Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is a complex tear of the medial meniscus predominantly involving the posterior horn and body with both horizontal and vertical components. The tear also consists of a full-thickness radial component through the body and posterior horn. Intermediate signal intensity also extends into the anterior horn indicating intrasubstance degeneration. Additional low signal intensity adjacent to the anterior horn of the medial meniscus presumably represents scar tissue but could also represent displaced meniscal fragments.There is vertically oriented signal intensity along the free edge of the posterior horn of the lateral meniscus likely representing incomplete radial tearing. Additional intrasubstance degeneration is seen throughout the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the medial tibiofemoral compartment. There is a curvilinear subchondral band of low signal intensity within the weightbearing portion of the medial femoral condyle which may represent a stress fracture with surrounding marrow edema or perhaps early osteonecrosis. Mild marrow edema is also evident within the medial tibial plateau.The articular cartilage of the lateral compartment is relatively spared. There is moderate to severe degeneration of the articular cartilage of the patellofemoral compartment with foci of full-thickness cartilage loss along the medial patellar facet and delamination of the articular cartilage of the lateral patellar facet. Mild degeneration of the articular cartilage of the femoral trochlea is also noted.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tear of the medial meniscus with a complete radial component. There is also severe osteoarthritis of the medial compartment with subchondral signal intensity likely representing a stress fracture or developing osteonecrosis.2. Small partial-thickness tear of the lateral meniscus.3. Additional osteoarthritic changes of the knee with a moderate joint effusion and other findings described above.


Instruction: Generate impression based on findings.

Input: Female 3 years old with a history of NF1 and multiple plexiform fibromas. Evaluate for change in size or structure of left chest and axilla plexiform fibroma.EXAMINATION: MR chest without and with IV contrast 4/12/2016 LUNGS AND PLEURA: The lungs appear normal.MEDIASTINUM AND HILA: Normal cardiac size. The infiltrative chest wall mass extends into the left anterosuperior mediastinum resulting in anterior displacement of the left common carotid artery and internal jugular vein. There is also extension into the posterior mediastinum as on the previous exam. The upper mediastinum is shifted to the right with rightward displacement of the trachea. The arch vessels and tributaries to the left brachiocephalic vein are patent. Overall, findings in the mediastinum are similar to the previous exam.CHEST WALL: The large, infiltrative T1 and T2 hyperintense mass involving the neural foramina on the left from C5 to T5, intradural tumor on the left results in slight rightward displacement of the spinal cord at the cervicothoracic junction similar to the previous exam. The mass involves the left lateral neck, chest wall, axilla and upper arm extending outside the field of view. There is extension into the pleural space as on the prior exam. There has been a small increase in size of the mass in the AP dimension.There are postoperative changes related to thoracotomy and C5-C7 laminoplasty. Hyperlordosis at C5-7 and kyphosis at the cervicothoracic junction have increased since the prior MRI but were better characterized on the recent neck radiograph.An additional T1 and T2 hyperintense lesions in the right T7 neural foramina and several lesions in the posterior intercostal spaces at multiple levels likely represent additional nerve sheath tumors and are unchanged.UPPER ABDOMEN: The partially visualized liver and spleen are normal.OTHER

Output: 1.Slight increase in AP dimension but otherwise no change in the large, infiltrative plexiform neurofibroma involving the left C5-T5 neural foramina, lateral neck, chest wall, mediastinum and axilla.2.Please also see the separately dictated report for MRI of the face and neck.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Mild posterior osteophyte disc complex without stenosis.C3/4: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild central and moderate bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex and left-sided uncinate hypertrophy. There is mild central, moderate left neural foraminal, and mild right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex with a bilobed central extruded portion which deforms the anterior cord surface causing a moderate central stenosis. The sagittal STIR techniques suggest the presence of T2 hyperintensity at this level (as well as at other levels), all of which are not confirmed on sagittal or axial T2 technique. There is also bilateral uncinate hypertrophy with moderate left neural foraminal and mild right neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex without significant stenosis.

Output: 1.C3/4: Mild central and moderate bilateral neural foraminal stenosis.2.C4/5: Moderate bilateral neural foraminal stenosis.3.C5/6: Mild central, moderate left neural foraminal, and mild right neural foraminal stenosis.4.C6/7: Posterior osteophyte disc complex with a bilobed central extruded portion which deforms the anterior cord surface causing a moderate central stenosis. The sagittal STIR techniques suggest the presence of T2 hyperintensity at this level (as well as at other levels), all of which are not confirmed on sagittal or axial T2 technique. There is also bilateral uncinate hypertrophy with moderate left neural foraminal and mild right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Generalized abdominal pain weight loss and diarrhea. Evaluate for chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates mild diffuse loss of joint T1-weighted signal intensity. It demonstrates homogeneous enhancement. No focal lesion or pancreatic ductal dilatation. No evidence of acute peripancreatic inflammation. Following secretin administration there is a mildly dampened exocrine response.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: Mild non-specific loss of intrinsic T1 weighted signal intensity of the pancreas and mildly dampened exocrine response to secretin administration. These findings are non-specific but may reflect mild chronic pancreatitis. Otherwise no additional specific findings of acute or chronic pancreatitis.


Instruction: Generate impression based on findings.

Input: 43 year-old right-handed male with recurrent GBM, WHO grade IV, IDH1 R132H mut, ATRX wt, s/p outside resection on 3/7/2016; compare to prior MRI on 4/28/16; currently s/p 2 cycles of IDO immunotherapy plus TMZ There are post-surgical findings of a right-sided craniotomy with removal of a right inferior parietal lobule and adjacent temporal lobe mass. The resection cavity is CSF signal intensity with surrounding siderosis appearing less prominent compared to prior exam. There is a small linear focus of enhancement along the superior aspect of the resection cavity, which may represent granulation tissue or a vessel. There are multiple scattered tiny enhancing nodules along the resection cavity appearing similar to prior exam. The previously described more heterogeneous prominence along the inferolateral aspect of the resection cavity appears decreased in thickness, with the hypo-enhancing central component no longer visualized.There are more conspicuous nodules now noted along the posterior aspect of the right thalamus extending laterally to the resection cavity, which do not demonstrate increased perfusion. However, on coronal images which are the best direct comparison, there is now a triangular-shaped area of enhancement along the lateral aspect of the unroofed portion of the right lateral ventricle, which demonstrates hyperperfusion and appears more confluent and conspicuous on this exam. This appears band-like on axial images, with increased extent of associated FLAIR hyperintensity. Additional areas of new linear enhancement along the right posterior body of the corpus callosum with extension along the right fornix as well as the left splenium/ependymal surface and right occipital horn lateral ependymal surface are also noted and demonstrate corresponding hyperperfusion and FLAIR hyperintensity. There is also ill-defined enhancement along the right splenium with mild hyperperfusion and FLAIR hyperintensity.There are bilateral extra-axial collections with the right collection appearing similar in size, measuring up to 9 mm. The left-sided collection appears nearly resolved with heterogeneous areas of increased susceptibility and diffusion restriction suggestive of residual blood products. Interval more focal blood products are also noted within the left paramedian anterior frontal and left posterior parietal subdural space measuring up to 6 mm in greatest thickness.There is redemonstration of an arachnoid cyst within the left middle cranial fossa measuring approximately 70 x 39 mm in AP and transverse dimensions (series 301, image 10). The cyst is still slightly T1 hyperintense with respect to CSF, but more homogeneously hyperintense on FLAIR. A definite fluid-blood level is no longer visualized. There is no associated diffusion restriction.There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Post-surgical findings of a right-sided craniotomy for prior resection of a right inferior parietotemporal lobe mass. There are multiple areas of stable scattered nodular enhancement along the margins of the resection cavity, with a few additional progressed or new nodular areas of enhancement extending from the margins some of which demonstrate hyperperfusion, including involvement of portions of the corpus callosum as well as scattered ependymal surfaces along the lateral ventricular margins. Findings are suspicious for tumor progression.2. Ill-defined nodular enhancement which appears progressed along the posterior aspect of the right thalamus, and does not demonstrate hyperperfusion.3. Previously described more heterogeneous prominence along the inferolateral aspect of the resection cavity appears decreased in prominence, likely evolved post-operative changes.4. Bilateral extra-axial collections appearing improved from prior exam. The right-sided collection is essentially stable, while the left-sided collection is nearly resolved except for a few areas of interval although non-acute more focal blood products, as detailed above.5. Interval expected evolution of blood products in left middle cranial fossa arachnoid cyst.


Instruction: Generate impression based on findings.

Input: 16-year-old male with deformity and pain. Evaluate for radial collateral ligament disruption and possible volar plate injury. LIGAMENTS: Note is made of a small avulsion fracture along the radial aspect of the head of the first metacarpal at the insertion of the radial collateral ligament. There is minimal bone marrow signal abnormality in the surrounding area suggesting that this may be chronic in etiology. The radial collateral ligament itself appears intact. The ulnar collateral ligament appears intact.TRIANGULAR FIBROCARTILAGE COMPLEX: Within the limitations of a non arthrogram study, the triangular fibrocartilage complex appears intact. Note is made of lobulated fluid signal abnormality along the volar aspect of the articular disc of the triangular fibrocartilage which may represent ganglion formation, however, no discrete tear is identified within the triangular fibrocartilage complex.TENDONS: The flexor and extensor tendons appear intact. BONES: Note is made of a small avulsion fracture along the radial aspect of the head of the first metacarpal at the insertion of the radial collateral ligament. There is minimal bone marrow signal abnormality in the surrounding area suggesting that this may be chronic in etiology. The alignment is anatomic. There is a subchondral cyst within the lunate. Note is made of negative ulnar variance.ADDITIONAL

Output: Avulsion fracture of the first metacarpal head at the insertion of the radial collateral ligament as described above, which may be chronic in etiology. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Left knee pain, status post left knee arthroscopy/microfracture/partial meniscectomy. Assess for healing, reinjury. Evaluation of the knee is limited on some sequences due to patient motion artifact.MENISCI: The lateral meniscus appears intact. There is truncation of the posterior horn of the medial meniscus medial to its root attachment which I suspect reflects prior partial meniscectomy. However, the majority of the posterior horn of the medial meniscus (with the exception of its root) is replaced with intermediate signal intensity that is new when compared with the prior study. I suspect that this represents extensive degeneration and degenerative tearing of the posterior horn of the meniscus, although I see no discrete fluid-filled meniscal defect. There is also attenuation of the body of the medial meniscus, perhaps reflecting prior partial meniscectomy, with intrasubstance signal likely representing mucoid degeneration. There is slight medial extrusion of the body of the medial meniscus. The anterior horn of the medial meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage along the weight-bearing portion of the medial femoral condyle above and anterior to the degenerated and torn posterior horn of the medial meniscus that appears more extensive on the current study than on the prior study. Signal abnormality in the underlying medial femoral condyle likely represents a combination of degenerative cysts and edema-like signal, and perhaps residual postoperative changes from prior microfracture. There is also full-thickness cartilage loss along the medial aspect of the medial tibial plateau which is new when compared with the prior study. The articular cartilage of the lateral compartment is unremarkable. There is mild subjective thinning of the articular cartilage of the patella compatible with mild degeneration, but I see no discrete fluid filled cartilage defect. There are small medial and patellofemoral compartment osteophytes. A lesion of the proximal tibial diaphysis is incompletely imaged on this study; please refer to the tibia/fibula MRI exam report dictated under a separate accession number.LIGAMENTS: The anterior cruciate ligament appears intact, but is thickened and of increased signal intensity indicating moderate mucoid degeneration. The posterior cruciate ligament is intact. The superficial fibers of the medial collateral ligament are intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: 1.Progression of cartilage degeneration in the medial tibiofemoral compartment.2.Postoperative changes of the medial meniscus with new diffuse signal abnormality involving the posterior horn which I suspect represents extensive degeneration and degenerative tearing.3.Mucoid degeneration of the anterior cruciate ligament.4.Thin elongated Baker cyst containing intermediate signal intensity that I suspect represent synovitis and/or debris.5.Proximal tibial lesion incompletely imaged on this study; please refer to the tibia-fibula MRI exam report dictated under a separate accession number.


Instruction: Generate impression based on findings.

Input: Male, 69 years old, status post SRS for brain metastasis, surveillance scan. The enhancing left cerebellar lesion measures up to 10 mm in diameter, previously 11 mm. Minimal surrounding FLAIR hyperintensity is unchanged. No new enhancing lesions are identified.A nonenhancing, susceptibility inducing and centrally T2 hyperintense lesion within the right temporal lobe is unchanged likely representing an incidental cavernous malformation. A few scattered foci of nonspecific FLAIR hyperintensity are demonstrated in the cerebral hemispheres without significant interval change. No edema or mass effect is detected. No abnormal extra axial fluid collections are seen. The ventricles are normal in size and morphology.

Output: 1.Enhancing left cerebellar lesion is stable to slightly smaller in size.2.No findings to suggest new intracranial metastases.


Instruction: Generate impression based on findings.

Input: Short stature. Pituitary: There is an ectopic posterior pituitary bright spot located in the region of the tuber cinereum. The anterior pituitary is otherwise unremarkable. There is no evidence of pituitary region mass lesions. The cavernous sinuses and optic apparatus are intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, with an expected degree of myelination. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Ectopic posterior pituitary.


Instruction: Generate impression based on findings.

Input: Reason: Left knee pain x several years, anterior and medial evaluate for medial meniscus tear vs chondral injury History: left knee pain MENISCI: There is intrasubstance degeneration of the posterior horn of the medial meniscus. Some of this increased signal abnormality extends to the tibial articular surface consistent with superficial fraying/degenerative tearing. No fluid-filled tear is evident. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Note is made of full-thickness articular cartilage degeneration along the medial facet of the patella with underlying degenerative subchondral signal and cyst formation. There is articular cartilage degeneration along the medial facet of the femoral trochlea and median eminence of the patella. There is full-thickness articular cartilage degeneration/defect along the lateral femoral condyle anteriorly best seen on image 12 of sagittal series 901. There is relative sparing of the articular cartilage of the medial tibiofemoral compartment.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is no evidence of patellar alta. There is increased signal abnormality within the proximal patellar tendon indicating mild patellar tendinosis. There is a small amount of fluid within the deep infrapatellar bursa.ADDITIONAL

Output: 1. Osteoarthritis of the left knee with full-thickness articular cartilage degeneration most pronounced along the patellofemoral compartment.2. Intrasubstance degeneration of the medial meniscus and superficial fraying without evidence of an unstable tear.3. Findings suggestive of a mild patellar tendinosis.


Instruction: Generate impression based on findings.

Input: Male 41 years old Reason: EEG showing possible R-sided focal lesion History: Seizures. Linear areas of diffusion restriction are seen along the right precentral gyrus, right post central gyrus, as well as the left post central gyrus with involvement of the gray matter and relative preservation of the underlying white matter. There is no significant associated edema or mass effect. There is no evidence of intracranial hemorrhage or mass. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Fairly symmetric areas of diffusion restriction along the right precentral, right postcentral gyrus as well as left postcentral gyrus as detailed above. The differential includes an ischemic process, more likely to be related to a generalized perfusion deficit rather than an embolic process. Differential also includes a metabolic process, including hyperammonemia in the setting of renal or liver dysfunction. Findings may also be related to drug exposure or vasculitis. Findings discussed with Dr. Cunningham at 1000 on 10/24/2016.


Instruction: Generate impression based on findings.

Input: 63-year-old male with altered mental status, assess for etiology. CVA, hemorrhage, mass.IMAGE ACQUISITION: Nonenhanced CT of the head. No acute intracranial abnormality is evident. Specifically, there is no evidence of intracranial hemorrhage, focal mass, edema, midline shift, or hydrocephalus. There is no CT evidence for acute territorial ischemia.Again demonstrated is extensive hypoattenuation in the supratentorial white matter, unchanged and most consistent with small vessel ischemic disease. Atherosclerotic vertebral and internal carotid arteries arteries are again noted.Persistent opacification of the bilateral mastoid air cells with soft tissue attenuation within the left external auditory canal, unchanged. Please refer to recent MRI of the internal auditory canal for additional details.

Output: 1. No acute intracranial abnormality.2. Unchanged small vessel ischemic disease of indeterminate age.3. Persistent opacification of the left mastoid air cells with soft tissue attenuation within the left external auditory canal. Please refer to recent MRI from 9/28/11 for additional information.


Instruction: Generate impression based on findings.

Input: Patient with history of multiple dislocations, evaluate left shoulder labrum. ROTATOR CUFF: There is no evidence of rotator cuff tear. There is no evidence of contrast in the subdeltoid bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is cartilaginous Bankart lesion of the anterior inferior labrum. There is also flattening of the posterior humeral head with bone edema consistent with Hill-Sachs deformity.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1.Hill-Sachs deformity of the posterior humeral head.2.Cartilaginous Bankart lesion of the anterior inferior labrum.


Instruction: Generate impression based on findings.

Input: 63-year-old female with lung cancer and metastasis. There is an unchanged heterogeneously enhancing, mildly expansile lesion in the occipital bone. There is an unchanged left parietal skull resection cavity without evidence of abnormal enhancement in this region. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged encephalomalacia in the right orbitofrontal gyri. There is also unchanged mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable. There is mild ethmoid sinus mucosal thickening, unchanged.

Output: 1.Unchanged encephalomalacia in the right orbitofrontal gyri, with no evidence of intracranial metastases or acute infarction. 2.Unchanged occipital skull metastasis and no evidence of recurrent left parietal skull metastasis.


Instruction: Generate impression based on findings.

Input: Headaches. Evaluate pineal cyst from prior scan in 2013. There is a 7 mm T1 hypointense, T2 hyperintense, and peripherally enhancing pineal gland lesion compatible with a simple cyst is unchanged in size and appearance from outside MRI dated 5/18/2013. There are a few scattered foci of FLAIR hyperintensity which are nonspecific. There is no evidence of intracranial hemorrhage, parenchymal mass, or acute infarct. There is no abnormal intraparenchymal or meningeal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a partially empty sella and suggestion of mild distention of the optic nerve sheaths. The orbits, skull, paranasal sinuses, and scalp soft tissues are otherwise grossly unremarkable.

Output: 1. No appreciable change in size or appearance of 7 mm pineal gland cyst as compared to MRI on 5/18/2013. No suspicious intracranial lesions.2. Partially empty sella which can be a normal variant or represent intracranial hypertension in the appropriate clinical setting. There is mild distention of the optic nerve sheaths which favors the latter, but suggest correlation with clinical findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 70 year old female with history of right-sided weakness and hyperacusis in right ear. History of TIA, DM and HTN. Evaluate. Low attenuation within the right posterior parietal lobe with loss of gray-white differentiation. Likely subacute infarct; recommend MRI for further evaluation.Periventricular low attenuation compatible with small vessel disease of indeterminate age.Atrophy of the right caudate head with ex-vacuo dilatation of the frontal horn of the right lateral ventricle.There is no evidence of intracranial hemorrhage, mass or edema. 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.Ectasia of the basilar artery is noted.

Output: Low attenuation within the right posterior parietal lobe with loss of gray-white differentiation. Likely subacute infarct; recommend MRI for further evaluation.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, with brain metastasis versus artifact on recent MRI. History of stage III non-small cell lung cancer status post neoadjuvant chemotherapy with intermittent leg numbness. The previously demonstrated punctate focus of enhancement along the paramedian right superior frontal gyrus is no longer visualized. There is no evidence of T2 hyperintensity or susceptibility at this site. No new pathologic intracranial enhancement is seen. A focus of T2 hyperintensity within the left superior frontal gyrus is unchanged and nonspecific. No edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits. A mucous retention cyst is present in the right maxillary sinus.

Output: The punctate focus of enhancement seen previously along the right superior frontal gyrus is no longer appreciated on this examination. No additional pathologic enhancement is seen, nor is there any other evidence of intracranial metastasis.


Instruction: Generate impression based on findings.

Input: Reason: Assess frp small bowel abnormality History: abd pain bloating ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or dilatation. No abnormal enhancement. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis is likely physiologic.

Output: Normal MR enterography without findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Male, 79 years old, with acoustic neuroma status post radiosurgery on 4/17/2015, bibasal changes. A tumor is redemonstrated involving the left CP angle and IAC. The lesion enhances heterogeneously. On comparison with the prior examination, there has been no significant interval change in size.No additional enhancing lesions are seen. Patchy periventricular white matter T2 hyperintensity is unchanged. No evidence of parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. The ventricles and sulci are slightly prominent compatible with parenchymal volume loss.

Output: 1.A treated schwannoma involving the left CP angle and IAC shows no interval change in size.2.No new enhancing lesions are seen.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for labral tear/other pathology, previous removal of heterotopic ossification with capsulotomy History: Pain ACETABULAR LABRUM: Mild heterogeneity is seen within the superior acetabular labrum in the area of the previously observed (superioanterior) and described labral tear along with suspected postoperative changes. There are no additional new findings, specifically no discrete defects or fluid outlined abnormality within the labrum to suggest an acute tear.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Heterogeneity of the superior acetabular labrum is suspected to be post-surgical. No acute new labral tear or additional abnormality identified.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with seizures. Evaluate for limbic encephalitis. T2 hyperintensity involving the mesial temporal lobe structures persists but has improved relative to the prior examination. The amygdala and hippocampi appear less swollen. The hippocampal cortex remains slightly hyperintense on DWI similar to prior. No associated pathologic enhancement is seen.No new parenchymal signal abnormality is seen. No evidence of significant generalized mass effect is detected. Previously demonstrated mild thickening and enhancement of the dura has resolved. No acute intracranial hemorrhage or any abnormal extra axial fluid collections are detected. The ventricular system is normal in size and morphology.

Output: 1.Interval improvement in signal abnormality and edema affecting the mesial temporal lobe structures. As before, the differential would include infection, limiting encephalitis or sequelae of seizure activity.2.Interval resolution of dural thickening and enhancement. No new intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: 62 year old with strong family history of breast cancer in mother (diagnosed at age 46) and sister (diagnosed at age 46). There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with back pain and left leg pain. Spinal alignment is anatomic. Vertebral body morphology is normal. No concerning marrow replacement or evidence of marrow edema is detected.The visualized spinal cord, conus and cauda equina are unremarkable.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Loss of disc height and disc bulging. Very mild spinal canal narrowing. Severe left and moderate right foraminal narrowing. L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant spinal canal stenosis. Severe right and moderate left foraminal narrowing. L5-S1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.

Output: 1.Disc degeneration and posterior element hypertrophy at L3-4 resulting in a mild spinal canal stenosis, severe left and moderate right foraminal narrowing.2.Degenerative findings at L4-5 without significant spinal canal stenosis, but with severe right and moderate left foraminal narrowing.


Instruction: Generate impression based on findings.

Input: 59 year old female with a history of recurrent syncope and ventricular dilation noted on echocardiogram. She is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 91 ml/m2 (normal range: 65+/-11), the LVEDV is 141 ml (normal range 109+/-23), the LV end systolic volume index is 39 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10), the LV mass index is 26 g/m2 (normal range 67+/-11), and the LV mass is 40 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is an imaging artifact noted on late gadolinium enhancement images in the basal inferolateral wall. There is no evidence of myocardial iron overload. The pre-contrast native myocardial T1 relaxation time is normal (980 ms). Left AtriumThe left atrium is normal in size (75ml). No atrial septal defect noted. Right VentricleThe right ventricle is upper limits of normal size with normal systolic function. The overall RV ejection fraction is 53%. There is no focal aneurysm or wall motion abnormalities of the RV. The RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVEDV is 144 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 67 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Dilated coronary sinus suggesting increased right atrial pressure. Aortic ValveThe aortic valve opens widely and there is mild 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 mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsStomach is air-filled. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with systolic function (LVEF 57%) without evidence of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process2. The right ventricle is upper limits of normal size with normal systolic function (RVEF 53%). There is no focal aneurysm or wall motion abnormalities of the RV to suggest arrhythmogenic right ventricular cardiomyopathy. 3. Moderate right atrial enlargement and dilated coronary sinus. 4. Mild aortic regurgitation5. Mild to moderate tricuspid regurgitation. 6. Extra-cardiac findings as described above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 46 years Female (DOB:11/23/1970)Reason: headaches and generalized muscle twitches, rule out masses or Arnold Chiari History: headaches and generalized muscle twitches, rule out masses or Arnold ChiariPROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY 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: No evidence for intracranial mass lesion or Chiari malformation. MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: Clinical question: altered mental status. Signs and symptoms: Altered mental status. Nonenhanced head CT:Examination demonstrate multiple foci of vasogenic edema extensively on the left side and to a lesser degree on the right. This results in effacement of adjacent cortical sulci and mass effect on the left lateral ventricle as well as 7.7-mm rightward midline shift. Within the areas of vasogenic edema there are isodense to mildly high density masses which are highly suspected for multiple metastatic foci. Images through the posterior fossa are unremarkable.Calvarium is intact. Visualized mastoid air cells and middle ear cavities as well as paranasal sinuses are unremarkable. Recommend further follow-up with a dedicated MRI of brain with enhancement.

Output: Multiple bihemispheric foci of vasogenic edema a component disease left greater than right) and suspected internal foci of isodense to slightly high density masses. Findings are highly suspected of metastatic disease. Recommend further follow-up with an MRI exam for confirmation of metastases and/or an infectious process.


Instruction: Generate impression based on findings.

Input: Memory and gait impairment. Rule out normal pressure hydrocephalus. There is no acute infarct or intracranial hemorrhage. There is no mass-effect, midline shift or brain herniation. Punctate T2 hyperintense lesion are present predominantly in the frontoparietal white-matter. There is enlargement of the lateral and third ventricles while the fourth ventricle is normal size. However, the basal cisterns and the sulci are also prominent. The orbits are grossly unremarkable. The mastoid air cells are clear. There is mild maxillary and ethmoid sinus mucosal thickening. There is no destructive skull lesion.

Output: 1.Diffuse volume loss without a specific lobar predominant atrophy pattern.2.Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 74 years Female (DOB:10/7/1941)Reason: pain History: painPROVIDER/ATTENDING NAME: RODERICK H. BIRNIE RODERICK H. BIRNIE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disc desiccation present.At L5-S1 there is loss of disc space height, chronic endplate reactive changes diffuse disc bulge associated mild degree of facet and ligamentum flavum hypertrophy. Is partial effacement of the fat at the lateral recess bilaterally but more so on the right versus the left side. Encroachment of the nerve roots at the right lateral recess at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. At L4-5 there is loss of disc space height, disc desiccation and a mild disc bulge associated with mild ligamentum flavum hypertrophy. There is no significant compromise to the spinal canal or neural foramina at this level.At L3-4 there is diffuse disc bulge associated with endplate reactive changes of a chronic nature as well as facet ligamentum flavum hypertrophy. There is partial effacement of the spinal fluid surrounding the nerve roots at this level overall there is a mild to moderate degree of spinal stenosis at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. The fat at the lateral recess is not effaced at this level.At L2-3 there is disc desiccation and a diffuse disc bulge associated with ligamentum flavum hypertrophy and some facet hypertrophy. There is some crowding of the nerve roots within the thecal sac at this level. The fat at the lateral recess is not effaced at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. Overall there is a mild degree of spinal stenosis at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum thickening this level.There is a disc bulge at T11-T12 and another one at T12-L1.

Output: There are multilevel degenerative changes present in the lumbar spine associated with encroachment of the nerve roots at the right lateral recess at L5-S1 and mild to moderate degree of spinal stenosis at L4-5 and L3-4.


Instruction: Generate impression based on findings.

Input: Clinical question: Remote ischemia. Signs and symptoms: Lower extremity weakness. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. CT is insensitive for early detection of acute ischemic strokes. If clinical concern persists an MRI examination is recommended.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.Calvarium is intact.Mastoid air cells and middle ear cavities are unremarkable and well pneumatized.Extensive bilateral ethmoid sinus disease and near complete opacification of right maxillary sinus a been limited view of paranasal sinuses.

Output: 1.No evidence of acute intracranial findings. Please see above comments.2.Extensive chronic sinus disease.


Instruction: Generate impression based on findings.

Input: Evaluate for extensor tendon tear. Epicondylitis pain for months. LIGAMENTS: The lateral collateral ligament, ulnar collateral and lateral ulnar collateral ligament appear intact.TENDONS: There is increased T2 signal within the common extensor tendon, consistent with a partial tear. The common flexor, biceps, triceps and brachialis tendons appear intact. ARTICULAR SURFACES AND BONE: No significant abnormality noted. SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Partial tear of the right common extensor tendon.


Instruction: Generate impression based on findings.

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

Output: Stable CT examination of brain.


Instruction: Generate impression based on findings.

Input: Headaches and right leg weakness. The right cerebellar tonsil extends up to 4 mm inferior to the foramen magnum and the posterior fossa appears slightly small in capacity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: The right cerebellar tonsil extends up to 4 mm inferior to the foramen magnum and the posterior fossa appears slightly small in capacity, which raises the possibility of mild Chiari type 1 malformation. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 57 year-old female with headache. There is no evidence of intracranial hemorrhage, mass or edema. 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: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with GBM, findings on recent prior exam concerning for stroke and for disease progression, but post contrast images were technically inadequate. Repeat post contrast imaging is requested along with further evaluation of suspected stroke and tumoral changes. Again seen is evidence of left anterior temporal tumor resection. Enhancing tissue immediately surrounding the resection cavity has not significantly changed from the immediate prior examination. However, it is more nodular when compared to prior examinations, particularly along the roof of the resection cavity where ill-defined enhancement tracts along and may even encase the left MCA. More posteriorly along the left temporal lobe, nodular cortically based or extra-axial enhancement has increased in size now measuring up to 18 mm in length, previously 8 mm. In addition, there is a band of thickened and faintly enhancing white matter along the lateral aspect of the left temporal horn which has progressed from the prior examination. Also noted is a new 6 mm focus of enhancement at the posterior aspect of the left gyrus rectus.rCBV mapping demonstrates elevated blood volume which correlates with the progressive nodular enhancement along the left lateral temporal lobe. Elevated blood volume is also seen in the thickened tissue along the lateral aspect of the left temporal horn.Single voxel spectroscopic assessment of the enhancing nodule demonstrates significant reduction of NAA and a modest elevation of the choline peak. More convincing, however, is the multi voxel assessment of the entire region which demonstrates reduced NAA and moderately elevated choline in the white matter surrounding the enhancing nodule.Signal abnormality correlating to the suspected infarct involving the left basal ganglia and overlying white matter is again seen. No part of this lesion demonstrates true enhancement. The apex of the lesion again shows intrinsic T1 hyperintensity.MRA images are degraded by motion artifact. Nevertheless, it does appear that the left MCA is narrowed through most of its M1 segment as it passes along the roof of the resection cavity. This is the same area that appears to be encased by enhancing tissue, and stenosis in this segment correlates with the patients lenticulostriate stroke. The visualized left MCA distal branches are also of somewhat smaller caliber than the right. There may be some narrowing of the supraclinoid right ICA, but the right MCA vessels are free of significant stenosis. The posterior circulation is also free of significant stenosis.On perfusion imaging, the area of left basal ganglia and periventricular infarct demonstrates expected matched deficits of cerebral blood volume and cerebral blood flow. In addition, however, mean transit time and time to peak are significantly elevated through a large portion of the left MCA territory which corroborates the MRI and MRA findings of left M1 stenosis.

Output: Since the prior examinations, an enhancing nodule which may be cortically based or leptomeningeal along the left posterolateral temporal lobe has increased in size. In addition, there is progressive ill-defined thickening and enhancement in the adjacent white matter tracking along the lateral surface of the left temporal horn. There is also a new small focus of enhancement along the left gyrus rectus. The enhancing nodule and the surrounding abnormal white matter both demonstrate spectroscopic and rCBV evidence of tumor, and as such these findings are favored to represent progressive disease over treatment effect.Ill-defined somewhat nodular enhancement along the roof of the left anterior temporal resection cavity is stable when compared to the immediate prior examination, but progressed when compared to older exams. This enhancing tissue tracks along and appears to encase the left M1 MCA.MRA imaging demonstrates narrowing of the left M1 MCA as it passes along the roof of the resection cavity. The possibility is raised that the enhancing tissue which surrounds the vessel in this area may represent tumor which is either extrinsically compressing or possibly invading the vessel. In corroboration, there are perfusion findings which indicate vascular compromise in the left MCA distribution. As such, the patient may be at risk for additional ischemic events.


Instruction: Generate impression based on findings.

Input: Male, 5 years old. Perianal abscess, possible fistula. Drainage, pain. There is a 1.1 x 0.9 x 1.0 cm enhancing collection along the right perianal skin/subcutaneous tissue, compatible with a given history of abscess. A T2 hyperintense and enhancing tract extends to this collection from the anus, compatible with a fistula. Mild surrounding subcutaneous edema. No other fluid collections or fistulae are identified. The imaged intrapelvic contents and osseous structures are grossly unremarkable.

Output: A 1 cm right perianal abscess with associated fistula to the anus.


Instruction: Generate impression based on findings.

Input: 66-year-old male with prostate cancer undergoing active surveillance. Target lesions for Uronav. Biopsy showed Gleason grade 6 in the right lateral base, left medial and lateral base and left lateral mid gland. PELVIS:PROSTATE:Prostate Size: 6.1 x 4.5 x 5.6 cmPeripheral Zone: There are scattered foci of T2 to and ADC signal abnormality for example in the right mid gland where a small focus measures 2 x 2 mm (series 301/72). An additional punctate focus of signal abnormality left apex (series 508/164) may be an additional lesion versus periprosthetic vessels. Scattered areas of T1 hyperintensity are related to hemorrhage from prior biopsy. Central Gland: Benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Scattered foci of signal abnormality within the peripheral zone but no dominant lesion.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: Left neck pain, submandibular gland removal 40 years ago, possible carotid stenosis, possible Eagle's, torticollis. There are postoperative findings in the left neck, including absence of the left submandibular gland. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and remaining salivary glands are unremarkable. The osseous structures are unremarkable. The carotid artery flow voids appear to be grossly intact. The orbits, paranasal sinuses, and imaged intracranial structures are grossly unremarkable.

Output: 1. Postoperative findings in the left neck, without evidence of mass lesions.2. MRI is limited for the assessment of Eagle syndrome and CT may be useful for further evaluation.3. The carotid artery flow voids appear to be grossly intact, but the sequences are not intended for evaluating the vasculature. However, Doppler ultrasound, MRA, or CTA is recommended for further assessment of suspected carotid stenosis.


Instruction: Generate impression based on findings.

Input: Pineal tumor resection. There are interval postoperative findings related to partial resection of a pineal tumor via a posterior approach. There is pineal tumor, particularly along the inferior aspect of the resection cavity, which measures up to 32 mm and protrudes into the left thalamus. There is an area of restricted diffusion along the medial aspect of the right thalamus. There is a small amount of hemorrhage and gas within the ventricular system. There is encephalomalacia and superimposed edema in the right occipital lobe, with adjacent extra-axial fluid, blood products, and hemostatic agent along the surgical approach. The ventricles are not significantly changed in size, with a right transfrontal ventricular catheter in position. There are unchanged scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is an enhancing 20 mm diameter left occipital subcutaneous nodule. There is a small amount of fluid within the maxillary sinuses.

Output: 1. Interval subtotal resection of a pineal mass associated with a small amount of intraventricular and regional extra-axial hemorrhage, as well as acute ischemia in the right thalamus.2. No significant change in size of the shunted ventricular system.3. Nonspecific enhancing 20 mm diameter left occipital subcutaneous nodule.


Instruction: Generate impression based on findings.

Input: 82-year-old male with history of Whipple for ampullary adenoma in 2008 now with multiple episodes of documented recurrent acute pancreatitis and pancreatic ductal dilatation. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation with evidence of a hepaticojejunostomy. Gallbladder is surgically absent. No suspicious hepatic lesions; portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: Postoperative changes of Whipple procedure. Pancreatic duct is dilated to approximately 5 mm. No evidence of an obstructing mass in the pancreatic body. Poor intrinsic T1 hyperintensity and mild increased T2 hyperintensity of the pancreatic parenchyma.Nonspecific subcentimeter peripancreatic lymph nodes.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small incisional hernia without evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of obstructing pancreatic body mass.2.Mildly dilated pancreatic duct may be secondary to mild stricture at the pancreaticojejunostomy/changes of chronic pancreatitis, not siginificantly changed.


Instruction: Generate impression based on findings.

Input: Lower extremity numbness Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. Abnormal T2 signal is noted involving the right central and dorsal cervical cord at the C1-C2 level. Abnormal T2 signal is also noted within the right lateral aspect of the cervical cord at the mid C2 level, well seen on sagittal STIR image 7/11. Abnormal T2 signal is also noted within the cervical cord at the C4-C5 level. Small focus of T2 hyperintensity is also noted within the dorsal aspect of the cord at the midline and slightly to the left of midline at the C5-C6 level and also noted on recent cord compression protocol MRI study.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: There is a disc osteophyte complex with central disc protrusion as well as ligamentum flavum thickening posteriorly. There is moderate spinal canal stenosis including mild flattening of the cervical cord. There is abnormal T2 signal centrally within the cord at this level. There is mild bilateral neural foraminal narrowing related to uncovertebral hypertrophy.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar:Five lumbar type vertebral bodies are 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. Abnormal T2 signal is noted in the ventral cord at the upper T12 level on the sagittal T2 and STIR sequences.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is disc desiccation and diffuse bulge which along with ligamentum flavum thickening, epidural fat, and facet arthropathy result in mild to moderate spinal canal stenosis. There is bilateral facet arthropathy with distention of the facet joints. Tiny synovial cyst is noted posterior to the inferior aspect of the left L3-L4 facet joint left. There is mild right and minimal left neural foraminal narrowing.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Multiple foci of T2 signal abnormality within the cord at the right C1-C2, right lateral mid C2, dorsal C5-C6, and ventral T12 levels. These foci are of indeterminate age but suggest demyelinating or other chronic inflammatory etiologies. Brain MRI as well as postcontrast imaging may be helpful if there is suspicion for an active inflammatory process.2. Degenerative changes in the cervical spine with moderate cervical spinal canal stenosis at the C4-C5 level related to central disc protrusion with mild cord flattening. There is associated abnormal T2 signal in the cord at the C4-C5 level.3. Degenerative changes in the lumbar spine with mild to moderate spinal canal stenosis at L3-L4. Otherwise no high-grade spinal canal stenosis in the lumbar spine is appreciated.


Instruction: Generate impression based on findings.

Input: History of ACL reconstruction and meniscal repair now with knee pain. Evaluation somewhat limited by patient motion artifact.MENISCI: There is abnormal, irregular increased signal intensity within the medial meniscus at the junction of the body and the posterior horn that extends to the tibial articular surface. This signal abnormality is more pronounced on the current study than on the prior exam and is suggestive of a tear. Furthermore, both the body and posterior horn of the medial meniscus appear attenuated on the current exam compared to the prior exam suggesting chronic attritional tearing in the absence of prior meniscectomy. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Postsurgical changes of prior ACL repair are present. There is mild edema within the posterior aspect of the medial tibial plateau with what appears to be mild loss of the overlying articular cartilage. The articular cartilage of the medial compartment is otherwise intact. There is also edema within the posterior aspect of the lateral tibial plateau which may represent bone contusion. The articular cartilage of the lateral compartment appears intact. The articular cartilage of the patellofemoral compartment appears intact.LIGAMENTS: The ACL graft is not well visualized on the sagittal images suggestive of near-complete or complete tear. The PCL appears intact. The collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complete or near-complete tear of the ACL graft.2.Findings suggestive of new tear or re-tear of the medial meniscus.3.Other findings as described above.


Instruction: Generate impression based on findings.

Input: 68-year-old female with a cerebellopontine angle meningioma status post surgical resection and radiotherapy. Follow-up exam.. Postsurgical changes related to right suboccipital craniotomy and CP angle tumor resection are unchanged. A small amount of T2/FLAIR hyperintensity along the right cerebellum and right middle cerebellar peduncle are stable. There is persistent flattening of the right cerebellar hemisphere and a prominence of the extra-axial space in this location. Mild dural enhancement along the posterior aspect of the petrous apex is stable. No residual mass lesion is identified in the area of resection. There has been interval development of a subcentimeter focus of susceptibility artifact in the posterior limb of the left internal capsule. Mild patchy periventricular and subcortical white matter T2 hyperintensities and the prior right corona radiata lacunar infarct are stable. There is no evidence of acute ischemic infarct. There is a left parietal developmental venous anomaly. There is a 10 x 5 mm extra-axial lesion along the left occipital lobe that is T1 isointense, mildly T2 hyperintense and avidly enhancing with a dural tail. This is stable in size and appearance since 7/16/2014.The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Stable postsurgical changes related to right cerebellopontine angle meningioma resection. There is no evidence of residual or recurrent tumor.2.Stable 10 x 5 mm left occipital meningioma, even dating back to baseline exam.3.Interval punctate hemosiderin staining in the posterior limb of left internal capsule related to trace hemosiderin.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with memory loss. Assess for any specific pattern of atrophy. Diffusion weighted images are within normal limits. There are numerous scattered foci of T2 hyperintensity in the subcortical and periventricular white matter, with a few also to be found in the pons.No evidence of significant parenchymal atrophy is seen. No edema or mass effect is detected. There is no evidence of acute intracranial hemorrhage. A focus of susceptibility within the right cerebellar hemisphere likely represents chronic microhemorrhage. No abnormal extra-axial fluid collections are seen. The ventricles are normal in size and morphology.On post contrast imaging, no pathologic parenchymal or extra-axial enhancement is seen.

Output: 1. No evidence of significant parenchymal atrophy is seen.2. Numerous scattered foci of white matter signal abnormality are nonspecific but most commonly represent the sequelae of chronic microvascular ischemic disease.3. No acute intracranial abnormality or other specific findings are seen which would account for the patient's memory loss.


Instruction: Generate impression based on findings.

Input: 49-year-old female with left lower quadrant pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nonspecific hypodense lesions in the liver. Their etiology is unknown. MRI of the liver may be helpful for further evaluation. An index lesion in the left lobe adjacent to the falciform ligament measures 2.2 x 2.1 cm image number 40, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Nonspecific borderline enlarged retroperitoneal lymph nodes. An index left para-aortic node measures 1 x 1 cm image number 84, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There is multiloculated cystic collections in the left adnexa associated with surrounding fat stranding. Left ovary cannot be seen separate from these collections. One of the large pockets in the level quadrant measures 5.7 x 2.8 cm image number 119, series number 3. Medial to the peripheral enhancing fluid collection, best seen on coronal images there is a multiloculated left adnexal mass measuring 8 x 6.3 cm image number 63.Right ovary is enlarged. There is a 2 x 1.3 cm hypodense focus within the lower uterus/cervix. The etiology is unknown.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is diffuse wall thickening of the sigmoid colon, best image number 107, series number 3. This may represent colitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of fluid in the pelvis.

Output: Multiloculated fluid collections in the left lower quadrant associated with surrounding fat stranding. These findings may represent an abscess. Etiology is unknown. This may be a tubo-ovarian abscess versus an abscess secondary to sigmoid colitis or diverticulitis. An underlying ovarian neoplasm cannot be excluded.Enlarged right ovary.Nonspecific retroperitoneal borderline enlarged lymph nodes.Liver MRI with focal nodular hyperplasia protocol is recommended for further evaluation of the nonspecific hypodense liver lesions.


Instruction: Generate impression based on findings.

Input: Cerebral vascular accident. 48-year-old male. The CSF spaces are appropriate for the patient's stated age with no midline shift. A hypodense focus is present along the left cerebellar hemisphere. It is somewhat ill-defined and measures 35 x 40 mm in axial dimensions and corresponds to an area of infarction identified on the MRI of 2/18/10.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. 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.Left cerebellar hemisphere subacute infarction in PICA distribution.2.no hemorrhagic conversion.3.The ventricles are nondilated.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with metastatic breast cancer to the brain, treatment planning MRI for radiation therapy. A hemosiderin stained resection cavity is present in the right paramedian parietal lobe compatible with prior resection of a metastatic lesion from this location. The surgical cavity is approximately the same size as that seen on the immediate postoperative exam. Since the immediate postoperative examination, patchy peripheral enhancement has developed along the margins of the cavity which, in some areas, appears rather gyriform in nature. Redemonstrated is a heterogeneously but briskly enhancing lesion within the inferior left cerebellum. This lesion measures approximately 22 x 17 mm which is unchanged from the preoperative evaluation. The lesion is associated with fairly strong susceptibility artifact which may reflect internal blood product.No new enhancing lesions are identified. No new or significant generalized mass effect is seen. The ventricular system is within normal limits.

Output: 1.Interval development of patchy somewhat gyriform enhancement around the margins of the right parietal resection cavity. This is nonspecific but favored to represent postoperative granulation rather than residual/recurrent tumor.2.No significant interval change in the size or appearance of a second metastatic lesion in the left cerebellum.3.No evidence of any new intracranial lesion is seen.


Instruction: Generate impression based on findings.

Input: Female 80 years old with history of low back pain and bilateral leg pain, L4-5 stenosis The spinal canal is developmentally slender. The vertebral column alignment is within normal limits without evidence of subluxation. The vertebral body and disc space heights are preserved with mild signal dessication throughout the discs. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus terminating at the L2-3 level. The paravertebral soft tissues are unremarkable.T11-12: No evidence of significant central or foraminal stenosis on sagittal images.T12-L2: Mild facet arthropathy without evidence of significant central or foraminal stenosis.L2-L3: Disc bulging with moderate bilateral facet arthropathy and ligamentum flavum hypertrophy causing moderate to severe central and mild to moderate bilateral foraminal stenosis, appearing stable from prior exam.L3-L4: Mild disc bulging with severe bilateral facet arthropathy and ligamentum flavum hypertrophy causing moderate to severe central and mild to moderate bilateral foraminal stenosis, appearing stable from prior exam.L4-5: Disc bulging with severe bilateral facet arthropathy, osteophytosis, and ligamentum hypertrophy causing severe central and severe bilateral foraminal stenosis. The right foraminal stenosis appears slightly progressed from prior.L5-S1: Disc bulging with moderate bilateral facet arthropathy. Mild to moderate bilateral foraminal stenosis without significant central stenosis.

Output: Marked degenerative changes of the lumbar spine with severe central and bilateral foraminal stenosis at L4-5, moderate central and bilateral foraminal stenosis at L3-4, as well as moderate central and bilateral foraminal stenosis at L2-3. There is slight progression of right foraminal stenosis at L4-5, otherwise, findings appear stable from prior exam.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsionsClinical question: Compare to previous MRI, any change?Signs and Symptoms: Break through seizures (R arm tingling/pain, eyes rolling back, R arm shaking) The CSF spaces are appropriate for the patient's stated age with no midline shift. A focus of encephalomalacia is redemonstrated along the left postcentral gyrus.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A focus of encephalomalacia is redemonstrated along the left postcentral gyrus. This is stable compared to the prior exam


Instruction: Generate impression based on findings.

Input: 29-year-old female with biopsy proven invasive ductal carcinoma at 2 sites in the left breast. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.LEFT BREAST: At the 2:00 position in the posterior left breast, there is an ovoid homogeneously enhancing mass with irregular margins, with artifact from the biopsy clip. This mass measures 18 x 16 x 17 mm (AP X ML X CC). While the lesion abuts the prepectoral fascia posteriorly, no definite enhancement is identified in the underlying pectoralis muscle.At the 3:00 position in the left breast, there is an irregular heterogeneously enhancing mass that measures 21 x 15 x 16 mm(AP X ML X CC), with biopsy clip artifact. This mass is located approximately 13 mm inferior to the mass at the 2:00 position described above.Just posterior to this mass at the 3:00 position there are 2 small enhancing satellite lesions, located medially and laterally. The largest of these satellite lesions located laterally measures 9 x 8 x 10 mm(AP X ML X CC); this lesion also abuts but does not appear to invade the underlying pectoralis muscle. Extensive non-mass enhancement is also noted surrounding the mass at the 3:00 position, extending anteriorly, laterally, and medially.Total extent of the 2 enhancing left breast masses, satellite lesions, and non-mass enhancement is 5.6 x 3.6 x 6.5 cm (AP X ML X CC).RIGHT BREAST: No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1.Two left breast masses, satellite lesions, and associated non-mass enhancement, compatible with the patient's known invasive ductal carcinoma with maximum extent of 5.6 x 3.6 x 6.5 cm. The masses/satellites abut but does not definitively invade the underlying left pectoralis muscle; see additional measurements above.2.No abnormality noted in the right breast or axillary regions. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 70-year-old male patient with history of RCC status post resection 9/2012. Surveillance imaging. Note that the examination is limited by the lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Again seen is a lobular T2 hyperintense lesion in segment seven of the liver, which has previously been characterized as hemangioma, unchanged.SPLEEN: Lobulated T2 hyperintense lesion in the region of the anteroinferior spleen is unchanged and nonspecific.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. There is no soft tissue signal seen in the region of the right renal bed to suggest local tumor recurrence. T2 hyperintense lesions in the left kidney compatible with renal cysts.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings from prior right nephrectomy without evidence of recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:2/6/1958)Reason: r/o infection History: s/p craniotomy with wound dc from incision sitePROVIDER/ATTENDING NAME: DAVID A HARTER KATIE TATARIS The patient is status post right-sided craniotomy along the high convexities for removal of an extra-axial mass adjacent to the posterior and medial aspect of the right frontal lobe. The T2 signal hyperintensity previously along the right superior frontal gyrus and right paracentral lobule as regressed. There is no evidence for local recurrence on the current exam.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: Status post removal of a right frontal meningioma without evidence of local recurrence.


Instruction: Generate impression based on findings.

Input: 60-year-old female with family history of breast cancer, for breast cancer screening. Moderate parenchymal enhancement is noted bilaterally.5 mm enhancing focus in the right breast at the 6:30 o'clock position. Multiple smaller benign appearing foci are also identified scattered in both breasts. Benign-appearing intramammary lymph node is identified in the right breast at the 10:00 position.No abnormal lymph nodes are identified in either axillary or in the left breast.

Output: 1. 5 mm enhancing focus in the right breast 6:30 position. This finding is probably benign, however prior mammographic/sonographic/MRI comparison studies are necessary to establish stability of finding. Please submit prior mammogram if performed. MRI directed ultrasound is recommended of this lesion. If the lesion is not seen on ultrasound, short term MRI follow-up is recommended in 6 months.2. Patient should also undergo bilateral screening mammography, if not already performed in the last 12 months.BIRADS: 0 - INCOMPLETE; Need prior mammographic, sonographic or MRI study for comparison to establish stability of finding.RECOMMENDATION: O - Old Study For Comparison.


Instruction: Generate impression based on findings.

Input: Diagnosis: Tinnitus, bilateral Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral sideClinical question: evaluated IACs, asymmetrical SNHL (Right) on AudiogramSigns and Symptoms: Right ear tinnitus, Asymmetrical SNHL No abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.To extent of visualization 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.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the IACs is within normal limits.


Instruction: Generate impression based on findings.

Input: Diffuse large B-cell lymphoma. Back pain. History of skull base mass. The marrow is heterogeneous with widely distributed areas of T1-hypointense, T2-hyperintense, contrast-enhancing signal. This focality is most pronounced at C5 vertebral body, T1 spinous process, T10 vertebral body, the medial end of the right 11th rib, T12 spinous process, L1 vertebral body, L4 vertebral body as well as the sacral ala and iliac bones. However, there is no osseous expansion, pathologic fracture or epidural involvement. Alignment is anatomic. The vertebral bodies are present in height. There is mild upper/mid cervical disc desiccation. There is a small central disc protrusion at T8-T9 which abuts the ventral aspect of the spinal cord. The spinal canal is preserved. There is no significant neural foraminal stenosis. The spinal cord shows normal signal. The conus medullaris has normal shape and signal and its tip lies at L1 level. While the spinal cord itself shows no abnormal contrast enhancement, there is nodular contrast enhancement along the cauda equina roots, which may reflect leptomeningeal involvement but is nonspecific otherwise.Central skull base involvement is only partly included as well as the right sigmoid sinus/internal jugular venous thrombosis. Please refer to the recent brain MRI from May 25, 2016 for more details. Asymmetry of the tongue with increased fatty signal in its right side probably reflect denervation from the skull base involvement. There is less pronounced asymmetry in the larynx, also suggestive of right recurrent laryngeal nerve paresis's as well as atrophy of the soft tissues in the right side of the neck which may relate to intracranial involvement. A large right hilar mass as well as multiple mildly enlarged mediastinal lymph nodes are only partly included. In addition, there are multiple small retroperitoneal lymph nodes.

Output: 1.There is diffuse abnormal marrow signal with more pronounced involvement at some levels as described above. There is however, no associated osseous expansion, pathologic fracture or epidural soft tissue component. In this clinical setting, this would be compatible with lymphomatous involvement of the marrow although without gross destruction.2.While there is no abnormal spinal cord signal or contrast enhancement, there is nodular contrast enhancement along the cauda equina nerve roots, compatible with a leptomeningeal process. The finding is otherwise nonspecific and while here it may represent lymphomatous involvement of the leptomeninges, it can also be seen with other inflammatory/infectious processes.3.Multilevel degenerative spondylosis is mild.4.Large right hilar mass and mildly enlarged mediastinal lymph nodes are only partly included. Also, involvement of the central skull base and associated venous thrombosis are only partly included.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for ischemia History: slurred speech, L facial weakness MRI of the brainthere is diffusion restriction present in the subcortical white matter and centrum semiovale of the right frontal lobe with a punctate lesion in the right insular cortex. There is associated adjacent signal loss on SWI in the adjacent peri-medullary veins.Several punctate foci of signal loss are present in the subcortical white matter of the left frontal lobe. These are nonspecific in isolation.There is a focal signal loss on the T1 weighted higher signal on T2 present in the lower pons with a lesion measuring approximately 3 mm in diameter. It is associated with a more profound signal loss on susceptibility imagingThere is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrates scattered opacities. 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. The right middle cerebral artery as 3 and divisions in this patient. The largest one which supplies the posterior parietal artery, angular artery and of the central and precentral arteries is occluded at the proximal M2 segment.There is no evidence for intracranial aneurysm.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. There is a fetal origin of the posterior cerebral arteries bilaterally with a small P1 segments The vertebral arteries are similar in size.

Output: 1.There is a branch occlusion of the right middle cerebral artery at the proximal M2 segment.2.There is acute/subacute infarction present in the right frontal lobe mainly involving white matter corresponding to the middle cerebral artery branch occlusion.3.There is a small hemorrhagic lesion present in the pons. It is nonspecific. One possibility is that this represents a cerebral cavernous malformation, however, it may also represent residua from a small old hemorrhage.4.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: History of thyroid cancer and right hip and groin pain: rule out metastatic lesion. There is a partially imaged mass in the right iliac fossa with fluid-fluid levels. There is a lesion with fat signal characteristics in the T12 vertebral body, which likely represents a hemangioma. The vertebral body heights are preserved. There is multilevel degenerative spondylosis with mild spinal canal stenosis and at least moderate right neural foramen stenosis at L3-4. There is also unchanged mild anterolisthesis of L3 upon L4. There unchanged are perineural cysts in the sacral spinal canal and along the extraforaminal left L5 nerve roots. There are also degenerative changes of bilateral sacroiliac joints and including effusion on the right. There are subcentimeter probable left renal cysts.

Output: 1. Partially imaged mass in the right iliaca fossa, which may represent a hemorrhagic thyroid metastasis, although this is incompletely characterized without intravenous contrast.2. No evidence of lumbar spine metastases, although the evaluation is limited without intravenous contrast.3. Multilevel degenerative spondylosis with mild spinal canal stenosis and at least moderate right neural foramen stenosis at L3-4. 4. Degenerative changes of bilateral sacroiliac joints and including effusion on the right.Results were discussed with the primary service physician, Dr. Plonka (pager #1044) by Dr. Veronesi of the Radiology service regarding the right iliac fossa lesion at the time of this dictation.


Instruction: Generate impression based on findings.

Input: 56-year-old male with squamous cell carcinoma of the right neck. Status post right neck dissection. Evaluate status. CT of the soft tissues of the neck with infusion:Images through the skull base and including cavernous sinuses are unremarkable. Paranasal sinuses and mastoid vessels are unremarkable with the exception of a small retention cyst within the right maxillary sinus. Limited images through the orbits demonstrate thickening of the right lateral rectus muscle with enhancement. This is best appreciated on axial images 11 through 13. The rest of extraocular musculature remain within normal size and morphology. Please correlate with history and follow-up with an MRI examination of orbits is recommended.The finding may represent Graves' disease. Possibility of a post traumatic change cannot be ruled out. A less likely possibility of a mass should also be considered. MRI is recommended.Images through the soft tissues of the neck demonstrate prominence of bilateral tonsils with multiple calcification which may be result of prior repetitive infection. There is effacement of partial plane on the right secondary to prior surgical intervention. No definitive evidence of a primary tumor is detected. No definitive pathologic adenopathy is identified.Limited images through the apices of the lungs and mediastinum are negative. Please review dedicated report of CT of chest performed the same date.Bony density of area of exam is unremarkable however degenerative disk disease of the cervical spine is noted.CT of brain with infusion:No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits. No evidence of metastatic disease to the brain, leptomeninges or the calvarium.80 cc of Omnipaque 350 was utilized for a bone studies.

Output: 1.No definitive mass or pathologic adenopathy in the neck.2.Post operative changes of right neck.3.Prominence of right lateral rectus muscle as detailed above. MRI is recommended.4.Unremarkable CT of brain with infusion.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate cervical abnormality/stenosis. Signs and symptoms: Clumsy hands, weakness. Nonenhanced cervical MRI:The signal intensity of the vertebral column demonstrate changes related to degenerative disease and unremarkable otherwise.The alignment of vertebral column is anatomical.There is generalized uniform narrowing of the spinal canal on sagittal images. The finding although partially secondary to uniform posterior longitudinal hypertrophy possibility of underlying congenital anatomical variation should also be considered.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes with resultant mild right neural foraminal compromise and unremarkable otherwise.C3-C4 demonstrate moderate disc disease and loss of disc height, asymmetric (R>L) uncovertebral hypertrophy with resultant significant right and moderate to significant left neural foraminal compromise. There is a ventral hypertrophic spur which results in slight flattening and posterior displacement of the cord and moderate central spinal stenosis. There is no detectable cord signal abnormality.C4-C5 demonstrate moderate disc disease and loss of disc height, mild bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in significant left and moderate right neural foraminal compromise and mild central spinal stenosis.C5-C6 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy and asymmetric (L>R) uncovertebral hypertrophic changes. Constellation of changes results in significant right and moderate to significant left neural foraminal compromise and moderate central spinal stenosis.C6-C7 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is asymmetric uncovertebral hypertrophic changes (L>R) present. Constellation of changes results in complete effacement of subarachnoid space, flattening and posterior displacement of the cord, moderate central spinal stenosis and significant bilateral neural foraminal compromise.C7-T1 demonstrate moderate disc degeneration and loss of disc height, moderate bilateral ligamentum flavum and mild bilateral facet hypertrophic changes. Constellation of changes could results in mild central spinal stenosis and significant left neural foraminal compromise.There is no detectable signal abnormality of the cord.There is no detectable. Spinal soft tissue abnormalities. Partially visualized T2-T3 disc level demonstrates a prominent midline ventral epidural defect with suggestion of subtle mass effect on the ventral aspect of the cord. Finding likely representing degenerative changes. Correlate with neurological exam and consider follow-up with thoracic MRI if clinically warranted.

Output: 1.Extensive degenerative changes of cervical spine primarily of disc disease as well as uniform hypertrophy of posterior longitudinal ligament. Findings resulting in multilevel central spinal stenosis at C3-C4 through C7-T1 levels. Worse stenosis appears to be at C5-C6 and C3-C4 levels as detailed.2.Degenerative changes also results in multilevel bilateral neural foraminal compromise (several significantly) as detailed per level above.3.There is normal signal intesity of the cervical cord.4.Degenerative disease of partially visualized T2-T3 level as detailed above. Correlate with neurological exam and consider follow-up with dedicated imaging.


Instruction: Generate impression based on findings.

Input: Reason: HEADACHES: SARCOID: TREATED HIV: NOW SERO NEGATIVE History: FRONTAL HEADACHES: NORMAL SINUS SCOPE AND NORMAL EYE EXAM: HAS CHEST SARCOID. There is a punctate focus of susceptibility artifact along the left parietal cortex appearing unchanged and compatible with a chronic microhemorrhage or prominent vessel. The brain parenchymal signal is otherwise unremarkable. There is no restricted diffusion to suggest acute ischemic infarction. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal mucosal thickening within the ethmoid air cells. The orbits, skull, paranasal sinuses, and scalp soft tissues are otherwise grossly unremarkable.

Output: No acute abnormality or specific findings to account for the patient's headaches. Please note that this examination does not include intravenous contrast, limiting sensitivity for findings of neurosarcoidosis.


Instruction: Generate impression based on findings.

Input: Entire left sided numbness in the last 2 weeks which occurs daily usually when waking up. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is unchanged mild coaptation of the right frontal horn. The ventricular system is otherwise unremarkable. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or cerebral aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of acute infarct, acute intracranial hemorrhage, or mass.2. No evidence of significant steno-occlusive lesions in the major head and neck arteries.


Instruction: Generate impression based on findings.

Input: 57 years Female (DOB:10/4/1959)Reason: h/o Chiari s/p decompression with nystagmus HA and ataxia History: h/o Chiari s/p decompression with nystagmus HA and ataxiaPROVIDER/ATTENDING NAME: CHRISTOPHER M GOMEZ CHRISTOPHER M GOMEZ The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient status post suboccipital craniotomy. There is reversal of normal cervical curvature present. There is no evidence for ventriculomegaly or syrinx.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.CSF flow study is stable.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst in the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Status post suboccipital craniotomy for Chiari I malformation. There is no evidence for ventriculomegaly on this exam and no significant change compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Relapsed neuroblastoma with headache. The lobulated heterogeneous mass along the floor of the left middle cranial fossa and infratemporal fossa with perineural extension into the left cavernous sinus through foramen ovale and rotundum has slightly increased in size, measuring up to approximately 4.5 cm, previously 4.0 cm. In addition, tumor along the left lateral extraconal space appears to have slightly increase in size, measuring up to 11 mm in thickness, previously 7 mm, with mass effect upon the left lateral rectus muscle and compression of the left optic nerve in the orbital apex. An extradural nodule adjacent to the lateral inferior left frontal lobe now measures up to 7 mm, previously 5 mm, and displays central non-enhancement. There is also interval increase in size of the tumors along the bilateral mandibular condyles, measuring up to 22 mm in overall width on the right, previously 15 m, and 13 mm in overall width on the left, previously 11 mm. There is no evidence of intracranial hemorrhage or acute infarct. There is mild mega cisterna magna. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift. There is scattered paranasal sinus mucosal thickening and secretions. There is obstructed fluid within the left mastoid air cells.

Output: 1. Interval increase in size of tumor along the left lateral wall of the orbit with associated compression of the left optic nerve at the orbital apex.2. Slight interval increase in size of the mass along the floor of the left middle cranial fossa and infratemporal fossa with apparent perineural extension into the left cavernous sinus through foramen ovale and rotundum, as well as associated left Eustachian tube obstruction.3. A subcentimeter extradural lesion adjacent to the inferior left frontal lobe laterally has slightly increased in size and now appears to be partly necrotic.4. Interval increase in size of the tumors along the bilateral mandibular condyles.