2.9 cm.The underlying marrow signal of the distal humerus and proximal forearm are normal. Within the limits of this exam, the ligaments and tendons of the elbow appear normal. There is no joint effusion.

Output: Single soft tissue mass consistent with peripheral nerve sheath tumor. This has increased in size on the comparison examination dated 8/15/2014.


Instruction: Generate impression based on findings.

Input: Back pain radiating to legs. 46-year-old with history of back surgery presenting with back pain and possible radiation down leg. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Ventral bridging osteophytes in the lower thoracic spine suggestive of diffuse idiopathic skeletal hyperostosis better imaged on prior abdominal CT.There is developmental narrowing of the mid to lower lumbar spinal canal with superimposed degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: There is bilateral facet arthropathy, ligamentum flavum thickening, and minimal disc bulge superimposed on developmental narrowing and resulting in mild to moderate spinal canal stenosis. Neural foramina are patent. There is mild edema associated with the right L3-L4 facet arthropathy involving the adjacent soft tissues. T2/STIR hyperintensity involving the bone marrow of the right L4 pedicle and right L3 inferior articular facet may also be reactive. There is 4 x 6 mm focus of fluid posterior inferior to the facet joint, series 8 axial image 18.L4-L5: There is mild to moderate spinal canal stenosis which is predominantly on a developmental basis, with prominence of the epidural fat and bilateral facet arthropathy, ligamentum flavum thickening, and minimal disc bulge also present. Mild narrowing of the left neural foramen. Right neural foramen is patent.L5-S1: No significant disc disease. Thecal sac tapers at this level. No spinal canal or neural foraminal stenosis.

Output: 1. There is mild to moderate degree of spinal canal stenosis at the L3-L4 and L4-L5 levels which is predominantly on a developmental basis. There are mild superimposed degenerative changes.2. Multilevel facet arthropathy, relatively worse at the right L3-L4 level, which may be contributing to patient's low back pain. There is mild edema/inflammatory change surrounding the right L3-L4 facet joint with subcentimeter fluid collection in the soft tissues posterior inferior to the facet joint. These findings indicating inflammation are nonspecific and infection should be considered in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: pT1N1M0 right tonsil squamous cell carcinoma, status post resection. There are postoperative findings in the right suprahyoid neck without evidence of measurable locoregional mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is mild multilevel degenerative spondylosis. The airways are patent. There is an unchanged left posterior lower neck subcutaneous nodule, which likely represents an inclusion cyst. The imaged intracranial structures and orbits are unremarkable. There is a left internal jugular venous catheter.

Output: Postoperative findings in the right suprahyoid neck without definite evidence of measurable locoregional mass lesions or significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Left ankle pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Small joint effusion. Otherwise no significant abnormality of the left ankle.


Instruction: Generate impression based on findings.

Input: Female 64 years old Reason: evaluate for response/progression History: radiation induced osteosarcoma The left ilium has abnormal low T1 and patchy high T2 signal with a surrounding soft tissue mass, extending anteriorly and posteriorly, which demonstrates irregular peripheral enhancement consistent with known osteosarcoma. The soft tissue mass is significantly increased in size compared to the prior exam measuring approximately 4.9 x 3.4 cm in axial dimensions (series 701, image 44). There is also edema in the musculature surrounding this soft tissue mass. No new foci suspicious for malignancy are identified.In the right ilium, adjacent to the sacroiliac joint there is linear decreased signal with associated increased signal abnormality on fluid sensitive sequences indicating an insufficiency fracture, similar to the prior exam. There is similar signal abnormality indicating a insufficiency fracture in the right sacrum adjacent to the sacroiliac joint.

Output: 1.Left iliac wing osteosarcoma significantly increased in size compared to prior exam.2.Insufficiency fractures adjacent to the right sacroiliac joint as detailed above.


Instruction: Generate impression based on findings.

Input: Multiple myeloma, rule-out new bony metastases Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is loss of normal cervical lordosis. Alignment is otherwise maintained. Bone marrow signal is within normal limits. There is a disk extrusion at the C4-C5 level which indents the ventral cord, left greater than right. No associated cord signal abnormality is seen. No significant change based on limited comparison scout view from thoracic MRI dated 9/22/2014. There is a mild disk bulge at the C3-4, 5-C6, and C6-7 levels with partial effacement of the ventral thecal sac. There is minimal right neural foramina narrowing at the C4-C5 and C5-C6 levels. Neural foramina in the cervical spine are otherwise patent.No evidence of suspicious osseous lesions, pathologic compression fractures, or epidural tumor in the cervical spine.Thoracic Spine: Vertebral body heights in the thoracic spine are normal. Alignment is normal. T1 shortening is noted involving the vertebral bodies in the midthoracic spine consistent with history of prior radiation. Compared to 9/22/2014, there is slight interval decrease in size low T1 signal and enhancement involving the posterior superior aspect of the T7 vertebral body on the right extending into the right pedicle, lamina, and transverse process. Lesion measures approximately 2.2 x 3.0 in the craniocaudal and AP dimensions in the sagittal plane, previously 2.2x3.3 cm.Previously seen subcentimeter area of mild enhancement in the dorsal T4 vertebral body is similar, on the sagittal T1 sequence measuring approximately 7x7 mm. No new lesions in the thoracic spine. No evidence of pathologic compression fracture. No epidural tumor.Thoracic cord is normal in signal and caliber. No significant spinal canal or neural foraminal stenosis in the thoracic spine.Lumbar Spine:There are 5 lumbar type vertebral bodies. Vertebral body heights in the lumbar spine are within normal limits. There is grade 1 anterolisthesis of L4 on L5. There is T1 shortening involving the L5 and sacral vertebral bodies consistent with prior radiation.Compared to MRI dated 9/5/2014, there is no significant change in of destructive, enhancing mass involving the right aspect of the sacrum with involvement of the S1, S2, S3 vertebral bodies. There is however decrease in size compared to 12/20/2013 as noted previously. No new lesions in the lumbar spine or visualized sacrum are appreciated. Unchanged increased T2 signal within the right sacral tumor.Mild degenerative changes are seen as below.L1-L2: No significant disk disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: Minimal disk bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: Minimal disk bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-L5: Advanced facet arthropathy and mild disk bulge result in mild bilateral neural foraminal narrowing. No significant spinal canal stenosis. Moderate fluid in the left facet joint.L5-S1: Advanced bilateral facet arthropathy, disc bulge, and tumor result in moderate to severe right-sided neural foraminal stenosis similar to prior. Severe narrowing of the right S1-S2 neural foramen related to tumor is also again seen similar to prior.

Output: 1. No evidence of disease progression in the spine. No significant change in right T7 and probably tiny T4 lesions. No pathologic compression fractures in the spine or epidural tumor.2. No significant change in size and appearance of visualized destructive right sacral mass with narrowing of the right L5-S1 and S1-2 neural foramina compared to 9/5/2014, although it is much smaller compared to 12/23/2013. Please refer to separate report for additional findings in the pelvis.3. Disc extrusion at the C4-C5 level which indents the ventral cord, left greater than right. No associated cord signal abnormality.


Instruction: Generate impression based on findings.

Input: 85 year-old male with fall and loss of consciousness. CT of brain without infusion.Large vessel intracondylar vascular calcification is noted.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Patchy areas of periventricular lucencies are concerning for small vessel disease considering patient's age. Small area of cortical encephalomalacia in the high convexity left parietal is believed to represent an old small cortical stroke. No evidence of post traumatic findings. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.CT of the cervical spine.Extensive degenerative changes of the cervical spine with significant loss of intervertebral disk height at multiple levels are noted. The alignment of cervical spine remains within normal limits. The facets are aligned and demonstrate no subluxation. A linear defect bilaterally across the pedicles of C6 is noted. There is however no evidence of any malalignment of these pedicles. Considering the patient's history I cannot entirely rule out nondisplaced bilateral pedicular fracture.These findings are best appreciated on sagittal image 15 for the right pedicle of C6 and sagittal images 24 and 25 for the left. Both of these findings are also appreciated on axial images 41 and 42. Follow-up with a repeat thin cuts CT and or an MRI is recommended.Dr. Watts from the emergency service was notified of the findings at the time of interpretation.

Output: 1.Unremarkable CT of brain without infusion.2.Suspected bilateral C6 pedicular fracture as detailed.3.Extensive degenerative changes of cervical spine.4.No malalignment of the cervical spine.


Instruction: Generate impression based on findings.

Input: Dizziness, giddiness and orthostatic hypotension. Also peripheral neuropathy. Question autoimmune process.Additional clinical history from the electronic medical record: History of anxiety, palpitations, and dizziness in the past (on Xanax). Presented with orthostatic tachycardia with syncope and dizziness on standing, in the context of recent foot dysesthesias. Workup at Methodist Hospital revealed high ANA, >12 CSF oligoclonal bands, but no CSF leukocytosis. She also has a few asymptomatic white matter lesions with no corresponding neurological exam findings, of uncertain significance. Her nonfocal neurological examination, history of orthostatic tachycardia and symmetric distal LE dysesthesias are suspicious for an underlying autoimmune disorder such as MS with transverse myelitis (vs a small fiber neuropathy), SLE, Sjogren's, or a paraneoplastic antibody syndrome. Brain:There is a relatively well-defined, juxtacortical T1-hypointense, T2-hyperintense lesion in the inferior left parietal lobe. In addition, the lesion shows a targetoid or concentric morphology on T2 imaging with a hyperintense center surrounded by a relatively hypointense ring and a hyperintense rim. There are at least three T2-hyperintense lesions in a periventricular distribution. The largest is just anterior to the frontal horn of the left lateral ventricle and measures up to 9 mm. Additional ones are present along the body of the lateral ventricles.There are smaller, less specific T2-hyperintense lesions scattered in the white-matter of both cerebral hemispheres. There is no diffusion restriction or intracranial hemorrhage. The corpus callosum is unremarkable in volume and signal intensity as well as the brainstem, accounting for perivascular spaces. There is no mass-effect, midline shift or brain herniation. The ventricles and other CSF-containing spaces are normal in size.The orbits are unremarkable. Major intracranial vascular flow voids are preserved. There is no destructive skull lesion or significant scalp soft tissue abnormality.Cervical spine:There are two T2-hyperintense peripheral spinal cord lesions at the upper C5 level. One involves the right ventrolateral aspect and a smaller one involving the right dorsal aspect of the spinal cord. The larger, anterior lesion spans craniocaudally just under a full vertebral body height. There is no other cervical cord signal abnormality.Sagittal alignment is notable for straightening which can be positional. The vertebral bodies are preserved in height and there is no suspicious marrow lesion. There is disc desiccation at all the cervical levels. Disc heights are preserved except for moderate loss at C5-C6, where an eccentric to the left disc bulge causing mild-to-moderate spinal canal stenosis and minimally indenting the spinal cord, especially on the left side. However, there is no spinal cord signal abnormality and the CSF space posterior to the spinal cord at this level is preserved. A small ventral indentation of the thecal sac but no significant spinal canal stenosis is present at C6-C7 by a central disc extrusion with minimal caudal migration. There is no neural foraminal stenosis. There is minimal ventral indentation of the thecal sac by the C3-C4 disc but no signal spinal canal stenosis. There is also no spinal canal stenosis at the other cervical levels. There is suggestion of rightward deviation of the uvula. This can be better assessed clinically, as it may be adherent to adjacent mucosa. Included cervical soft tissues are unremarkable, otherwise. Major neck vessels show preserved flow voids.Thoracic spine:There is a fairly large central, T2-hyperintense lesion involving the spinal cord at T9-T10 level, measuring up to 5 mm transaxially. In addition, there are two peripheral T2-hyperintense cord lesions; small one on the left at T5-T6 level and a larger one on the right at the upper T8 level. Sagittal alignment is preserved. The vertebral bodies are preserved in height. There is no suspicious marrow lesion. There is a small fat-containing hemangioma in T4 vertebral body. The thoracic discs are preserved. The spinal canal is preserved. There is mild facet arthropathy in the lower thoracic spine. There is no spinal canal or foraminal stenosis.The thyroid gland is mildly enlarged, especially the right lobe, though without a dominant focal lesion.Lumbar spine:Sagittal alignment is anatomic. There is disc desiccation and height loss in addition to type II degenerative marrow signal at L5-S1 but only a small disc bulge, barely indenting the ventral aspect of thecal sac. There is mild facet arthropathy contributing to mild narrowing of the neural foramina. A small bulge is present also at L4-5 but without significant spinal canal or foraminal stenosis. There is no significant degenerative disease or stenoses at the other levels. Conus medullaris shows normal signal and morphology. The tip of the conus lies at L1-L2 level. Cauda equina roots are normal, symmetrically distributed in the thecal sac.Subcentimeter, well-circumscribed, homogeneously T2-hyperintense, T1-hypointense central right and peripheral left renal lesions are likely cysts though not completely assessed. A small T2-hypointense lesion within the fundic myometrium likely represent leiomyoma. A larger, more elongated T2-hypointense lesion involving the dorsal myometrium with mild distortion of the uterine outline is probably also a leiomyoma.

Output: 1.Few small cerebral white-matter lesions. The largest is juxtacortical in the left parietal lobe. In addition, there are at least 3 periventricular bifrontal lesions as well as a few smaller scattered nonspecific ones. 2.A few scattered spinal cord lesions. The largest is a central lesion at T9-T10 level. The other lesions are peripherally located.3.Mild degenerative cervical and lumbar spondylosis as described above.4.Suggestion of rightward deviation of the uvula. Please correlate with direct inspection.5.Suspected uterine fibroids. If further assessment is needed, please consider pelvic ultrasound. While each of the brain lesions in isolation is nonspecific, the constellation and the distribution of the brain lesions as well as the presence of the cord lesions is suggestive of a demyelinating disorder such as multiple sclerosis. However, dissemination in time cannot be confirmed on a single, noncontrast-enhanced MR examination.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for perirectal abscess History: perineal pain, exam sig for tenderness in posterior vaginal vault, left perineum PELVIS:BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction is evident.BONES, SOFT TISSUES: There is a complex fluid collection posterior to the rectum with possibly small foci of gas that abuts the 6:00 position of the anorectal junction. The abscess measures 2.0 x 1.8 cm. There is moderate to severe surrounding inflammation. There is an inflammatory tract extending along the left aspect of the rectum without definite fistula. There is some inflammation in the left medial thigh.OTHER: No significant abnormality noted.

Output: 1.Small perirectal 2 cm abscess about the 6:00 position of the anorectal junction without definite fistulization to the skin however, there appears be some inflammation along the left perianal region which may represent a developing fistula. There is some inflammation in the left medial thigh as well.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma follow up. There has been further increase in size of the inferior component that projects into the sphenoid sinuses, measuring up to 27 mm, previously 22 mm. The suprasellar component also appears to have slightly increased in size, measuring up to 29 mm in width, previously 27 mm. Nevertheless, there is a similar degree of right cavernous sinus extension with partial encasement of the right cavernous carotid artery. Likewise, there does not appear to be significantly increased mass effect upon the right prechiasmatic optic nerve and optic chiasm. The pituitary stalk remains deviated to the right. There are numerous foci of T2 hyperintensity in the partially-imaged cerebral white matter, which likely represent chronic small vessel ischemic disease.

Output: Further interval increase in size inferior component of the pituitary macroadenoma that projects into the sphenoid sinuses.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow-up newly found ventricular mass. Signs and symptoms: Left eye vision loss. Pre and post cervical MRI:Examination demonstrate no evidence of abnormal enhancement of the vertebral column, cord or the leptomeninges to suggest malignancy/metastatic disease.Foramen magnum is unremarkable.C2-C3 demonstrate degenerative changes without spinal stenosis or neural foraminal compromise.C3-C4 demonstrate advanced disc disease and loss of disc height, mild facet and ligamentum flavum hypertrophic/degenerative changes. There is mild kyphotic deformity of cervical spine centered at this level secondary to degenerative changes. Constellation of findings results in flattening and posterior displacement of the cord (R>L) and moderate central spinal stenosis. Significant right and mild left neural foraminal compromise is also detected.C4-C5 demonstrate mild disc disease and degenerative changes of posterior elements without central spinal stenosis or neural foraminal compromise.C5-C6 demonstrate mild disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. No central spinal stenosis however moderate left and mild right neural foraminal compromise is present.C6/C7 demonstrates mild disc disease and mild facet ligamentum flavum degenerative changes without spinal stenosis or neural foraminal compromise.C7-T1 is unremarkable.Incidental note is made of a prominent right lobe of thyroid which is poorly visualized on this exam and recommend follow-up with dedicated imaging. Incidental note as well is made of partially visualized postoperative changes of transsphenoidal hypophysectomy.Pre- and post enhanced thoracic MRI:The alignment of vertebral column is anatomical.The signal intensity of vertebral column is unremarkable.The signal intensity and caliber of the thoracic cord is within normal limits.There is no detectable abnormal enhancement of the vertebral column, thoracic cord or the leptomeninges.Mild degenerative changes of thoracic spine is noted however without evidence of spinal canal or neural foraminal compromise.Pre and post lumbar MRI:There is normal anatomical alignment and signal intensity of vertebral column without abnormal enhancement.The lower most visualized thoracic cord, conus and the cauda equina is unremarkable and without abnormal enhancement.T12-L1 is unremarkable exception of mild hypertrophic changes of posterior elements.L1-L2 is unremarkable with the exception of mild degenerative changes of posterior.L2-L3 demonstrate mild facet and ligamentum flavum hypertrophy and unremarkable otherwise.L3-L4 demonstrate mild to moderate ligamentum flavum hypertrophy and mild facet disease without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild to moderate disc disease, loss of disc height, moderate left and mild right facet and ligamentum flavum hypertrophic changes. Examination of this level also demonstrates a broad-based disc protrusion extending from midline laterally with resultant moderate left lateral recess compromise and mild central spinal and left neural foraminal stenosis.L5-S1 demonstrate mild degenerative changes and unremarkable otherwise.Unremarkable visualized SI joints.Unremarkable. Spinal soft tissues.

Output: 1.Pre- and post enhanced MRI of cervical spine demonstrate no evidence of a mass or malignancy. Extensive degenerative changes at C3-C4 with resultant mild reversal of cervical lordosis and central spinal stenosis as detailed. Mild degenerative changes at other levels without central spinal stenosis. No detectable abnormal enhancement of the cord or the vertebral column and normal signal intensity and caliber of the cervical cord.2.Pre- and post enhanced MRI of thoracic spine is unremarkable other than mild degenerative changes. No detectable abnormal enhancement of the vertebral column, cord or the leptomeninges.3.Pre- and post enhanced lumbar MRI demonstrate no evidence of a mass or malignancy. Degenerative changes at L4/L5 and including a left sided disc protrusion resulting in mild central spinal stenosis, moderate left lateral recess compromise and left neural foraminal compromise as detailed above.4.Incidental note on this exam is made of a Tornwaldt cyst, partially visualized postoperative changes of transsphenoidal hypophysectomy and prominence of right lobe of thyroid which can be further assessed with dedicated imaging.


Instruction: Generate impression based on findings.

Input: 58-year-old female with history of primary sclerosing cholangitis. Evaluate for hepatocellular carcinoma or cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Again seen are multifocal intra- and extrahepatic biliary ductal strictures, including focal stricture at Klatskin point and short segment mid common bile duct stricture, unchanged in morphology. There is hyperenhancement of the ducts at Klatskin's point without a mass or nodularity, unchanged compared to the previous examination. No new dominant stricture or suspicious hepatic mass is identified to suggest HCC or cholangiocarcinoma. Cholecystectomy.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 visualized colon wall demonstrates restricted diffusion and enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in findings of PSC affecting the intra-and extrahepatic biliary tree. 2.No evidence of cholangiocarcinoma or HCC.3.Findings consistent with colitis.


Instruction: Generate impression based on findings.

Input: A 54 year old female with past history of patent foramen ovale close in 2008 with a occluder device, then diagnosed with mild left ventricular dysfunction and right ventricular enlargement by echocardiography. A cardiac MRI on 4/2014 showed normal left and right ventricular function with no late gadolinium enhancement. Referred now for cardiac MRI to evaluate cardiac function. Left VentricleThe left ventricle is normal in size with mild systolic dysfunction. There is mild reduced contractility of the apical anterior and inferior walls compared to the previous exam. There is slight paradoxical motion of the interventricular septum which may be conductional, stable. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 79 ml/m2 (normal range: 65+/-11), the LVEDV is 163 ml (normal range 109+/-23), the LV end systolic volume index is 41 ml/m2 (normal range 18+/-5), the LVESV is 85 ml (normal range 31+/-10), the LV mass index is 37 g/m2 (normal range 67+/-11), and the LV mass is 75 g (normal range 114+/-24). Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 88 ml/m2 (normal range 69+/-14), the RVEDV is 180 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 90 ml (normal range 35+/-13). Left and Right AtriumThe left and right atrium are mildly dilated. Susceptibility artifact in located at the interatrial septum which may be the PFO closure device.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation which visually appears mild but was not quantified.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. No thoracic aortic aneurysm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.

Output: 1. The left ventricle is normal in size with mild systolic dysfunction, with an LVEF of 48%, reduced from 55% in 2014. 2. The right ventricle is normal in size with normal systolic function, the RVEF is 50%, also slightly decreased from prior exam.3. The left and right atrium remain mildly dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient presenting with memory loss, evaluate. Scattered areas of T2 hyperintensity in the subcortical and periventricular deep white matter have slightly progressed as compared to the prior exam. There is no evidence of acute infarct. There is mild diffuse cerebral volume loss, appearing similar to prior exam. There appears to be an unchanged punctate focus of susceptibility effect in the inferior left temporal lobe, which may represent a chronic microhemorrhage. 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: Minimal progression of mild scattered areas of signal abnormality in the subcortical and periventricular deep white matter, which are suggestive of chronic microvascular ischemic disease, but no evidence of acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 88 years Female (DOB:7/22/1927)Reason: fall with c2 fx, ?hematoma History: neck painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG Cervical spine:There is traumatic spondylolisthesis of C2 (Hangman's fracture) associated with mild (2mm) anterior subluxation of C2 on C3, 4mm posterior displacement of C2 posterior elements . Fracture lines extend into the vertebral foramina at C2 and a small fracture fragment extends into the left vertebral foramen. There is no evidence for vertebral artery dissection. There is fluid within the C1-2 articulations and adjacent high signal within the lateral masses of C1 and C2.No foci of diffusion restriction are present in the brain.There is fluid ventral to the upper cervical vertebral bodies. There is some The cervical vertebral bodies are appropriate in overall height. At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level. There are endplate and uncovertebral osteophytes at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level. There are endplate and uncovertebral osteophytes at this level with mild narrowing of the left neural foramen,At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level. There are endplate and uncovertebral osteophytes at this level with mild narrowing of the left neural foramen,At C7-T1 there is no significant compromise to the spinal canal or neural foramina.Since the prior CT exam circumferential thickening of the epidural space has resolved and was likely related to epidural venous engorgement from collateral venous flow.There is subdural effusion in the posterior fossa likely related to brain atrophy.The right lobe of the thyroid is enlarged and the thyroid id heterogenous.MRA neck:There is a 7x9mm pseudoaneurysm along the left vertebral artery. It originates at the proximal v3 segment at the proximal end of the vertebral foramen and is directed superiorly. There is subtle signal hyperintensity within the left half of the epidural venous plexus at this level. On the contrast enhanced MRV there is contrast present along the adjacent venous structures during the arterial phase of image acquisition. This is less dramatic than on the CTA where the pseudoaneurysm was obscured by the venous engorgement.There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is a 7x9mm pseudoaneurysm along the V3 segment of the left vertebral artery associated with an arteriovenous fistula which is less dramatic than on the CTA. This could represent a traumatic arteriovenous fistula on the CTA which is now regressing but has not resolved. A follow-up MRA using the same exact technique in 24 hours may help monitor its progress,2.Traumatic spondylolisthesis of C2 associated with fracture lines extending into the vertebral artery foramina. There is associated bone edema and ligamentous injury.3.Since the prior CT exam circumferential thickening of the epidural space has resolved and was likely related to epidural venous engorgement from collateral venous flow.4.There is no evidence for acute ischemic cerebral infarction.5.Enlarged right thyroid lobe. Please note that MRI and CT are not accurate in the evaluation of the thyroid.6.Findings were discussed with Dr Roitberg


Instruction: Generate impression based on findings.

Input: Male 78 years old Reason: cause of severe pain right groin radiating to buttocks status post stent in place for renal stones. E faecalis bacteremia. History of recurrent colon cancer with lung metastases. History: severe pain right groin radiating to buttocks; back pain Bilateral psoas abscesses and lumbar spine osteomyelitis is better evaluated on lumbar spine MRI. T2 hyperintense edema signal extends inferiorly along the iliopsoas bilaterally. Subchondral cyst formation is noted in the femoral heads bilaterally, right greater than left, most likely degenerative in etiology. There is no significant joint effusion.

Output: Bilateral psoas abscesses and lumbar spine osteomyelitis, better evaluated on lumbar spine MRI. Degenerative changes in the hips.


Instruction: Generate impression based on findings.

Input: 35 years Female (DOB:9/27/1981)Reason: r/o structural causes of migraine headaches with vertigo History: chronic headaches with recent increase in frequency and character PROVIDER/ATTENDING NAME: SANDRA NAAMAN SANDRA NAAMAN The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no intracranial mass lesion appreciated. MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: Reason: stones? History: RUQ pain, lots of stones in RUQ ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without significant biliary dilatation. No choledocholithiasis. Hepatic steatosis. Mild enhancement of the common bile duct can be seen in cholangitis.SPLEEN: No significant abnormality noted.PANCREAS: No ductal dilatation or mass. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis with no MRI evidence of cholecystitis. There is mild enhancement of the common bile duct which may reflect mild cholangitis.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for lytic lesions History: pain Again seen is a lobulated subcentimeter focus of intermediate signal intensity on T1-weighted images which is hyperintense on T2-weighted images within the intertrochanteric region of the left femur. There is enhancement following gadolinium administration. This measures 6 mm in the transverse dimension and approximately 7 mm in the craniocaudal dimension. These dimensions are identical to those seen on the prior examination. The reference L5 vertebral body lesion also appears unchanged. The hip joints and sacroiliac joints appear normal. The pubic symphysis appears normal. The imaged musculature of the pelvis is unremarkable.

Output: 1. Small focus of signal abnormality in the left intertrochanteric region appears similar to the prior study. While its is possible that this may represent the residua of a treated metastases, this could represent a benign cartilaginous rest.2. Treated L5 metastatic lesion, appearing similar to the prior study. No new findings.


Instruction: Generate impression based on findings.

Input: Diagnosis: Headache(784.0)Subarachnoid hemorrhageClinical question: Please evaluate for lesions that may cause SAHSigns and Symptoms: headache, h/o SAH The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a linear increased T2 signal tract representing an old ventriculostomy tract located in the right frontal lobe.A previously noted punctate focus of diffusion restriction in the right parietal lobe white matter is reidentified and is associated with signal loss on SWI. The signal loss on SWI was not present on the prior exam. There are a couple other foci of punctate signal loss on SWI in the left temporal lobe and in the right occipital lobe adjacent to the right occipital horn.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are several microhemorrhages identified within the brain parenchyma. These were not readily seen on the prior exam.2.There is no evidence for leptomeningeal disease.3.There is no MRI evidence for intracranial hypotension.4.There is no abnormal intracranial mass lesion identified.


Instruction: Generate impression based on findings.

Input: Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: Negative MRI of the internal auditory canals including gadolinium enhancement.


Instruction: Generate impression based on findings.

Input: Reason: Gall stone pancreatitis History: Pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensity, likely a cyst. Common bile duct appears normal without stones.SPLEEN: No significant abnormality noted.PANCREAS: There is a multiloculated cystic lesion within the lesser sac along the lesser curvature which measures 3.4 x 2.8 cm (501/29), previously 3.4 x 3.1 cm. This lesion demonstrates low ADC and peripheral enhancement. There is a sinus tract approaching the main pancreatic duct, however no definite communication is evident.There is focal dilatation of the mid pancreatic duct up to 5 mm with narrowing within the head, likely representing a structure.The body and tail the pancreas demonstrates low T1 signal, increased T2 signal and mild peripancreatic edema consistent with acute pancreatitis. No evidence of necrosis. Portal venous system is intact. No pseudoaneurysms.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pseudocyst formation within the lesser sac, similar to the prior CT.2.Abnormal signal and adjacent edema in the pancreatic tail is suggestive of acute pancreatitis.3.Focal narrowing in the pancreatic head with associated ductal dilatation, likely representing a stricture.


Instruction: Generate impression based on findings.

Input: 27 years Male (DOB:12/11/1988)Reason: MS, f/u progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED There is redemonstration of multiple T2 and FLAIR hyperintense lesions in the corpus callosum, some periventricular white matter especially adjacent to the trigones of the lateral ventricles, the right internal capsule the right posterior lateral cervical cord at the C1 level, cerebellum, cervical medullary junction, brainstem as well as subcortical white matter in the frontal lobes. This appears stable compared to the previous exam.There is a hyperintense appearance along the optic nerves is present. It is suspected that this is artifactual.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple lesions scattered throughout the brain which are stable compared to prior exam and compatible with patient's diagnosis of multiple sclerosis.2.Signal hyperintensity on T2 and FLAIR imaging on the optic nerves is suspected to be artifactual. Please correlate with patient's clinical symptoms related to the optic nerves to confirm.


Instruction: Generate impression based on findings.

Input: Firm nodule in the left medial eyelid. There is a T1 and T2 hyperintense cystic lesion in the subcutaneous tissues of the medial left upper eyelid, which measures 7 mm in diameter. The orbital contents are otherwise unremarkable bilaterally. The imaged intracranial structures and paranasal sinuses are unremarkable.

Output: A cystic lesion in the subcutaneous tissues of the medial left upper eyelid, which measures 7 mm in diameter, likely represents an inclusion cyst.


Instruction: Generate impression based on findings.

Input: Female 54 years old with right knee pain; no locking presently. Evaluate for degenerative joint disease. The bones appear slightly demineralized but the knee otherwise appears normal for age. No specific findings to account for the patient's pain.

Output: Slightly demineralized bones but normal-appearing knee.


Instruction: Generate impression based on findings.

Input: 79 year-old female with fever, evaluate for osteomyelitis Ankle: There is slight increased T2 signal, likely representing edema within the posterior aspect of the calcaneus without T1 marrow changes to indicate osteomyelitis. Mild overlying soft tissue irregularity is noted. The lateral and medial collateral ligaments are intact. The Achilles tendon is intact.Foot: Bone marrow signal is within normal limits. There is increased T2 signal likely represent edema within the soft tissues posterior to the metatarsals. The soft tissue structures are otherwise unremarkable.

Output: Mild edema along the posterior calcaneus which is likely reactive without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate sinuses. Signs and symptoms: New headaches with sinusitis. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.There is normal anatomical morphology/development of brain and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable calvarium and orbits and without abnormal enhancement.All visualized mastoid air cells and middle ear cavities are unremarkable.There is minute mucosal thickening in the dependent right maxillary sinus. There is minute mucosal thickening in the left dependent maxillary sinus and a small retention cyst measuring approximately at 15 x 16 mm. All other paranasal sinuses demonstrate normal pneumatization signal pattern. There is moderate leftward deviation of nasal septum and suspected small bony septal spur which is in contact and deforms the mucosal lining of the left inferior turbinate.

Output: 1.Negative pre and post enhanced brain MRI.2.Minimal chronic maxillary sinusitis and unremarkable all paranasal sinuses otherwise.3.Moderate leftward nasal septum deviation and suspected a small bony septal spur as detailed.


Instruction: Generate impression based on findings.

Input: Knee pain and tenderness despite conservative management. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits without fracture or bone marrow edema. There is mild thinning of the articular cartilage of the patellofemoral compartment without focal defects. The articular cartilage is otherwise intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Mild degenerative changes. Menisci and ligaments are intact.


Instruction: Generate impression based on findings.

Input: Male, 62 years old. Right knee locking, mechanical symptoms, medial joint line tenderness MENISCI: There is increased signal intensity along the posterior horn of the medial meniscus near its junction with the body of the meniscus, indicating a horizontally oriented undersurface tear. While it is possible that this could represent a flap tear, we see no displaced meniscal fragment at this time. The anterior horn appears normal. A small focus of signal abnormality seen on a single image within the body of the lateral meniscus near its junction with the anterior horn may represent a small vertically oriented tear, but this is equivocal and not necessarily of any clinical significance.ARTICULAR CARTILAGE AND BONE: There is delamination of the articular cartilage along the anterior aspect of the lateral femoral condyle with foci of degenerative signal abnormality in the underlying subchondral bone, surrounded by marrow edema. Mild heterogeneity of the articular cartilage of the medial femoral condyle above the posterior horn of the medial meniscus with small irregularly spaced foci of signal abnormality in the underlying bone may represent a site of prior microfracture. There is a full-thickness cartilage defect along the anterior aspect of the medial femoral condyle. There is severe degeneration of the articular cartilage of the patella superiorly with full-thickness cartilage loss and delamination and degenerative signal abnormality in the underlying bone. There is mild edema-type signal abnormality in the medial tibial plateau beneath the meniscal tear that is likely degenerative in etiology.LIGAMENTS: The cruciate and collateral ligaments are intact. There is edema within the medial subcutaneous fat of the knee, including along the medial collateral ligament which could reflect a sprain in the correct clinical context. EXTENSOR MECHANISM: The extensor mechanism appears intact, although there is edema in the soft tissues anterior to the patella and patellar tendon which is nonspecific.ADDITIONAL

Output: 1.Undersurface tear of the medial meniscus as described above.2.Tricompartmental cartilage abnormalities as described above including delamination of the articular cartilage of the lateral femoral condyle anteriorly with extensive subchondral edema in the underlying marrow. There is also severe degeneration of the articular cartilage of the patella.3.Nonspecific edema within the anterior and medial soft tissues of the knee as above. The possibility of a mild medial collateral ligament sprain and mild inflammation around the pes anserine tendons is considered in the correct clinical context.4.Irregular hypointensity within the lumen of the popliteal vein and its branches with surrounding increased vascularity may reflect chronic deep venous thrombosis, or less likely a vascular malformation. Of note, review of the patient's medical record indicates a history of chronic deep venous thrombosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for lumbar disc disease. Reported the disc bulging on prior imaging at OSH years ago. Signs and symptoms: Some radiculopathic pain down right lower extremity. High doses of hydrocodone. Nonenhanced lumbar MRI:Examination demonstrates normal signal intensity and alignment of vertebral column and without detectable fracture.There is no evidence of a spinal stenosis in the lumbar spine at any level. There is no detectable neural foraminal compromise at any level. Mild degenerative disc disease and hypertrophic changes of posterior elements of present. There is no detectable abnormal bulge of disc, disc protrusion or extrusion at any level.Partially visualized lower thoracic spine at T11-T12 demonstrate advanced disc disease and loss of disc height as well as mild degree of central spinal stenosis secondary to degenerative disease. Neural foraminal at this level are fully visualized and cannot be assessed. The signal intensity of lower most visualized thoracic cord, conus and cauda equina is within normal.

Output: 1.Nonenhanced MRI of the lumbar spine demonstrate no spinal stenosis or neural foraminal compromise.2.Mild degenerative changes are noted. Partially visualized T11-T12 disc level demonstrates moderate disc disease and loss of disc height and suspected mild central spinal stenosis.3.Normal signal intensity and caliber of lower most visualized thoracic cord, conus and the cauda equina.4.Partially visualized right lower thoracic cavity demonstrate pleural effusion symmetrically 17 mm in thickness. Review of prior CT of chest from 8-31-14 demonstrated right-sided pleural effusion as well. Correlate with clinical symptoms and consider follow-up with dedicated imaging.


Instruction: Generate impression based on findings.

Input: 61-year-old male with Gleason 6 prostate cancer on prior core biopsy (left mid lateral) on active surveillance PELVIS:PROSTATE:Prostate Size: 5.3 x 3.1 x 4.0 cm.Peripheral Zone: Heterogeneous T1 hyperintensity and T2 hypointensity throughout the peripheral gland compatible with hemorrhage, possibly from recent biopsy. There is a 14 x 9 mm T2 hypointense lesion in the right midgland peripheral zone with corresponding restricted diffusion. Central Gland: Moderate to severe degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: The aforementioned lesion abuts but does not demonstrate extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited examination due to heterogenous T1 hyperintensity and T2 hypointensity throughout the peripheral zones of prostate gland compatible with hemorrhage, possibly from recent biopsy. 2.Within above limitations, suspicious T2 hypointense lesion in the right midgland peripheral zone with corresponding restricted diffusion.


Instruction: Generate impression based on findings.

Input: Redemonstrated are postsurgical changes related to a left frontal craniotomy for resection of a brain metastasis. There is stable mild dural thickening and enhancement subjacent to the craniotomy. There is stableT2/FLAIR signal abnormality surrounding the resection cavity. Susceptibility artifact within the resection cavity is unchanged and likely represents old blood product. A small round 4 mm focus of apparent enhancement in the anterior temporal lobe as well as a more posteriorly located focus of curvilinear enhancement within the inferior left temporal lobe are noted on SPGR postcontrast imaging. However these cannot be confirmed on any other imaging sequence and there is no associated edema. Therefore, these findings may be artifactual but close interval follow-up is suggested. Scattered periventricular and subcortical T2 hyperintensities are nonspecific but may be related to mild chronic small vessel ischemic disease. The ventricles are within normal limits. The cisterns remain patent. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There are bilateral lens implants.

Output: 1.Stable postsurgical changes and T2/FLAIR signal in the left frontal lobe without evidence of tumor recurrence in the surgical bed. 2.Small round 4 mm focus of apparent enhancement in the anterior temporal lobe as well as a more posterior focus of curvilinear enhancement within the inferior left temporal lobe are noted on SPGR postcontrast imaging. However these cannot be confirmed on any other imaging sequence and there is no associated edema. Therefore, these findings may be artifactual but close interval follow-up is suggested. 3.Findings were discussed with the primary service time of this dictation.


Instruction: Generate impression based on findings.

Input: Confusion, ataxia There is a globular and elliptical shaped enhancing mass starting from the right basal ganglia extended superiorly toward right caudate head and downward to the level of right midbrain with the extensive surrounding edema. The longitudinal diameter of the mass is measured about 43.7 mm in transverse diameter was measured around 23 mm. There is also midline shift toward left side at the level of the third ventricle measured around 6 mm.Due to significant motion artifact during susceptibility imaging, intralesional hemorrhagic foci cannot be evaluated precisely.There is no evidence of restricted diffusion on the scan.There is no evidence of additional enhancing lesion on the scan.The differential diagnosis of this intra-axial mass includes primary brain tumor such as high-grade glioma or metastatic lesion.Underlying brain shows multiple encephalomalacia seen including right external capsule left cerebellar hemisphere and right posterior edema of internal capsule indicate chronic ischemic infarct related encephalomalacia seen.Moderate degree nonspecific small vessel ischemic disease is also seen.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Intra-axial mass centered at the level of right basal ganglia extends from right caudate nucleus to the level of right midbrain with contrast enhancement, surrounding edema and mass effect as described above. Differential diagnosis includes primary malignant brain tumor or metastasis2. Underlying brain shows multifocal chronic ischemic infarcts with encephalomalacia seen as well as moderate degree nonspecific small vessel ischemic disease.3. There is no evidence of acute ischemic lesion on the scan.


Instruction: Generate impression based on findings.

Input: History of melanoma. ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology and signal intensity. 1.8 x 1.6 cm lesion in the peripheral aspect of segment VII (series 10/39) demonstrates intermediate T2-weighted signal hyperintensity and restricted diffusion. The lesion demonstrates peripheral rim enhancement, with mild internal enhancement and central necrosis. There is surrounding perfusion abnormality on arterial phase imaging which becomes isointense to liver parenchyma on portal venous and delayed imaging.No additional liver lesions. No biliary ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.8 cm peripheral segment VII lesion is most suspicious for metastatic disease given the patient's history. It is mildly increased in size compared to the 2/23/2016 CT accounting for technical differences.


Instruction: Generate impression based on findings.

Input: 74-year-old with a history of TIA, peripheral vascular disease, diabetes, status post carotid endarterectomy, brought to the ER after physical therapy with suspected facial droop and slurred speech. Now at baseline per daughter. Rule out acute ischemic or hemorrhagic event. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease of indeterminate age. However, if there is concern for an acute stroke, an MRI is recommended for further evaluation.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease of indeterminant age. No definite acute findings, however if there is concern for an acute stroke an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Laminectomy L1-4, diskectomy L3-4 in 3/12: right radicular pain. There are postoperative findings related to laminectomy at L1-4. There is a small disc protrusion eccentric to the right with an annular fissure at L3-4, as well as bilateral facet arthropathy with joint effusion. There is associated moderate right and mild left neural foraminal stenosis, but no significant spinal canal stenosis. There are slight disc bulges at L1-2, L2-3, and L4-5 and facet arthropathy, but no significant spinal canal or neural foraminal stenosis. There is no significant spinal canal or neural foraminal stenosis at L5-S1 either. The lumbar vertebral alignment is unchanged, without evidence of spondylolisthesis. There are scattered areas of degenerative endplate signal alterations. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Postoperative findings related to laminectomy at L1-4. A disc protrusion eccentric to the right with an annular fissure at L3-4 is associated moderate right and mild left neural foraminal stenosis, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 85-year-old female with bilateral apparently non-functional adrenal masses. Evaluate for change in adrenal masses. ABDOMEN:LIVER, BILIARY TRACT: Stable cyst of the left hepatic lobe (series 1101 image 26). The 1 x 0.9 cm T2 hyperintense focus of hepatic segment 2 (series 1101 image 27) is stable in size, and the prior exam demonstrated post contrast imaging characteristics compatible with a benign hemangioma. Contrast was not given the current exam. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule measuring 2.1 x 1.5 cm (series 501 image 17) is stable in size. The left adrenal nodule measuring 1.6 x 1.2 cm (series 501 image 18) is stable in size. Both adrenal nodules demonstrate loss of signal on the out of phase sequences compatible with benign adenomas.KIDNEYS, URETERS: Stable bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable size of the bilateral benign lipid-rich adrenal adenomas; based on imaging no additional surveillance imaging needed.2.Stable hepatic and renal cysts.3.Previously characterized hepatic hemangioma is stable in size.


Instruction: Generate impression based on findings.

Input: 65-year-old male with history of kidney cancer. Evaluate for metastatic disease. Evaluate lesions in the liver. ABDOMEN:Left subpleural nodule measuring approximately 4 mm is not appreciated on this MRI examination.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct size is upper limits of normal without an obvious lesion. There is a fatty cleft within the pancreatic body.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: RIGHT KIDNEY: There is a 1.5 x 1.1 cm T1 hyperintense, T2 hypointense focus at the right nephrectomy site which does not demonstrate contrast enhancement or diffusion restriction. This lesion has decreased in size compared to the previous examination where it measured 2.3 x 2.5 cm. This is most likely post operative in etiology. There are 2 additional subcentimeter foci within the right kidney which demonstrates T1 hypointensity and T2 hyperintensity without corresponding diffusion restriction or enhancement, was compatible with cysts.LEFT KIDNEY: There is a 3.6 x 4.2 cm (series 10, image 21), T1 isointense and T2 hypointense focus, which demonstrates diffusion restriction. While there is suspected minimal enhancement, given appearance of this lesion and diffusion restriction, this is a suspicious mass. This mass was not well visualized on the prior noncontrast CT examination but is stable in size compared to the 8/20/2014 contrast enhanced CT examination.There are additional subcentimeter T2 hyperintense foci with corresponding T1 hypointensity; there is no diffusion restriction or contrast enhancement. These are compatible with simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Suspicious left renal lesion measuring up to 4.2 cm as detailed. Differential considerations include papillary versus chromophobe renal cell carcinoma.2.Subcentimeter bilateral renal cysts.3.Interval decrease in size of the right nephrectomy bed postoperative collection, likely hematoma.


Instruction: Generate impression based on findings.

Input: Pain The femur appears normal, with no findings to account for the patient's pain.

Output: Normal-appearing femur without findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Male 65 years old with high volume Gleason 4+3 prostate cancer in left lobe and Gleason 3+4 prostate cancer in right lobe. PELVIS:PROSTATE:Prostate Size: 5.7 x 3.9 x 4.9 cm.Peripheral Zone: Linear foci of T1 hyperintensity are compatible with mild hemorrhage from prior biopsy. There is a lesion in the centered in left mid gland (appears to extend from base towards apex) that is hypointense on T2 and ADC demonstrates early contrast enhancement suspicious for adenocarcinoma. It measures 20 x 11 mm in the midgland (series 1001, image 16) and 11 x 8 mm in the apex (series 1001, image 12). There is indistinctness of the capsule at the level of the lesion, suspicious for extracapsular extension, and abutment of the neurovascular bundle. A small focus in the right midgland/apex (series 1001, image 13) has similar imaging characteristics and is suspicious for an additional site of adenocarcinoma (series 1001, image 13).Central Gland: Multiple BPH nodules.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Indistinctness of the capsule in the left mid gland suspicious for extracapsular extension with abutment of the neurovascular bundle.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral foci suspicious for prostate adenocarcinoma with findings concerning for extracapsular extension and involvement of the neurovascular bundle on the left.


Instruction: Generate impression based on findings.

Input: Reason: Hx Knee arthroscopic debridement History: Pain and Patella subluxation MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is moderate diffuse degeneration of the articular cartilage of the patella, most severely affecting the central portion of the lateral facet with at least one partial thickness fluid-filled cleft. The articular cartilage of the femoral trochlea appears relatively intact as does the articular cartilage of the femorotibial compartment. Bone marrow signal intensity is normal. The femoral trochlea appears shallow, indicating dysplasia. The Insall-Salvati ratio is within normal limits. The TTTG is approximately 1.6 cm, which is borderline.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. The medial patellofemoral ligament appears intact.ADDITIONAL

Output: Patellar cartilage degeneration with femoral trochlear dysplasia and other findings as above.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: h/o GBM, intracranial tumor recurrence History: h/o GBM, intracranial tumor recurrence Significant interval increase in size of the left parietal mass with increased extent of surrounding edema [now measures 62.7mm (AP) x 42.4mm (RL) x 61.2mm (CC)].The anterior inferior aspect of the mass shows extension of tumor mass toward left lateral ventricle occipital horn with ependymal enhancement indicating possible ependymal invasion.Previously seen left temporal extra axial mass lesion is not seen on today's scan.There is about 8mm left to right midline shift measured on coronal scan due to mass effect.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. Right mastoid air cells show opacification.

Output: 1. Significant interval increase of the left parietal mass with extensive surrounding edema and midline shift toward right side.2. Non visualization of the left temporal lobe extra axial mass on today's scan.


Instruction: Generate impression based on findings.

Input: Recently diagnosed prostate cancer. Biopsy dated 6/30/2015 3+4 right base, 3+3 right mid and 3+3 right apex prostatic adenocarcinoma. PELVIS:PROSTATE:Prostate Size: 3.4 x 4.9 x 3.9 cm.Peripheral Zone: In the right medial base extending towards the apex there is a 1.2 x 0.8 cm focus of T2 weighted hypointensity with associated restricted diffusion and early postcontrast enhancement compatible with prostatic adenocarcinoma. There is also mild T2 weighted hypointensity of the left mid gland with mild associated restricted diffusion which is also suspicious for an additional site of prostatic adenocarcinoma.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right mid gland and medial lesion abuts the capsule without frank extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter bilateral external iliac lymph nodes are nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right mid gland to apex peripheral zone lesion compatible with patient's biopsy-proven adenocarcinoma. The lesion abuts the capsule without frank extension.2.Left mid gland peripheral zone lesion also suspicious for an additional site of adenocarcinoma.


Instruction: Generate impression based on findings.

Input: Reason: please do dr javed MS protocol History: severe pain in neck and spine 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. There is small lesion present in the left hemicord at the C2 vertebral body level. There is another small lesion in the right hemicord at the C3-4 disk space level additional patchy lesions are present along the posterior aspect of the cervical spinal cord at the C4, C5, C6 and C7 levels as well as in the thoracic spinal cord at the T2 vertebral body level.A small focus of encephalomalacia is present along the lateral aspect of the left cerebellar hemisphere inferiorly.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.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Multiple lesions are present in the cervical spinal cord as well as the upper thoracic spinal cord which are compatible with the patient's diagnosis of demyelinating disorder.


Instruction: Generate impression based on findings.

Input: Left hip pain ACETABULAR LABRUM: The superior labrum is enlarged and demonstrates increased intrasubstance degenerative signal, however a discrete tear is not seen.ARTICULAR CARTILAGE AND BONE: There is decreased T1 signal within the head of the left femur however the overlying cortex is intact without collapse. Additionally, there are no signal abnormalities on T2 sequences and likely represents cortical bone.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Increased signal and enlargement of the superior labrum of the left hip representing intrasubstance degeneration however a discrete tear is not appreciated. Evaluation of the left hip is otherwise negative.


Instruction: Generate impression based on findings.

Input: Left optic neuritis with scotoma. Orbits: The globes and optic nerves appears unremarkable. The ocular adnexa are intact. There is no evidence of mass lesions or abnormal intraorbital enhancement.Brain: There is a T2 hyperintense enhancing lesion in the right pituitary lobe that measures up to 6 mm. There is also a non-enhancing focus in the right lateral pituitary lobe that measures up to 4 mm. There is no mass effect upon the optic apparatus. There is no evidence of intracranial hemorrhage or acute infarct. There are a few punctate foci of T2 hyperintensity in the cerebral white matter, without associated 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1. An enhancing lesion in the right pituitary lobe that measures up to 6 mm may represent a microadenoma. A non-enhancing focus in the right lateral pituitary lobe that measures up to 4 mm may represent a cystic microadenoma.2. A few punctate foci of T2 hyperintensity in the cerebral white matter are nonspecific.3. The orbits are unremarkable.Discussed with Dr. Reder at 8:40 AM on 1/9/15.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other injury of unspecified body region Accidental discharge from unspecified firearms or gun, initial encounter Unspecified open wound of unspecified part of head, initial encounter Accidental discharge from unspecified firearms or gun, initial encounterClinical question: Evaluate for interval changeSigns and Symptoms: GSW to head The patient is status post recent suboccipital craniotomy.There is heterogeneous diffusion restriction throughout the cerebellum, brainstem globus pallidus on a and portions of the thalami associated with blood products within the cerebellar hemispheres and swelling of the cerebellar hemispheres. Some blood products also present in the brainstem and medial thalami. The brainstem is flattened against the clivus and stretched superiorly.. There is a superior transtentorial herniation of posterior fossa contents above the tentorial notch. The third ventricle, thalami and basal ganglia are displaced superiorly. The brainstem is flattened against the clivus and there is near obliteration of the fourth ventricle. The inferior aspect of the right cerebellar hemisphere appears less affected. The rest of the cerebellum has abnormal signal throughout. The brainstem has abnormal signal on the left side more than the right. There is some herniation of intracranial contents into the craniotomy defect. There are subdural hematomas present adjacent to the occipital lobes bilaterally. The one on the left is larger than the one in the right. One of the left measures 6 mm in thickness whereas the one on the right measures approximately 4 mm in thickness.The flow voids of the basilar artery and vertebral arteries are small. The internal cerebral veins are displaced superiorly. The flow void of the vena Galen appears compressed. The straight sinus flow void is identified and also appears somewhat compressed. The flow-void of the right and left sigmoid sinus are both identified.There is leptomeningeal enhancement present in the posterior fossa.A ventriculostomy tube courses to the right frontal lobe into the right lateral ventricle with tip in the region of foramen of Monro.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are opacified. The visualized portions of the orbits are intact.

Output: 1.Marked cerebellar swelling associated with infarctions and hemorrhage and superior transtentorial herniation. Additional infarcts are present in the medial thalami and globus pallidi. There is associated compression of the brainstem and near obliteration of the fourth ventricle. The inferior aspect of the right cerebellar hemisphere appears less affected.2.There are subdural hematomas adjacent to the occipital lobes bilaterally.3.The patient is status post suboccipital craniotomy. There is some herniation of intracranial contents into the craniotomy defect4.A leptomeningeal pattern of enhancement could be inflammatory in nature or it could also be reaction to subarachnoid blood products. The possibility of meningitis cannot be excluded on the basis of this exam.5.A ventriculostomy tube is in place. The ventricles are not particularly dilated.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with diffuse large B-cell lymphoma, presenting with weakness and tingling sensation no signs. Assess for compressive lesions. Extensive enhancing soft tissue infiltration of the dorsal and lateral epidural space is seen beginning at the C5 level and extending caudally down to the T4 level. The bulkiest disease is seen between C6 and T2 where it causes complete or near complete effacement of the CSF space and slight flattening of the dorsal spinal cord. No evidence of cord signal abnormality is seen.Tumor infiltrates the left C7-T1 neural foramen; the bilateral T1-2 neural foramina with extensive extraforaminal tumor on the right; and the left T2-3 neural foramen.Spinal alignment is anatomic. Vertebral body height and morphology are preserved. No definite areas of pathologic marrow replacement are seen. Mild marrow heterogeneity is evident within the T1 and the T12 vertebral bodies without obvious edema or pathologic enhancement.Very mild spondylosis is seen at C4-5 and C5-6 without significant spinal canal stenosis or foraminal narrowing. The remaining disc levels are preserved without significant disc degeneration, spinal canal or neuroforaminal narrowing. Right paracentral annular fissuring is seen at L5-S1.Patchy marrow heterogeneity is seen within the right iliac bone, partially visualized on this examination.

Output: 1.Extensive tumor infiltration of the dorsal and lateral epidural space beginning at C5 and continuing caudally to the T4 level. The bulkiest disease exists between C6 and T2 where it causes complete thecal sac effacement and slight flattening of the dorsal spinal cord. No evidence of spinal cord edema is seen.2.Elsewhere, the spinal cord is unremarkable. No evidence of pathologic intrathecal enhancement is seen to suggest leptomeningeal disease.3.No definite evidence of marrow space disease is seen in the spine. Mild marrow heterogeneity at two vertebral body levels as discussed above is nonspecific. More significant marrow heterogeneity involving the right iliac bone is, however, concerning for tumor involvement.4.Findings discussed with Dr. Patel at 11:15 AM on 8/7/2015


Instruction: Generate impression based on findings.

Input: Clinical question: CVA. Signs and symptoms: New facial droop. Nonenhanced brain MRI:No detectable acute intracranial process and in particular no evidence of acute ischemic stroke as is questioned clinically.Examination demonstrates periventricular and to a lesser degree subcortical foci of flair hyperintensity which are nonspecific however considering patient's stated age of 90 they likely represent microvascular chronic ischemic changes. Signal intensity of brain parenchyma otherwise remains unremarkable. There is moderately enlarged supratentorial ventricular system however with preserved cortical sulci and maintained midline. Prominence of cortical sulci is also noted which is likely within normal for patient of stated age of 90.The signal voids of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are unremarkable.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Nonenhanced brain MRA:Bilateral internal carotid are free of are patent across the skull base and in their supraclinoid segments.Bilateral middle cerebral arteries are patent. There is apparent paucity of distal branches of MCA arteries which is believed to be secondary to poor quality imaging. The left anterior cerebral artery is patent. There is partial poor visualization of distal A1 and proximal A2 segments of the posterior cerebral artery which is believed to be secondary to severe tortuosity and suboptimal quality of the study. This finding can be further assessed if clinically deemed necessary with a CTA exam. There is hypoplastic right A1 which is a normal anatomical variation.Prominent bilateral posterior communicating arteries are identified. This anatomical variation (prominent bilateral posterior communicating arteries) resulting in generalized smaller caliber of the vertebral basilar circulation. Right vertebral artery and basilar artery demonstrate uniformly smaller caliber however without evidence of regional vascular lumen compromise or stenosis. A very small hypoplastic left vertebral artery is identified. There is no detectable communication of the left vertebral artery and the basilar artery which may be secondary to its very small hypoplastic size. The left pica branch is also non-detectable on source images or the reformatted images. This could also be secondary to very small size vessel however possibly occlusion cannot be excluded. MRI exam examination however demonstrate no ischemic changes in the distribution of the left vertebral/pica branches.

Output: 1.Nonenhanced brain MRI demonstrate no evidence of an acute intracranial process. Foci of flair hyperintensity in the in the subcortical and periventricular white matter of cerebral hemispheres are nonspecific however they are suspected for mild chronic nonhemorrhagic ischemic strokes. Mild to moderately enlarged supratentorial ventricular system without significant change since prior exam or deviation of midline.2.Patent bilateral internal carotid arteries and their distal branches. Uniformly small caliber of vertebrobasilar system secondary to presence of prominent bilateral posterior communicating arteries. The left vertebral artery is extremely small in size and without visualization of its very distal segment or left pica branch. This appearance could be result of very small size of the vessels however less likely possibility of occlusion cannot be entirely ruled out. There is no however no detectable foci of ischemic change in the distribution of the left vertebral/pica branch on MRI exam. If further assessment of intracranial vasculature is clinically deemed necessary follow up with CTA is recommended.


Instruction: Generate impression based on findings.

Input: 29-year-old female with bilateral lower extremity weakness. BRAIN MRI:No signal abnormalities are seen in the brain to suggest demyelinating disease. The small pineal cyst is again noted. Brain parenchyma is otherwise unremarkable. There is no acute infarct or intracranial hemorrhage. There is no mass-effect or midline shift. There is no abnormal extra-axial fluid collection. There is no abnormal intracranial contrast enhancement. The major intracranial vascular flow voids are preserved. There is a retention cyst in the inferior aspect of the left maxillary sinus. The orbits are unremarkable. There is no destructive skull lesion.CERVICAL SPINE MRI:The study is limited by patient motion.No definite abnormal intramedullary signal abnormality is evident in the cervical spinal cord. There is no definite abnormal contrast enhancement.There is straightening of the cervical spine and minimal disc desiccation but no significant degenerative disease otherwise. There is no spinal canal or neural foraminal stenosis. THORACIC SPINE MRI:This portion of the examination is especially limited due to motion artifact.Previously seen increased T2 signal in the upper thoracic cord is less conspicuous than on prior examination. The increased T2 signal in the mid to lower thoracic cord is again seen. Enhancement is not well assessed. There are no significant degenerative changes throughout the thoracic spine. No spinal or neural foraminal stenosis is evident.There is minimal dependent atelectasis in both lungs. LUMBAR SPINE MRI:There is normal vertebral body height and alignment. The intervertebral discs demonstrate normal height and signal. No abnormal enhancing lesions are appreciated in the lumbar spine. No significant degenerative changes or stenoses are present in the lumbar spine.

Output: 1.Note this examination is significantly motion degraded, particularly the thoracic cord sequences. The abnormal signal in the upper thoracic cord is slightly less conspicuous but persists. Extensive abnormal T2 signal in the mid to lower thoracic cord is not appreciably changed. Examination is not adequate to assess for new small lesions in the mid or distal cord. Repeat examination with sedation/anesthesia can be considered as clinically indicated.2.Brain parenchyma appears grossly unremarkable.3.No signal abnormality in the cervical cord is appreciated. 4.No significant spinal canal or neural foraminal stenosis in the lumbar spine. Cauda equina nerve roots also appear grossly unremarkable.