Instruction: Generate impression based on findings.

Input: 46-year-old male found down during fire. Evaluate for ligamentous injury Cervical spine:There is mild reversal of cervical lordosis at the C3-C4 level. Vertebral body heights are grossly maintained. Focus of increased T1 and T2 signal in the posterior aspect of the C5 vertebral body compatible with hemangioma.Anterior and posterior longitudinal ligaments as well as the ligamentum flavum appear intact. There is mildly increased T2 signal in the interspinous ligaments extending from C3 to C7 which may reflect mild ligamentous injury. No evidence of epidural hematoma. No evidence of hemorrhagic cord contusion.There is a large central disc protrusion at C3-C4 with mass effect and deformity of the cervical cord at this level. The anterior cord demonstrates increased T2 signal from C3 to C6 which may reflect gliosis with possible component of edema. Additional details as below.C2-C3: No disc bulge or spinal canal stenosis. No neural foraminal stenosis.C3-C4: Generalized disc bulge with focal central disc protrusion. There is complete effacement of the anterior and posterior thecal sac as well as focal mass effect and distortion of the underlying cord. Moderate left and mild right neural foraminal stenosis.C4-C5: Central disc protrusion with effacement of the ventral thecal sac results in mild spinal canal stenosis. No neural foraminal stenosis.C5-C6: Central disc protrusion slightly asymmetric to the right with effacement of the ventral thecal sac. Mild spinal canal stenosis. Minimal bilateral neural foraminal stenosis.C6-C7: Mild generalized disc bulge. No significant neural foraminal or spinal canal stenosis.C7-T1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.

Output: 1. Increased T2 signal in the interspinous ligaments raising possibility of interspinous ligamentous injury. Remainder of the ligaments including the anterior and posterior longitudinal ligaments as well as the ligamentum flavum are intact. No evidence of epidural hematoma or hemorrhagic contusion involving the cervical cord.2. Large central disc protrusion at C3-4 with mass effect and deformity of the cervical cord at this level. Smaller disc protrusions are evident at the C4-C5 and C5-C6 levels with minimal to mild mass effect on the cord. There is abnormal T2 signal within the cervical cord from C3 to C6 which may reflect gliosis/myelomalacia although component of acute edema can not be entirely excluded.3. Moderate left C3-C4 neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Female 60 years old Reason: leg pain s/p fusion History: leg pain Rods with screws into L4 and L5. We see no acute hardware complication. Intervertebral disc spacer is noted at L4-5. Grade 2 anterolisthesis of L4.

Output: Orthopedic fixation of the lower lumbar spine.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic lung cancer, brain metastases, status post SRS to lesion. On immunotherapy now. Compared to prior exams and evaluate response to treatment. Signs and symptoms: Brain metastases. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates stable chronic changes on the left anterior frontal paramedian tumor treatment with remaining encephalomalacia. Metallic artifact at this site partially obscures the region however beyond the region of artifact there is no detectable abnormal enhancement to suggest residual or recurrence of tumor.Multiple small foci of FLAIR hyperintensity with a small internal foci of enhancement noted in bilateral cerebral hemispheres and right cerebellum demonstrate significant interval improvement some with near complete resolution. On post contrast images there is a single punctate focus of enhancement in the right cerebellum measuring approximately 1.5 x 1.2 mm in transaxial dimensions consistent with a remaining metastatic disease with interval decreased since prior study measurement of 3.8 x 3.2 mm.None of the additional previously noted metastatic lesions in bilateral cerebral hemispheres or cerebellar hemispheres can be identified.A stable subcentimeter dural based focus of enhancement at the left jugulum sphenoidale demonstrate no significant change in size or enhancement and could represent a tiny dural based metastatic lesion or a benign extra-axial tumor such as a meningioma. This finding similar to prior exam appears to be at least partially within the left cavernous sinus.

Output: 1.Examination demonstrates significant interval improvement of metastatic brain lesions since prior study. Compared to prior exam there is only a single 1.5 x 1.2 mm (previously 3.8 x 3.2 mm) remaining enhancing metastatic lesion in the right cerebellum is detected. No additional metastatic lesions are visualized on the postcontrast series.2.Stable subcentimeter dural base enhancing lesion of the jugulum sphenoidale with partial extension into the left cavernous sinus is again noted.3.Stable focus of encephalomalacia without detectable enhancement in the left paramedian inferior frontal.


Instruction: Generate impression based on findings.

Input: Paresthesias. Probable CNS vasculitis. Evaluate for progression. There is no evidence of intracranial hemorrhage, mass, or acute infarction. The pituitary gland appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids appear to be intact. There is moderate T2 hyperintensity within the subcortical and periventricular white matter, more extensive on the left, particularly within the left occipital lobe, which is unchanged. Another T2 hyperintense focus within the left medulla appears unchanged. There are postoperative findings related to left posterior parietal craniotomy. The orbits are grossly unremarkable. There are bilateral maxillary sinus retention cysts.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarction.2.Unchanged white matter lesions and postoperative findings in the left hemisphere.


Instruction: Generate impression based on findings.

Input: 28-year-old female patient status post resection of pelvic schwannoma. Evaluate postsurgical changes. ABDOMEN:LIVER, BILIARY TRACT: The common bile duct is prominent in diameter but smoothly tapers distally without evidence of a distal obstructing lesion, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild bilateral pelvocaliectasis with bilateral ureteral stents noted.RETROPERITONEUM, LYMPH NODES: There are two enhancing nodules within the left retroperitoneum posterior to the left psoas muscle measuring up to 1.3 cm (image 83, series 1103), which are stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from lumbosacral orthopedic fixation hardware. Post-surgical changes of the midline abdominopelvic ventral wall. OTHER: There are prominent periaortic lymph nodes within the chest. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Bilateral ureteral stents. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from lumbosacral orthopedic hardware limits evaluation of pelvic bony structures. Post-surgical changes in the left hemipelvis with a T2 hyperintense collection with peripheral thick enhancement within the surgical bed measuring 5.5 x 9.2 x 9.7 cm. Foci of susceptibility artifact within this collection are compatible with foci of air as seen on prior CT. Enhancing tissue is present along the inferior margin of the surgical bed and is invading the left sacrum, as seen on prior studies, compatible with residual tumor (image 82, series 1901). OTHER: No significant abnormality noted.

Output: Post-surgical changes in the left hemipelvis with a large thick walled fluid collection within the surgical bed and enhancing soft tissue along the posterior margin compatible with residual tumor; this may represent an evolving post-operative seroma though abscess is not excluded in the appropriate clinical context.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness and numbness. Pain down posterior thighs. Unable to walk greater than 100 feet, must sit to have symptoms settle down. History of lumbar fusion at outside hospital in 2013, L3-S1. Starting to have same symptoms. Need to evaluate for stenosis above fusion or fusion breakdown. Five lumbar type vertebral bodies are presumed to be present. Again seen are postsurgical changes of posterior lumbar fusion from L3 through S1. Laminectomies are evident at L4, L5, and partially at L3. Hardware including loosening involving the bilateral L3 and right S1 screws is better appreciated on recent CT.Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L3 on L4; alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position. Small Schmorl's node is seen involving the inferior endplate of L2Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is moderate degree of spinal canal stenosis related to combination of disc bulge, bilateral facet arthropathy, and epidural fat which is predominantly in the lateral aspects of the spinal canal. There is also mild to moderate bilateral neural foraminal stenosis.L3-L4: There is moderate degree of spinal canal stenosis just above the level of the laminectomy related to combination of grade 1 anterolisthesis with disc uncovering, facet arthropathy, ligamentum flavum thickening. There is moderate bilateral neural foraminal stenosis.L4-L5: Spinal canal is well decompressed. There is moderate right-sided neural foraminal stenosis, with prominent endplate osteophytes more apparent on recent CT. Left neural foramen is grossly patent.L5-S1: Spinal canal is well decompressed. There is mild to moderate bilateral neural foraminal stenosis, not well assessed due to hardware.Aside from postsurgical changes, paraspinous soft tissues are grossly unremarkable.

Output: 1. Postsurgical changes of L3-S1 posterior fusion with loosening involving the bilateral L3 and right S1 screws better demonstrated on recent CT.2. There is moderate spinal canal stenosis at the L2-L3 level as well as at the L3-L4 level, just above the laminectomy. There is also multilevel neural foraminal stenosis including the bilateral L2-L3, L3-L4, L5-S1 and right L4-L5 levels. Please see details above.


Instruction: Generate impression based on findings.

Input: Patient w/ prostate CA here w/ diffuse weakness, please eval for cervical spinal stenosis/ cord compression Severe degenerative changes of the cervical spine at C3-4, C4-5, C5-6, and C6-7 levels with obliteration of the disc spaces. This is most severe at C3-4 as below. Heterogeneous marrow signal with edema is evident in the vertebral bodies from C3 through C7, most likely degenerative in nature. There is some degenerative loss of vertebral body height. There is grade 1 anterolisthesis of C6 over C7. Normal cervical medullary junction. No definite spinal metastasis.C1-2: No significant spinal canal stenosis or foraminal narrowing.C2-3: Mild disc osteophyte formation. No significant spinal canal or foraminal narrowing.C3-4: Disc osteophyte formation with superimposed right paracentral disc extrusion. Thickening of ligamentum flavum and facet arthropathy. There is significant spinal canal stenosis and impingement of the spinal cord and evidence of cord edema. Mild right foraminal narrowing. Moderate left foraminal narrowing.C4-5: Facet arthropathy, ligamentum flavum thickening, and disc osteophyte formation. There is moderate spinal canal stenosis without cord edema. There is moderate right foraminal narrowing. There is severe left foraminal narrowing.C5-6: Facet arthropathy, ligamentum flavum thickening, left greater than right, and disc osteophyte formation. There is moderate to severe spinal canal stenosis without cord edema. There is bilateral severe foraminal narrowing.C6-7: Facet arthropathy, left greater than right, and disc osteophyte formation. There is mild spinal canal narrowing without cord edema. There is moderate right foraminal narrowing. There is severe left foraminal narrowing.

Output: Severe degenerative changes of the cervical spine from C3 to C7, most severe at the C3-4 level with adjacent cord edema. No definite spinal metastasis.


Instruction: Generate impression based on findings.

Input: Hypotonia. Evaluate for brain abnormality. There is T1 hyperintense subdural hemorrhage in the posterior fossa bilaterally without mass-effect on the underlying brain. There is a small focus of susceptibility in the right cerebellar hemisphere associated with apparent decreased right cerebellar sulcal delineation on axial T2-weighted images, although appearing more symmetric on coronal T2-weighted images. Another small focus of susceptibility effect is present superficially in the anterior left temporal lobe. An apparent focus of susceptibility in the body of the left caudate nucleus is probably artifactual. Otherwise, there is no acute infarct. Myelination is very mildly delayed for adjusted gestational age. There is no significant mass-effect or midline shift. The ventricles are normal in size. There is asymmetric expansion of the extra-axial space in the anterior aspect of the left middle cranial fossa with probable mass-effect on the underlying parenchyma, which may represent a small arachnoid cyst.

Output: 1.Posterior fossa trace subdural hemorrhage without significant mass-effect might be birth-related.2.Small foci of parenchymal hemorrhage in the right cerebellar hemisphere and left temporal lobe.3.No acute infarct or significant mass-effect.4.Suggestion of a small arachnoid cyst in the left middle cranial fossa.5.Myelination may be very minimally delayed for adjusted gestational age.


Instruction: Generate impression based on findings.

Input: Suspicious for osteomyelitis on foot xray, probe to bone, diabetic foot infection. Question of osteomyelitis. There is heterogeneous T1 signal and increased STIR signal within the head to midshaft of the first metatarsal. This region also enhances on post-contrast imaging and is compatible with osteomyelitis. There is destruction of the head of the first metatarsal.There is hypointense T1/hyperintense STIR signal within the fourth digit proximal phalanx with associated enhancement and cortical destruction, which is also compatible with osteomyelitis. There is a soft tissue defect dorsal to this as well. There is mild increased STIR signal and enhancement of the head of the third metatarsal with slightly decreased T1 signal which is also highly suspicious for osteomyelitis. There is a chronic fracture of the midshaft of the second metatarsal with surrounding intermediate signal. There is a 8 x 28 mm T1 hypointense/T2 hyperintense collection adjacent to the head of the first metatarsal with rim enhancement which likely represents an infected fluid collection. There is diffuse soft tissue edema/inflammatory changes of the forefoot.

Output: 1. Osteomyelitis of the first metatarsal, fourth digit proximal phalanx, and third metatarsal as described above with surrounding inflammation.2. Infected fluid collection adjacent to the first metatarsal head. 3. Fracture of the second metatarsal.


Instruction: Generate impression based on findings.

Input: 19 year-old female. Abdominal pain, increasing frequency of stool. Ongoing symptoms with weight loss. 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: Multiple prominent mesenteric lymph nodes, likely reactive.BOWEL, MESENTERY: Approximately a 20 cm long segment of most distal terminal ileum up to the IC valve demonstrates active inflammation with wall thickening, hyperenhancement, and hyperemia. No fistulae, abscess, or bowel obstruction.Artifact from gastrostomy tube limits evaluation of adjacent anatomy.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 perianal fistula or abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free pelvic fluid, likely physiologic.

Output: Active inflammatory bowel disease involving approximately 20 cm of the most distal terminal ileum.


Instruction: Generate impression based on findings.

Input: Pain. Evaluate for fracture. There is soft tissue swelling, but I see no acute fracture. Osteoarthritis affecting the midfoot appears similar to that seen on the prior study. The distal Achilles tendon silhouette appears thickened which may simply reflect overlying soft tissue swelling, but if there is clinical concern for Achilles tendon tearing, then MRI may be considered for further evaluation.

Output: Soft tissue swelling without fracture evident. If there is clinical concern for tendon injury, then MRI may be considered.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with metastatic lung cancer presenting with dysarthria, gait instability, headache and nausea. New brain metastases on MRI. Cervical:A thin layer of enhancement along the brainstem and within the cerebellar fissures is partially visualized compatible with leptomeningeal metastatic disease. In the cervical region, there is also some evidence of subtle enhancement along the cord surface and some of the intrathecal nerve roots compatible with leptomeningeal metastatic disease.No definite evidence of osseous metastatic disease is seen in the cervical region. Spondylotic disease is better assessed on the prior precontrast C-spine exam.Thoracic:Subtle thin enhancement along the surface of the thoracic cord is seen on some slices compatible with leptomeningeal metastatic spread.Areas of pathologic enhancement are seen within the posterior superior aspect of the T3, T4 and T8 at vertebral bodies concerning for bony metastatic disease.A right-sided pleural fluid collection is partially visualized with a drainage catheter in place.Lumbar:Image quality is degraded by motion artifact, particularly on the postcontrast sequences. Within this limitation, the following observations are made.Diffuse enhancement of the nerve roots of the cauda equina is seen compatible with leptomeningeal metastatic spread.Bone marrow signal characteristics are generally heterogeneous. Superimposed upon this is an area of T1 hypointensity, T2 hyperintensity and mild enhancement involving the posterior inferior aspect of the L1 vertebral body.Spinal alignment is anatomic. Vertebral body height is preserved. Signal intensity of the sacrum and iliac bones is also heterogeneous with superimposed more localized lesions, at least one of which in the right iliac bone seems to enhance partially.T12-L1: Small right paracentral/foraminal protrusion. Mild generalized spinal canal stenosis. No significant neuroforaminal narrowing.L1-2: Bulging disk with superimposed central/left paracentral protrusion. Effacement of the left ventral thecal sac. No significant generalized canal stenosis. No significant foraminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal stenosis. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. A perineural root sleeve cyst is evident along the right S2 nerve root.

Output: 1. Evidence of leptomeningeal metastatic disease involving the entire spinal cord and cauda equina.2. Localized enhancing lesions in the T3, T4 and T8 vertebral bodies are concerning for osseous metastases.3. A lesion along the inferior aspect of the L1 vertebral body is indeterminate and could reflect degenerative disease or a metastatic lesion.4. Osseous metastatic disease is also suspected in the sacrum and iliac bones.


Instruction: Generate impression based on findings.

Input: Left asymmetrical SNHL and tinnitus. Many of the images are degraded by patient motion. The bilateral cranial nerve 7 and 8 complexes are grossly intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: Clinical question: History of brain surgery 9 years ago for subdural hematoma. Signs and symptoms: Memory loss. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate expected chronic postoperative changes of a right parietal small craniotomy.Mild scattered patchy foci of FLAIR/T2 hyperintensity are present only in the subcortical and periventricular white matter of bilateral cerebral hemispheres. Although nonspecific considering patient's stated age of 88 this appearance is highly suggestive of chronic microvascular ischemic changes of mild degree. The signal intensity of brain parenchyma is otherwise within normal on all MRI sequences.There is generalized symmetrical bilateral prominence of cortical sulci which could be within normal range for patient's stated age. Ventricular system are normal and with maintained midline. CSF spaces remain patent and unremarkable.The signal void of major intracranial arterial branches are present.Images through the orbits, paranasal sinuses, mastoid air cells and calvarium are unremarkable.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter.3.Essentially unremarkable nonenhanced brain MRI otherwise for patient's stated age of 88. Please see above comments.


Instruction: Generate impression based on findings.

Input: Clinical question: Neck pain. Signs and Symptoms: Back and neck pain. Nonenhanced cervical MRI:There is post operative changes of an anterior cervical fusion spanning C5 through C7.There is maintained normal anatomical alignment however with mild straightening of cervical lordosis.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes, minimal left uncovertebral hypertrophy with minimal left neural foraminal compromise(axial T2 series 6 image 22) and no spinal stenosis. C3-C4 demonstrate mild degenerative changes with mild asymmetric right uncovertebral hypertrophic changes (Axial T2 series 6 images 30 through 33) with resultant moderate right neural foramen.C4-C5 demonstrate post operative changes of anterior fusion and without neural foraminal or spinal stenosis.C5-C6 demonstrate postoperative changes of an anterior fusion without central spinal stenosis or neural foraminal compromise.C6/C7 demonstrate post operative changes of anterior fusion, mild asymmetric left uncovertebral hypertrophy with resultant very subtle compromise of the left neural foramen. There is mild flattening of the ventral aspect of cord secondary to shallow ventral hypertrophic changes without convincing central spinal stenosis. Patent right neural foramen.C7-T1 demonstrate mild disc degeneration, mild loss of disc height and mild bulge with slight flattening of the ventral aspect of the cord. There is also mild symmetrical bilateral ligamentum flavum and facet hypertrophy. No central spinal stenosis or definitive neural foraminal compromise.T1-T2 is unremarkable.There is a trace vertical linear T2 stir hyperintense in the anterior cervical cord at C6 and C7 levels without change in cord caliber which conceivably could represent myelopathy.

Output: 1.Postoperative changes of anterior fusion spanning C4-C7. 2.No central spinal stenosis at any level.3.Multilevel neural foraminal compromise; mild left neural foraminal at C2-C3, moderate right neural foraminal at C3-C4 and subtle left neural foraminal compromise at C6-C7 levels as detail above.4.Trace linear T2 STIR hyperintensity of the cord at C6 and C7 could conceivably represent myelopathy.


Instruction: Generate impression based on findings.

Input: Stroke versus TIA: Transient left-sided weakness and aphasia. Many of the sequences are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the right maxillary sinus.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 65-year-old male patient with history of prostate cancer status post prostatectomy with rising PSA. Evaluate for extent of disease. PSA of 0.35 on 09/22/2015. Note the examination is limited by susceptibility artifact from right total hip arthroplasty. Given this limitation the following findings are made:PELVIS:PROSTATE:Prostate Size: Status post radical prostatectomy.Peripheral Zone: Status post radical prostatectomy.Central Gland: Status post radical prostatectomy.Seminal Vesicles: There are bilateral low T2 signal nodules in the expected area of the seminal vesicles, which may represent residual seminal vesicle tissue.Extracapsular Extension: Not applicable.BLADDER: At the urethral anastomosis there is asymmetry with thickening of approximately 9 mm on the right (series 501 image 75), which appears to demonstrate some enhancement.LYMPH NODES: No pelvic lymphadenopathy is identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Urethral anastomotic asymmetry with thickening and probable enhancement on the right, raising suspicion for recurrent/residual disease.2.Probable residual seminal vesicle tissue bilaterally.


Instruction: Generate impression based on findings.

Input: Female 23 years old with history of septic shock, unknown source, evaluate for abscess versus tissue necrosis in gluteal region, PET scan demonstrates bilateral right greater than left decreased activity within the gluteal musculature with peripheral increased activity Diffuse edema with increased T2 signal throughout the gluteal musculature and soft tissues bilaterally. A fluid collection is noted measuring up to 14 x 48 mm in the area of the right gluteus minimus/maximus muscles (601/29).Bilateral iliacus and iliopsoas muscle enhancement as well as diffuse and heterogeneous enhancement of the gluteal muscles, which appears more severe on the right, with central areas of decreased enhancement measuring up to 47 x 99 mm on the right (901/20) and 36 x 61 mm on the left (901/22). These regions correspond to areas of decreased FDG uptake on recent PET and are consistent with necrosis. Surrounding subcentimeter necrotic areas with rim enhancement are also noted within the gluteal musculature and to a lesser extent along the coccyx.Decreased T1 signal within the marrow of the iliac bones, right greater than left, with corresponding increased T2 signal. Additional areas of decreased T1 signal along the greater trochanters and lateral aspects of the bilateral femoral heads are also noted.Small bilateral hip effusions noted. Rectal tube in place. Distended bladder containing foci of gas.

Output: 1. Diffuse soft tissue edema with heterogeneous enhancement of the bilateral gluteal, iliacus, and iliopsoas muscles. Large central areas of necrosis within the gluteal muscles are noted bilaterally with multiple surrounding subcentimeter abscesses. An additional 1.5 x 5 cm fluid collection is also noted within the right gluteal musculature.2. Underlying osseous involvement of the iliac bones, right greater than left, suspicious for osteomyelitis. The greater trochanters and lateral aspects of the femoral heads are also involved to a lesser extent.


Instruction: Generate impression based on findings.

Input: Atypical meningioma status post surgery: surveillance. There are postoperative findings related to right transfrontal resection of a planum sphenoidale meningioma. There is a plaque-like areas of heterogeneous enhancement along the posterior right planum sphenoidale, which measures approximately 25 mm in diameter and 5 mm in thickness. There is a persistent focus of enhancement along the right frontal lobe resection cavity posteromedial margin. A more linear focus of enhancement laterally along the resection cavity margin is likely vascular in nature. There is unchanged diffuse confluent T2 hyperintensity in the right frontal lobe surrounding the resection cavity, as well as to a smaller extent in the left anterior left frontal lobe periventricular white matter. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Postoperative findings related to right transfrontal resection of a planum sphenoidale meningioma without significant change in what may represent a small amount of residual tumor along the right planum sphenoidale associated with hyperostosis and along the right frontal lobe resection cavity posteromedial margin.


Instruction: Generate impression based on findings.

Input: 27 year old female with palpable lesion in the left breast, for which FNA result was benign, presents for research MRI. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.An irregularly shaped enhancing mass is present at 12 o'clock position in the left breast, measuring 17 x 36 x 20 mm (AP x LR x CC), corresponding to the palpable lesion.There is a slowly enhancing mass at 9 o'clock position in the right breast, measuring 12 x 8 x 7 mm, consistent with fibroadenoma. A small intramammary lymph node is seen in the posterior 9 o'clock position in the right breast. No abnormal enhancement is seen in right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Irregularly shaped enhancing mass at 12 o'clock position in the left breast. Ultrasound guided biopsy of this lesion was performed later today.2. No MR evidence for malignancy in the right breast.3. No abnormal axillary lymph nodes in either axillary region.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: BRAIN: Again seen are posttreatment findings related to prior embolization and radiosurgery of a left hippocampal/thalamic/lateral ventricle arteriovenous malformation that appears to be fed by the left posterior cerebral artery. There is no significant change in T1 hyperintensity which may related to calcification. There is slight decrease in surrounding T2 hyperintensity/edema within the left hippocampus and posterior thalamus compared to 5/20/2015 and more clear decrease when compared to 3/5/2015. There is no evidence of acute infarct or acute hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There is minimal paranasal sinus mucosal thickening.MRA HEAD: There is unchanged flow-related signal within the AVM fed from the left posterior cerebral artery. The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are otherwise normal in course and caliber. There is no evidence of flow-limiting stenosis.

Output: No significant change in size of left hippocampal/lateral ventricle/thalamic AVM compared to 5/20/2015, but smaller compared to remote study from 10/30/2014. There is minimal interval decrease in edema compared to most recent prior and more significant decrease in edema compared to 3/5/2015. No hydrocephalus. No new hemorrhage or mass effect.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with intraspinal abscess, reevaluate burden of epidural abscess and soft tissue infection. Symptoms include right hip and knee flexion and extension weakness, and left knee weakness. STIR hyperintensity within the L4 and L5 vertebral bodies has become more uniform and more intense, as has marrow space enhancement. T2 hyperintensity within the L4-5 disc space has diminished compared to prior but the disc space itself has lost some height. Vague STIR hyperintensity and patchy enhancement within the L2 and L3 vertebral bodies appears grossly similar to the prior examination.The previously seen large ventral epidural abscess has significantly decreased in size. A discrete fluid collection is no longer seen, but rather, there is a band of solid enhancement within the ventral epidural space spanning the L4-S1 levels. The thecal sac has reexpanded with significant relief of the previously seen encroachment and nerve root crowding. Paraspinal edema and enhancement persists, most notably at the L5 and S1 levels. However, the previously seen left psoas abscess is no longer clearly identified.Mild posterior wedging of the L5 vertebral body is unchanged, as is a 7 mm anterolisthesis of L5 relative to S1. Spinal alignment is otherwise unremarkable. The remaining vertebral body heights are preserved. Marrow signal change likely related to disc degeneration at L2 and L3 is redemonstrated.The distal spinal cord and conus are unremarkable. Enhancing nerve roots are seen within the left aspect of the cauda equina. The posterior dura of the lower thecal sac is also mildly enhancing but reduced from prior.L1-2: Facet hypertrophy. No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Facet hypertrophy. Ligamentum flavum thickening. Left disc height with disc bulging. Moderate spinal canal narrowing, improved. Moderate bilateral foraminal narrowing, unchanged. L3-4: Facet arthropathy and ligamentum flavum thickening. Bulging disc. Mild spinal canal narrowing, improved from prior. Moderate bilateral foraminal narrowing, unchanged. L4-5: Facet arthropathy. Disc bulging. Mild spinal canal narrowing, improved from prior. Severe foraminal narrowing, similar to prior. L5-S1: Facet arthropathy. Disc bulging and disc uncovering. No significant spinal canal stenosis. Severe bilateral foraminal narrowing, unchanged.

Output: 1.Since the prior examination, the previously seen large ventral epidural abscess has largely resolved leaving behind a band of solid enhancing tissue in the ventral epidural space which likely represents granulation. A previously seen left psoas abscess has also resolved.2.The previously seen significant encroachment upon the thecal sac in the lumbar region has been relieved. There appear to be two or three enhancing nerve roots within the left aspect of the cauda equina which may represent a post compressive radiculopathy or mild arachnoiditis.3.Signal abnormality and enhancement within the marrow space of the L4 and L5 vertebral bodies have become more uniform and intense. However, this is an expected finding in discitis-osteomyelitis as the findings on MRI imaging often lag behind clinical response.4.Vague signal abnormality and enhancement centered on the L2-3 disc space is nonspecific and unchanged from prior. These findings may represent disc degeneration or mild infectious involvement.


Instruction: Generate impression based on findings.

Input: Clinical question: Lesion causing seizure? Signs and symptoms: First time generalized seizure. Pre-and post-enhanced brain MRI:Examination demonstrates a well demarcated T1 hypointense and T2/T2 flair hyperintense superficially located nonenhancing intraparenchymal mass in the left superior frontal gyrus with evidence of exophytic growth. There is questionable minimal associated edema. The lesion measures approximately at 19 x 23 x 22-mm in size. There is resultant subtle effacement of the adjacent cortical sulci.There is mild prominence of cortical sulci of the parietal and frontal lobes. The anatomical morphology as well as the signal intensity of brain parenchyma otherwise remains within normal on all MRI sequences. There is no detectable abnormal parenchymal or leptomeningeal enhancement.The signal void of major intracranial arterial branches are identified.There is anatomical variation of partially empty sella of no clinical significance. Unremarkable calvarium and orbits without evidence of abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized.

Output: 1.Well demarcated nonenhancing left superior frontal gyrus tumor (19 x 23 x 22 mm) with minimal surrounding edema and mass effect and with evidence of exophytic growth concerning for a low-grade tumor.2.Unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: 43-year-old female with diabetic wound about the right great toe for 2 weeks. Please value for osteomyelitis. A moderately deep ulcer is visualized along the plantar aspect of the first MTP joint with significant amounts of associated soft tissue edema and inflammatory change. There is a tiny focus of gas that just underlies the soft tissue defect.There is abnormal enhancement, again compatible with soft tissue inflammation within the aforementioned soft tissues, specifically about the first MTP joint. However, no cortical destruction is visualized. There is slight signal abnormality and abnormal contrast enhancement of the medial sesamoid of the first digit, likely representing reactive edema/inflammation. No fluid collections are seen.The tendons of the foot are grossly intact. The second through fifth metatarsals are intact without evidence of osteomyelitis.

Output: Ulcer about the first MTP joint with associated soft tissue edema and inflammatory change. There is mild signal abnormality and contrast enhancement of the medial sesamoid of the first digit. As such, early osteomyelitis of the sesamoid cannot be excluded.Follow-up or serial imaging may be warranted if clinically warranted


Instruction: Generate impression based on findings.

Input: left side weakness There are multifocal restricted diffusion lesions on the right side basal ganglia extending toward posterior aspect of internal capsule and right periventricular white matter, left periventricular white matter and right cerebellar hemisphere. Since the right cerebellar hemispheric lesions show minimal restriction, these lesions could represent relatively older lesions.There is no evidence of acute hemorrhagic lesion on this scan.Underlying brain shows multifocal high patchy high signal intensity lesions on FLAIR images on bilateral centrum semiovale and periventricular white matter indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal intracranial arterial luminal irregularities and narrowings involving right MCA M1 and M2 segments, bilateral ACA A2 segments. The right vertebral artery is hypoplastic. Bilateral PCAs are fetal origin.Acom artery appears to be patent.There is no major branch occlusion or evidence of intracranial arterial aneurysm.3D MRA neck TOF images with maximum intensity projections show normal bilateral carotid bifurcations and normal appearance of bilateral extracranial internal carotid arteries. The right vertebral artery appears to be hypoplastic and the left vertebral artery is dominant.Due to technical limitation, the aortic arch vessels especially origins of each vessels including bilateral vertebral arterial ostia cannot be evaluated.

Output: 1. Multifocal various aged acute ischemic infarctions without evidence of hemorrhagic transformation as described above.2. Underlying non specific small vessel ischemic disease.3. Multifocal various degreed intracranial arterial luminal narrowings indicating intracranial atherosclerosis.4. No evidence of significant luminal narrowing or irregularity on extracranial craniocervical arteries.


Instruction: Generate impression based on findings.

Input: 57-year-old female with epigastric pain status post laparoscopic cholecystectomy. Evaluate for biliary stricture. ABDOMEN:LIVER, BILIARY TRACT: The common bile duct measures proximally 7 mm, likely sequela of cholecystectomy. Mild intrahepatic biliary ductal dilatation. No evidence of choledocholithiasis, stricture, or mass within the common bile duct.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. No evidence of pancreatic mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild common bile duct prominence, most likely sequela of cholecystectomy.2.No choledocholithiasis, stricture, or mass within the common bile duct.


Instruction: Generate impression based on findings.

Input: 53-year-old male with meningioma, evaluate for progression surveillance A small left parietal convexity dural-based contrast enhancing mass has not changed. It has a maximum thickness of less than 5 mm. As before, there is no significant significant mass effect.Diffuse T2/FLAIR signal abnormality involving the deep gray nuclei, bilateral pons (with downward extension into the ventral medulla), left greater than right thalami as well as scattered foci of cerebral white matter remain unchanged. There is no diffusion restriction or susceptibility artifact. This most likely represents chronic microvascular ischemia. There is no space-occupying or contrast-enhancing brain lesion otherwise. The CSF-containing spaces are mildly expanded, reflecting mild volume loss. Major intracranial vessels are patent.Mild mucosal thickening in the right major sinus without fluid is unchanged. The other paranasal sinuses are clear. Remote small right orbital medial wall blowout fracture is unchanged with herniation of the extraconal fat into the ethmoid sinuses but no extraocular muscle entrapment.

Output: 1.A tiny left parietal convexity meningioma has not significantly changed.2.The relatively extensive and symmetric T2 signal abnormality primarily involving the deep gray nuclei and pons is not significantly changed since the previous examination. As discussed previously, this may be sequela of prior osmotic demyelination or other toxic-metabolic injury.


Instruction: Generate impression based on findings.

Input: Male, 39 years old, with neck pain and left upper extremity weakness. Spinal alignment is within normal limits. Vertebral body heights are maintained. Bone marrow signal intensity is within normal limits. Minimal prominence of the central canal the spinal cord is evident at C6-7 measuring no more than 1 mm in diameter, likely within the limits of normal variation. The visualized spinal cord otherwise demonstrates normal signal intensity and morphology. C2-3: Facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: Facet hypertrophy. Mild posterior disc-osteophyte complex formation asymmetric to the right. No significant spinal canal stenosis. No significant foraminal narrowing. C4-5: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C5-6: Facet hypertrophy. Posterior disc-osteophyte complex formation with a small central extrusion. Mild effacement of the ventral thecal sac but no significant spinal cord impingement. Mild bilateral foraminal narrowing. C6-7: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: Facet hypertrophy. No significant spinal canal or foraminal stenosis.

Output: 1.Relatively mild disc degeneration, most notable at C5-6 where there is a small central disc extrusion. However, this causes only mild effacement of the ventral thecal sac and no significant cord impingement.2.Mild foraminal narrowing is evident at several levels as discussed above.3.No significant spinal cord signal abnormality is detected. Minimal prominence of the central canal of the spinal cord at C6-7 is likely within the limits of normal variation.


Instruction: Generate impression based on findings.

Input: 30 year old female patient with Chiari malformation with decreased CSF flow, preoperative MRI for surgery . BRAIN: There is artifact from the patient's shunt apparatus which mildly obscures visualization of the right occipital lobe and posterior fossa. Within this limitation, there is no evidence of intracranial hemorrhage, mass, or acute infarct. There is stable curvilinear T2 hyperintensity traversing the right frontal lobe into the genu of the corpus callosum, which may represent Wallerian degeneration related to the shunt tract. There is unchanged punctate susceptibility in the pons and right middle cerebellar peduncle. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift. The major cerebral flow voids are intact. There is minimal scattered paranasal sinus mucosal thickening. The orbits are grossly unremarkable.CERVICAL SPINE: There are post-surgical changes related to a Chiari decompression. The cerebellar tonsils are unchanged in appearance and position, with tenting of the inferior cerebellum towards the overlying dura. There is biphasic cerebrospinal fluid flow anteriorly through the neoforamen magnum with minimal flow posteriorly, which is similar to the prior study. There is a catheter is entering the spinal canal posterior at the level of the foramen magnum and coursing to the left lateral aspect of the thecal sac. There is no signal abnormality within the cervical or imaged upper thoracic spinal cord. There is no syrinx. The alignment of the cervical spine is unchanged. The vertebral body heights are maintained. There is no significant degenerative disc disease, spinal canal stenosis, or neural foraminal stenosis.

Output: 1. Post-surgical findings related to Chiari decompression with suggestion of adhesion formation inferior cerebellum and the overlying dura, but preserved cerebrospinal fluid flow anteriorly through the neoforamen magnum. 2. No evidence of ventriculomegaly.3. No evidence of cervical syrinx.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Rule out multinodular goiter RIGHT LOBE MEASUREMENTS: 7.9 x 2.5 x 1.6 cmLEFT LOBE MEASUREMENTS: 7.1 x 2.1 x 1.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No thyroid nodules or other evidence of multinodular goiter.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of bronchus and lung, unspecified site. Examination of participant in clinical trial The patient is status post right sided parietal craniotomy.There is gyriform susceptibility effect associated with T1 signal hyperintensity and contrast enhancement along the lateral aspect of the right post central gyrus. This is unchanged since the prior exam.There is a T2 and FLAIR hyperintense non enhancing left frontal periventricular and subcortical white matter lesion measuring 8x6 mm axial dimensions. It measures 4mm on the prior exam which was performed with different technique.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 minor scattered opacities in the ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a hemorrhagic lesion in the right parietal lobe suspected to represent post surgical change. Please correlate with clinical treatment history. The possibility it represents post-radiation effect cannot be excluded. Continued surveillance would help assess for superimposed local recurrence. 2.There is a left frontal white matter lesion which is slightly larger on the current exam. It is non-specific. It is possible that this is treatment related.


Instruction: Generate impression based on findings.

Input: 63-year-old male with history of hepatic cirrhosis. Evaluate for liver lesions and vessel patency. ABDOMEN: Small left pleural effusionLIVER, BILIARY TRACT: Severe hepatic cirrhosis with sequela of portal hypertension. There are scattered T2 hyperintense foci in the liver compatible with cysts. There is a nonspecific segment 6/7 subcentimeter arterially enhancing focus (series 1601, image 452) without evidence of washout.SPLEEN: Splenomegaly with the spleen measuring 17 cm in length.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: Large-volume ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis with sequela of portal hypertension. No definite arterially enhancing and washing out lesion.2.Nonspecific segment 6/7 arterially enhancing subcentimeter lesion. Attention on follow-up is recommended.


Instruction: Generate impression based on findings.

Input: 51 year old female with known left IDC grade 2 presents for MRI examination. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast, there is a biopsy proven cancer at posterior 3:00 position, measuring 21 x 13 x 15 mm (AP x R x CC). No other abnormal enhancing lesions are seen in the left breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal left breast cancer2. No MRI evidence for malignancy in the right breast3. No abnormal lymph nodes in either axillary region. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 42 year-old female with breast cancer. Syncope with loss of consciousness. Hit head. There is no evidence of intracranial hemorrhage, edema or midline shift. No definite evidence of metastatic involvement. However, an MRI would better evaluate for metastases.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal without evidence of fracture. There is a small air-fluid level in the sphenoid sinus. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Minimal inflammatory sinus disease, otherwise unremarkable brain CT. MRI would better evaluate for metastatic involvement.


Instruction: Generate impression based on findings.

Input: Depth electrode placement for surgical planning. There has been interval insertion of multiple deep brain electrodes, including within the right frontal lobe and bilateral medial temporal lobes. There is minimal dural enhancement, particularly near the probe insertion sites related to the recent surgery. The ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are diffuse areas of scalp swelling from the recent surgery.

Output: Limited brain STEALTH MRI shows interval insertion of multiple deep brain electrodes.


Instruction: Generate impression based on findings.

Input: Female, 84 years old, with history of breast cancer, presenting with confusion and change of motor function. Brain:Patchy periventricular T2 hyperintense lesions are seen in both cerebral hemispheres. Also noted is mild T2 hyperintensity within the right subinsular region.No evidence of restricted diffusion, parenchymal edema or significant parenchymal mass effect is detected. No abnormal extra-axial fluid collection or evidence of intracranial hemorrhage is seen. The ventricles and sulci are diffusely and symmetrically prominent likely indicating underlying parenchymal volume loss.Lumbar spine:Grade 1 anterolisthesis of L3 relative to L4 and L4 relative to L5 is observed. Vertebral body height and morphology are within normal limits. Degenerative endplate irregularity and signal change is seen but no definite worrisome marrow replacement or evidence of marrow edema is detected. Visualized distal spinal cord, conus and cauda equina are unremarkable except as discussed by level below.No worrisome intraspinal enhancement is detected. No significant or concerning marrow space lesions are seen. Patchy degenerative endplate enhancement is noted, along with inflammatory enhancement along the degenerated lower facet joints. In addition, a 10 mm enhancing lesion within the right lateral aspect of the L4 vertebral body is nonspecific.The discs of the lumbar spine demonstrate diffuse loss of T2 signal. In addition, there is substantial loss of disc height at L4-5 and L5-S1. Additional level specific findings are as follows:L1-2: Facet hypertrophy and ligamentum flavum thickening. Bulging disc asymmetric to the right. Mild generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate to severe generalized spinal canal stenosis with near complete exclusion of CSF and slight crowding of the cauda equina. Moderate left and mild right foraminal narrowing. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal narrowing with particular effacement of the right lateral recess. Moderate bilateral foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Bulging disc with a small left paracentral annular fissure. No significant spinal canal narrowing. Moderate bilateral foraminal narrowing.

Output: 1.Within the limitations of a noncontrast examination, no definite evidence of intracranial metastatic disease is seen.2.No definite acute intracranial abnormalities are detected. Scattered white matter lesions are nonspecific but statistically most likely represent chronic microvascular ischemic disease.3.Multilevel degenerative findings in the lumbar spine resulting in fairly significant spinal canal narrowing at L3-4 and L4-5, as well as scattered foraminal narrowing as above.4.No definite evidence of metastatic disease is seen in the lumbar spine. A nonspecific enhancing lesion within the right lateral aspect of the L4 vertebral body is nonspecific. If clinical concern warrants, follow-up imaging can be considered.


Instruction: Generate impression based on findings.

Input: 73-year-old female with a history of posterior fossa GBM now with altered mental status. The exam is limited by motion. Again demonstrated are postsurgical changes of a prior suboccipital craniotomy for resection of posterior fossa tumor. The FLAIR hyperintensity in the cerebellar vermis and right greater than left cerebellar hemisphere surrounding the resection cavity are similar to the previous exam. The mass effect on the fourth ventricle is unchanged. There is mild restricted diffusion along the resection cavity without restricted diffusion elsewhere to suggest acute ischemic infarction. Contrast is not present and therefore assessment of contrast enhancement in the brain cannot be assessed.A nonspecific punctate focus of increased T2/FLAIR signal within the white matter adjacent to the frontal horn of the left lateral ventricle and within the bilateral medullary olives are unchanged. Stable mildly prominent lateral and third ventricles are likely related to volume loss. The basal cisterns remain patent. There is no midline shift. Normal flow-voids are demonstrated in the major intracranial vascular structures. Paranasal sinuses and mastoid air cells are clear.

Output: Nondiagnostic exam for evaluation of contrast enhancement. The remainder of the findings in the posterior fossa are unchanged compared to the exam from 8/24/2016. The patient may return at no additional cost to repeat the post-contrast portion of the exam if deemed clinically warranted. The technologist was contacted to identify what happened to the contrast. Christina Sicker was paged at the time of this report to discuss the above issues related to contrast injection site.


Instruction: Generate impression based on findings.

Input: 79-year-old female status post fall 3 days ago. Rule out bleed. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse hypodensity within the periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate. If there is concern for acute stroke, an MRI may be considered. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: small vessel disease, age indeterminate. If there is concern for acute stroke, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Reason: pancreatitis, pancreas graft-lesion, concern for mass History: Abdominal pain ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity without suspicious focal lesions.The gallbladder is again mildly distended but without evidence of cholelithiasis, wall thickening, or pericholecystic inflammatory changes.Minimal intrahepatic biliary ductal dilatation. The common bile duct measures 8 mm. No filling defects are present. SPLEEN: No significant abnormality noted.PANCREAS: There is atrophy of the native pancreatic distal body and tail. There is no ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic native kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Transplant kidney is present within the left hemipelvis without evidence of hydronephrosis.Transplant pancreas in right lower quadrant. There is redemonstration of a mass lesion which appears to arise from the transplant pancreatic head measuring 4.9 x 4.1 cm in the axial plane. The mass is well-circumscribed, has heterogeneous mildly increased T2 signal, and demonstrates avid enhancement with scattered cystic/necrotic areas. The pancreatic duct appears patent and is nondilated throughout its course. The pancreas transplant vasculature appears patent.Subcentimeter cysts/residual follicles are present within the bilateral ovaries, which are normal in size.

Output: 1.Solid enhancing mass which appears to arise from the transplant pancreatic head which is suspicious for neoplasm; suggest biopsy for further evaluation. Differential considerations include neuroendocrine tumor or acinar cell carcinoma among other etiologies. The mass may also arise from the portion of the donor duodenum or mesentery.2.Minimal intra and extrahepatic biliary ductal dilation with no evidence of distal mass or filling defect; a benign distal stricture cannot be excluded.Findings discussed with SAMRA, MANPREET at time of dictation.


Instruction: Generate impression based on findings.

Input: 68 years old female, with a history of multiple myeloma. She was referred for cardiac MRI to rule out cardiac amyloid. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 56 ml/m2 (normal range: 65+/-11), the LVEDV is 117 ml (normal range 109+/-23), the LV end systolic volume index is 21 ml/m2 (normal range 18+/-5), the LVESV is 45 ml (normal range 31+/-10), the LV mass index is 48 g/m2 (normal range 67+/-11), and the LV mass is 101 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is large patch of late gadolinium enhancement noted in mid inferior wall. It spares the endocardium and the pattern is atypical for prior myocardial infarction. It suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern of late gadolinium enhancement is also not typical of amyloidosis since it is not circumferential and it is not associated with a significant abnormality in gadolinium "kinetics." However, approximately 10% of amyloid cases have been associated with atypical late gadolinium enhancement patterns. Little is known about the pattern of late gadolinium enhancement in early cardiac amyloidosis. The differential diagnosis for this patient also includes but is not limited to myocarditis and other infiltrative processes such as sarcoidosis.Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 151 ml (normal range 110+/-24), the RV end systolic volume index is 74 ml/m2 (normal range 22+/-8), and the RVESV is 72 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is not well evaluated due to significant respiratory artifact.Mitral ValveThe mitral valve is not well evaluated due to significant respiratory artifact.Pulmonic ValveThe pulmonic valve is not well evaluated due to significant respiratory artifact.Tricuspid ValveThe tricuspid valve is not well evaluated due to significant respiratory artifact.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. Pulmonary ArteryThe main pulmonary artery is moderate to severely dilated (40mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. A catheter is noted in the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is iron in the spleen. Consolidation is noted of the left and right lower lungs. There is trace pleural effusion. 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 normal in size and systolic function (LVEF 62%). There is large patch of late gadolinium enhancement noted in mid inferior wall which is not consistent with prior myocardial infarction. It suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. Although the pattern of late gadolinium enhancement is not typical of amyloidosis, little is known about the late gadolinium enhancement pattern that would be expected in early cardiac amyloidosis. The differential diagnosis for this late gadolinium enhancement pattern also includes, but is not limited, to myocarditis and other infiltrative processes such as sarcoidosis. Unfortunately, the location of the late gadolinium enhancement is in a place that the yield of an endomyocardial biopsy would be low. Repeat cardiac MRI in 6 months to assess for change may help further determine the etiology of the late gadolinium enhancement.2. The right ventricle is normal in size and function.3. Mild left atrial dilation.4. Moderate to severe dilation of the main pulmonary artery.5. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma status post transphenoidal surgery: surveillance. There are postoperative findings related to transphenoidal surgery. There is a hypoenhancing lobulated structure in the sella that measures up to 15 mm in transverse dimension and 10 mm in craniocaudal dimension. The infundibulum remains deviated slightly to the left. The optic apparatus is intact. There is an unchanged probable Thornwaldt cyst in the nasopharynx. There is a subcentimeter left maxillary sinus retention cyst. There are scattered nonspecific cerebral white matter T2 hyperintense lesions.

Output: Postoperative findings related to transphenoidal surgery with unchanged residual pituitary tumor.


Instruction: Generate impression based on findings.

Input: There are several scattered foci of restricted diffusion within the paramedian right frontal lobe, right cingulate gyrus, and corpus callosum, which are similar in extent, although the associated T2 hyperintensity is generally now more conspicuous and the degree of diffusion restriction has diminished. There is otherwise an unchanged background of patchy and confluent areas of predominantly periventricular white matter T2 hyperintensity bilaterally and several chronic lacunar infarcts in the bilateral basal ganglia and right pons. There are punctate foci of susceptibility effect along the distal right anterior cerebral artery. There are otherwise unchanged punctate foci of susceptibility artifact in the basal ganglia lacunar infarcts right pons, and left frontal and temporal lobes. The ventricles and sulci are unchanged, including ex vacuo dilatation of the left lateral ventricle. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Interval evolution of areas of recent infarction in the right anterior cerebral artery territory and watershed zone with the middle cerebral artery, without hemorrhagic transformation or midline shift. Punctate foci of susceptibility effect along the distal right anterior cerebral artery likely represent thromboemboli responsible for this recent ischemic event.2. Unchanged background of chronic white matter microvascular disease and lacunar infarcts, some of which are associated with chronic microhemorrhages.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Exam is mildly degraded by motion artifact.BRAIN: There is cortical and subcortical T2 hyperintensity and mainly cortical diffusion restriction that is most prominent within the right occipital lobe, but also involves the right frontal, parietal, and temporal lobes. There is mild enhancement in these regions. There is an additional focus of diffusion restriction within the midline dorsal pons with associated susceptibility effect and T2 hyperintensity. There is also additional confluent T2 hyperintensity mainly within the bilateral occipital subcortical white matter but also within the bilateral parietal and left frontal subcortical white matter. There is a punctate focus of susceptibility effect within the right occipital lobe. The ventricles are somewhat slit like. The basal cisterns are normal in size and configuration. There is dilatation of the bilateral optic nerve sheaths, and mild flattening of the optic discs. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is fluid within the bilateral mastoid air cells, right greater than left.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRV HEAD: There is no evidence of venous sinus thrombosis.MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion.

Output: 1.Findings as detailed above are most compatible with posterior reversible encephalopathy syndrome with superimposed progression to right occipital cortical infarction and pontine infarction.2.Findings suggestive of increased intracranial pressure, likely secondary to the above process. 3.No evidence of venous sinus thrombosis.4.No evidence of intracranial aneurysm or significant steno-occlusive lesion within the head or neck.


Instruction: Generate impression based on findings.

Input: Pain. AC vs intraarticular vs cuff pathology. ROTATOR CUFF: The rotator cuff muscles and tendons are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal in appearance. There is no fluid in the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a tear of the superior labrum extending from anterior to posterior, "SLAP" tear. BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Findings compatible with a SLAP tear.


Instruction: Generate impression based on findings.

Input: Male, 47 years old, with dizziness and facial droop for five days. No restricted diffusion, edema or mass effect is seen. There are no findings to suggest intracranial hemorrhage. The pattern of intracranial enhancement is normal. There may be a very small incidental arachnoid cyst along the anterior left temporal lobe versus a prominent sulcus. The ventricles are normal in size and morphology. Bone marrow signal characteristics are unremarkable.

Output: No significant abnormalities are detected, and in particular, there are no findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Reason: eval for osteo History: possible osteo of left ileus on prior MRI, fevers Soft tissue irregularity along the posterior aspect of the left iliac bone consistent with ulceration which extends to the level of the posterior cortex of the left iliac bone. There is associated skin thickening in the surrounding area. There is also associated increased signal abnormality and fluid sensitive sequences as well as decreased signal abnormality on T1-weighted images and cortical indistinctness affecting the left iliac bone about the posterior aspect of the left sacroiliac joint, indicating osteomyelitis. There is marked fatty atrophy of the imaged musculature of the pelvis. There is a large cyst projecting along the inferior pole of the right kidney, which appears atrophic, although this is incompletely imaged on this examination. There is a Foley catheter in place. There is nonspecific increased signal abnormality within the adductor musculature of the pelvis bilaterally. No drainable fluid collection is identified. Note is made of multiple dilated loops of small bowel which are nonspecific but may reflect small bowel obstruction or ileus in the correct clinical setting. Note is made of compression fractures of the L3 and L5 vertebral bodies.

Output: 1. Findings consistent with osteomyelitis of the left iliac bone. There is soft tissue ulceration and inflammatory change in the surrounding area.2. Multiple dilated loops of small bowel are incompletely imaged. Obstruction or ileus could be considered in the correct clinical setting. Other findings as described.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type I. Evaluate extent of the plexiform tumor, any cord compression? There are postsurgical changes of anterior and posterior spinal fusion in the cervical spine. Anterior and posterior hardware can be better assessed with radiographs or CT. There is dural ectasia with extensive scalloping involving the cervical vertebrae resulting in severe thinning of the cervical vertebral bodies. Susceptibility artifact related to the hardware limits assessment of the residual vertebra ventrally.There is widening of the atlantodental interval measuring approximately 9 mm. There is approximately 90 degree angulation at the craniocervical junction with resultant effacement of the ventral thecal sac and mild impression on the ventral cervicomedullary junction. No associated parenchymal signal abnormality. There is no stenosis in the cervical spinal canal at any level.There are multiple masses involving the neck and paraspinous soft tissues, particularly on the left. There is a large left retropharyngeal mass measuring 3.9 x 5.6 x 8.8 cm, in the AP, transverse, and craniocaudal dimensions. There is significant associated deformity on the left lateral pharyngeal wall with rightward displacement and narrowing of the oropharyngeal lumen. There is also lateral displacement of the left carotid vasculature. There is a relatively smaller mass involving the left prevertebral space coursing along the margins of the left cervical vertebrae and anterior fusion hardware. This mass is questionably contiguous with the soft tissue filling the atlantodental interval which is widened as mentioned above. There is a relatively large mass involving the left lateral cervical paraspinous soft tissues measuring approximately 4.4 x 5.5 cm in the axial plane and extends craniocaudally from the C2 level to the approximately T3 level. There is no intraspinal extension associated with these lesions.Extensive masses compatible with neurofibromas are noted in the region left brachial plexus including the left supraclavicular fossa. Neurofibromas involving the upper thoracic nerve roots are also noted, with associated mass at the left thoracic inlet/lung apex measuring 1.8 x 3.1 x 4.4 cm. Multiple additional lesions including along the intercostal nerves, mediastinum, and subcutaneous soft tissues are also noted.

Output: 1. Stigmata of neurofibromatosis type I with multiple large heterogeneously enhancing neurofibromas in the left retropharyngeal, prevertebral, as well as cervical paraspinous soft tissues as described above. Extensive involvement in the left neck in the region of the left brachial plexus is also seen. There is no extension into the spinal canal associated with these lesions.2. Dural ectasia with resultant severe scalloping of the cervical vertebrae. Radiographs or CT can better assess the anterior and posterior fusion hardware and amount of residual bone in the cervical spine.3. There is no significant spinal canal stenosis. There is however abnormal configuration of the craniocervical junction with approximately 90 degree angulation and resultant mild ventral impingement at the cervicomedullary junction. There is also widening of the atlantodental interval measuring approximately 9 mm, possibly related to an underlying neurofibroma. Transverse ligament is intact. Please see details above.


Instruction: Generate impression based on findings.

Input: Pain at C7-C8 with radiation to arms. At C7-T1, there is a prominent left facet spur, which results in mild narrowing of the neural foramen. There is no significant right neural foramen or spinal canal stenosis at this level. At C6-C7, there is a posterior disc osteophyte complex that results in slight left and significant right neural foraminal narrowing. However, there is no significant spinal canal stenosis at this level. At C5-C6, there is a posterior disc-osteophyte complex that results in marked bilateral neural foramen narrowing. However, there is no significant spinal canal stenosis at this level. At C4-5, there is right uncovertebral hypertrophy that results in mild right neural foramen narrowing. However, there is no significant spinal canal or left neural foramen stenosis at this level. At C3-4, there is a posterior disc-osteophyte complex that mildly narrows the bilateral neural foramina. However, there is no significant spinal canal stenosis at this level. At C2-3, there is no significant spinal canal or neural foraminal stenosis. The C1-2 and C1-occiput articulations are intact. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative cervical spondylosis, including mild narrowing of the neural foramen at C7-T1 and marked bilateral neural foramen narrowing at C6-C7.


Instruction: Generate impression based on findings.

Input: 56-year-old male with knee pain, rule out meniscus or chondral injury. MENISCI: There is complex tear of the body of the lateral meniscus, extending to the tibial surface. There is also extensive tearing of the body and posterior horn of the medial meniscus, with a small fragment flipped into the intracondylar notch posteriorly.ARTICULAR CARTILAGE AND BONE: Full-thickness cartilage loss is seen in the central weight-bearing portion of the medial femoral condyle. Patellar chondral softening is also noted. Subchondral sclerosis and cyst formation particularly affects the medial tibial plateau.LIGAMENTS: There is subacute to chronic tearing of the anterior cruciate ligament. The posterior cruciate ligament is intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Medial and lateral meniscal tears, as above.2.Subacute to chronic ACL tear.


Instruction: Generate impression based on findings.

Input: 42 year old with history of ALH, LCIS and dense breasts. Family history of breast cancer in her mother at age 54 and sister at age 50. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Percutaneously placed metallic clip is again noted in the right breast upper outer quadrant. Two circumscribed masses are seen in the right breast, corresponding to the cysts seen on the recent MRI (1/29/15). No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: History of meningioma s/p xrt. There is no significant change in extra-axial enhancing mass in the right paraclinoid region and partially encasing the right prechiasmatic optic nerve in its inferior aspect. The mass measures 16 x 18 x 16 mm in the AP, transverse, and craniocaudal dimensions, and not significantly changed since prior. No other areas of abnormal post contrast enhancement identified.Coronal T2 fat sat sequence of the orbit demonstrates an abnormal T2 hyperintensity within the right prechiasmatic optic nerve and was not well assessed on prior study. Posteriorly the mass abuts the right A1 anterior cerebral artery segment and the cavernous internal carotid artery in its inferior aspect without occlusion. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. There is a small varix involving the left superior ophthalmic vein. The calvarium is diffusely thick as seen before. There is a 11 x 6 mm enhancing lesion involving the right frontotemporal calvarium, which is slightly larger compared to 3/4/2014 when it measured 7 x 5 mm and not seen on 7/10/2012.

Output: 1. Compared to 3/4/2014, there is no significant change in size and appearance of the right paraclinoid meningioma partially encasing the right prechiasmatic optic nerve. There is T2 hyperintensity within the right optic nerve which was not well assessed on priors as dedicated MRI orbit sequences were not obtained.2. Small right frontotemporal calvarial enhancing lesion (series 16 Ax T1 FS postgad image 16/23) demonstrates gradual enlargement compared to 3/4/2014 and not seen on 7/10/2012. No obvious destructive changes or epidural extension. Appearance is nonspecific however neoplastic osseous lesion cannot entirely be excluded. CT may be helpful to further assess the osseous changes.


Instruction: Generate impression based on findings.

Input: 38 years, Female, multiple sclerosis, evaluate for progression. Brain: There are numerous foci of T2/FLAIR hyperintensity within the periventricular and subcortical white matter with appearance and distribution consistent with known demyelinating disease. Much of the signal abnormality demonstrates a confluent appearance. Multiple lesions with T1 hypointensity are also noted. Prior comparison study from 4/28/2015 was obtained with thicker slices; however, given differences in technique no new lesions are definitively appreciated. Few infratentorial lesions are also noted including the right midbrain, bilateral medulla, and adjacent to the right fourth ventricle which also appear to be present on prior. There is mild diffuse thinning of the corpus callosum reflective of global parenchymal volume loss. No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. Calvarium and extracranial soft tissues are unremarkable.Cervical spine: There are numerous T2 hyperintense lesions throughout the cervical cord involving all levels from C1 through C7. There appears to be interval increased T2 signal abnormality involving the cervical cord from the C3 to the C4 level suggestive of progressive disease (best seen on axial T2 image 18/36 and axial series 1502 mFFE image 69), although smaller lesions were present at these levels on prior study. There is more questionable subtle interval increase in T2 hyperintensity at the C1-C2 posteriorly in the midline compared to prior, although this area was incompletely imaged on prior study. Otherwise no significant change is seen in the remainder of the lesions. There is volume loss involving the cervical cord at the C6 and C7 level similar to prior. Lesions involving the upper thoracic cord are also noted based on the sagittal images and present previously.Vertebral body heights and alignment are normal. Bone marrow signal is benign. There is no significant spinal canal or neural foraminal stenosis at any level.

Output: 1. There are numerous lesions in the brain supra- and infratentorially as well as throughout the cervical cord compatible with advanced demyelinating disease. Differences in technique with outside study slightly limit comparison however no new lesion within the brain is definitively appreciated. There does appear to be a new lesion in the cervical cord at the C3-C4 level, which is not seen on prior, and suggestive of progression. Please see additional details above.2. Numerous T1 hypointense lesions in the brain similar to prior.3. Mild global parenchymal volume loss in the brain including mild diffuse thinning of the corpus callosum. There is also volume loss in the cervical cord at the C6 to C7 levels and similar to prior.


Instruction: Generate impression based on findings.

Input: 15 year-old female. SRS planning. AVM. Enhanced MRI brain:Diffusion-weighted images are negative for acute ischemic stroke.MRI sequences demonstrate a chronic hemorrhage in the right thalamus measuring 7-mm in AP axis and 18.6-mm in transverse axis (axial flair and T2-weighted image 9). There is no evidence of any residual surrounding edema or encephalomalacia. This is at the site of previously known right thalamic hematoma and confirmed angiographically of presence of an arteriovenous malformation. Prominent draining vein of the AVM is noted to extend from the hematoma into the perimesencephalic cistern on the right.There are a few punctate foci of subcortical increased signal intensity in the right frontal lobe of unknown clinical significance.A linear increased signal intensity extends from inner table of the skull into the right lateral ventricle along the track of right sided ventricular catheter.There is prominence of cortical sulci for patient's stated age of 17 which although may be at the upper limits of normal remote possibility of volume loss cannot be report. On post infusion images within the area of hemosiderin deposition in the right thalamus there is evidence of enhancement which measures approximately 17.4 mm in transverse axis and 7.5-mm in AP axis which are measured on axial post infusion image 12. On coronal reformatted post infusion image 13 a subtle area of enhancement measures approximately 11.4 x 16.4-mm.There is no evidence of any additional area of abnormal enhancement the brain parenchyma or leptomeninges.MRA of intracranial circulation:Utilizing an independent workstation 3-D reformatted images of intracranial vascular structures were made.Bilateral internal carotid arteries, anterior cerebral arteries and middle cerebral arteries and their branches are unremarkable.Normal appearing bilateral intracranial vertebral arteries, prominent left pica artery. There is fenestration of basilar artery in its proximal portion. Basilar artery is otherwise unremarkable. There is unremarkable bilateral posterior cerebral arteries and superior cerebellar arteries. Please review report of dedicated cerebral angiogram for arterial supply and venous drainage of the AVM.There is minimal increased vascularity in the region of patient's known right thalamic AVM. This examination cannot assess for vascular pedicle to the AVM due to extreme small size feeding pedicles to this a small AVM.12 cc of Omniscan was administered for above study.

Output: 1.MRI examination of brain demonstrate hemosiderin deposition in the right thalamus at the site of prior hemorrhage. Post infusion images demonstrate an enhancing arteriovenous malformation in this location with draining vein extending into the right perimesencephalic cistern. Please see above measurement for the size of the enhancing AVM.2.Essentially unremarkable MRA of intracranial circulation. The very small size of AVM and its feeding branches are beyond the resolution of MRA. Please review report of patient's prior dedicated cerebral angiogram for feeding pedicles and draining venous system of the AVM.


Instruction: Generate impression based on findings.

Input: Redemonstration of postoperative findings related to a right posterior parietal craniotomy. The resection cavity is unchanged with stable mild T2/FLAIR signal surrounding the CSF-filled cavity. There are no areas of pathologic enhancement. Curvilinear susceptibility abnormality along the lateral aspect of the right frontal lobe and within the central sulcus/post central gyrus, likely reflects old blood product and is unchanged.The ventricles and sulci are within normal limits and the basal cisterns remain patent. No areas of diffusion restriction are present to suggest an acute ischemic event. No extra-axial fluid collection is identified. The cerebellar tonsils are in normal position. Pituitary gland is unremarkable. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Left maxillary sinus mucous retention cyst. The orbits are unremarkable.

Output: 1. No significant interval change in appearance of the right posterior parietal resection cavity with small areas of surrounding FLAIR hyperintensity without enhancement. No evidence of tumor progression/recurrence.2. Stable small focus of chronic hemosiderin deposition in the right central sulcus/post central gyrus.


Instruction: Generate impression based on findings.

Input: 67-year-old male. Status spleen preserving distal pancreatectomy 3/18/14 for neuroendocrine tumor and carcinoma in situ. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: Mildly complex cyst in the hepatic dome with thin septations. No bilary ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: Post-surgical findings of distal pancreatectomy with no evidence of local recurrence. Mild atrophy of the pancreas with diffuse main ductal dilatation measuring up to 6 mm in the neck. A few small dilated side-branch ducts measuring up to 4 mm in the body, suggestive of side-branch IPMNs.Partial pancreatic divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, including a large exophytic 8.6 cm cyst in the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Post-surgical findings of distal pancreatectomy without evidence of local recurrence.2.Diffuse main pancreatic ductal dilatation measuring up to 6 mm. Small dilated side-branch ducts, suggestive of side-branch IPMNs.


Instruction: Generate impression based on findings.

Input: Evaluate for bilateral anterior cerebral artery ischemia/hypoperfusion/infarction in the setting of bilateral anterior cerebral artery vasospasm History: Lower extremity, abulia. Severely limited exam.There is an globular area of diffusion restriction in the posterior right frontal lobe corresponding to blood products on recent CT. Additional more punctate focus of diffusion restriction in the right frontal lobe adjacent to the right frontal horn may represent an acute infarct or less likely related to blood products (which is difficult to conclude in the absence of additional diagnostic sequences or hyperdensity on recent CT). Otherwise no acute infarcts including the bilateral anterior cerebral artery territory. Additional findings of intracranial blood products, right parietal craniotomy, left parietal ventriculostomy, and dilated ventricular system better seen on recent CT of 7/11/2016.

Output: Severely limited study. Suspected punctate infarct in the right frontal lobe adjacent to the right lateral ventricle. Otherwise no clear evidence of acute infarction in the ACA territories or elsewhere in the brain.


Instruction: Generate impression based on findings.

Input: History of demyelinating lesions in the cervical spine. Evaluate for optic nerve lesions as there is clinical concern for an NMO versus MS. Reevaluated spine lesions. Orbits: The globes are intact. There is questionable increased STIR signal and subtle thickening of the immediate postchiasmatic left optic nerve (series 501 images 22-23) with very equivocal enhancement. This could in part potentially represent volume averaging with adjacent CSF. No orbital mass. Extraocular muscles are normal in signal and morphology. The visualized intracranial contents are unremarkable and without evidence of acute ischemia, mass, mass effect, or edema. Visualized paranasal sinuses demonstrate minimal mucosal thickening in the right maxillary sinus. The visualized mastoid air cells are clear. Cervical spine:Again seen is a focus of abnormal increased T2 signal in the midline dorsal cord at the C5-6 level. This is slightly decreased in size measuring 4 x 2 mm (previously 5 x 4 mm) and there has been progressive volume loss in the cord at this level. More subtle increased signal in the dorsal cord at the C2 level is decreased compared to prior. No new lesions. No abnormal enhancement is noted on the postcontrast images. There is straightening of the cervical lordosis. The vertebral body heights are preserved. Multilevel degenerative disc disease with loss of intervertebral disc height and intervertebral signal most notably from C3 to C7. Reactive marrow endplate changes are present at C6-7. Interval development of focal enhancement and minimal edema in the paraspinal musculature adjacent to the C6 spinous process may represent a muscle strain.Level by level findings are as follows: C2-C3: Minimal disc bulge eccentric to the left. No significant neural foraminal or spinal canal stenosis.C3-C4: Moderate disc osteophyte complex asymmetric to the left. Minimal left neural foraminal stenosis. No spinal canal or right neural foraminal narrowing.C4-C5: Prominent disc osteophyte complex with a superimposed central disc protrusion which effaces the ventral thecal sac and creates moderate spinal canal stenosis. No significant neural foraminal stenosis.C5-C6: Moderate disc osteophyte complex asymmetric to the left which in combination with uncovertebral joint hypertrophy creates severe left neural foraminal stenosis. Mild to moderate spinal canal stenosis. Minimal right neural foraminal stenosis.C6-C7: Moderate disc osteophyte complex and uncovertebral joint hypertrophy. Moderate to severe spinal canal stenosis with effacement of the ventral and dorsal thecal sac. Severe left and moderate to severe right neural foraminal stenosis.C7-T1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.Thoracic spine:The vertebral body and intravertebral disc heights are maintained. The alignment is anatomic. Round foci of increased T1 and T2 signal which suppresses on the STIR sequence in the T11 and T12 vertebral bodies compatible with intraosseous hemangiomas. Marrow signal is otherwise within normal limits. No significant neural foraminal or spinal canal stenosis.The visualized cord is normal in signal and morphology. No evidence of demyelinating disease. No abnormal enhancement on the postcontrast images.

Output: 1. Questionable thickening and increased STIR signal in the immediate postchiasmatic left optic nerve as described. This may reflect demyelinating process if clinically appropriate, or in part may relate to artifact/volume averaging.2. Redemonstrated demyelinating lesions within the cervical spine. The primary lesion at C5-C6 is slightly decreased in size and associated with progressive loss of cord volume consistent with expected evolution of a now chronic demyelinating lesion. The more ill-defined abnormal signal in the proximal cervical cord is decreased compared to prior. No associated enhancement or new lesions.3. Multilevel degenerative changes within the cervical spine which create moderate to severe spinal canal stenosis at C6-C7. Multilevel neuroforaminal compromise which is most severe on the left C5-6 and C6-7 levels.4. No evidence of demyelinating lesions in the thoracic spinal cord.


Instruction: Generate impression based on findings.

Input: For the purposes of numbering, there are 5 lumbar type vertebral bodies. Vertebral body heights are maintained. Alignment is maintained. Disc desiccation signal and mild loss of intervertebral disc height are noted at L4-5 and L5-S1. There are associated endplate degenerative bone marrow signal changes, most prominent at L5-S1. Other scattered areas of focal increased T1 and T2 signal within the vertebral bodies are likely related to focal fatty marrow and/or intraosseous hemangiomas. There is prominence of the lumbar dorsal and ventral epidural fat from the L3 to S1 levels compatible with epidural lipomatosis. Prominent facet arthropathy, particularly at the L4-5 and L5-S1 levels. The visualized portion of the distal spinal cord and conus medullaris are normal in signal and morphology. The conus medullaris terminates at the L1-2 level. Multilevel degenerative changes are seen, as describe below:At L1-2, there is no significant compromise to spinal canal or neural foramina.At L2-3, mild spinal canal stenosis, predominantly due to epidural lipomatosis. No significant neural foraminal narrowing.At L3-4, moderate spinal canal stenosis, predominantly related to epidural lipomatosis. Bilateral facet arthropathy and left foraminal to far lateral disc protrusion results in mild left neural foraminal stenosis.At L4-5, marked effacement of the thecal sac, predominantly due to epidural lipomatosis. Mild disc bulge. Marked bilateral, right greater than left, facet arthropathy. Moderate bilateral neural foraminal narrowing, worse on the right.At L5-S1, marked effacement of the thecal sac, predominantly due to epidural lipomatosis. Mild disc bulge. Marked bilateral, left greater than right, facet arthropathy. Mild to moderate left neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Diffuse infiltrative appearing T1 hypointense bone marrow signal is present in the visualized portion of the right iliac bone.

Output: 1. Diffuse T1 hypointense bone marrow signal throughout the partially visualized right iliac bone. Further imaging is recommended for evaluation, starting with CT, as an infiltrating lesion cannot be excluded.2. Findings compatible with epidural lipomatosis throughout the lumbar spine resulting in stenosis of the spinal canal, which is mild at L2-3, moderate at L3-4, and severe at L4-5 and L5-S1.3. Prominent facet arthropathy throughout the lumbar spine, in particular at L4-5 and L5-S1. Moderate bilateral neural foraminal narrowing at L4-5.


Instruction: Generate impression based on findings.

Input: 66 year old male create elevated alk phos and WBC. Assess elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Patent hepatic vasculature. No suspicious hepatic mass. Punctate right hepatic lobe focus without appreciable enhancement (series 15, image 56), likely a cyst. Cholelithiasis. No biliary ductal dilatation.SPLEEN: Mild splenomegaly measuring 13.6 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, including a T1 hyperintense hemorrhagic/proteinaceous cyst in the right kidney. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Small gastrohepatic ligament lymph nodes, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small umbilical hernia containing fluid.OTHER: Large amount of abdominal ascites.

Output: Cirrhosis with no suspicious hepatic mass. No biliary ductal dilatation or evidence of obstruction. Large amount of abdominal ascites.