Instruction: Generate impression based on findings.

Input: Seizure/epilepsy. History of left subdural hemorrhage. Susceptibility artifact in the left parietal region slightly limits evaluation of the adjacent parenchyma. There is evidence of encephalomalacia involving the left inferior parietal lobule with evidence of remote left-sided craniotomy. Minimal herniation of brain parenchyma is noted via the craniectomy site. There are additional smaller areas of encephalomalacia involving the left occipital lobe including the lingual gyrus and the left inferior temporal lobe involving primarily the left parahippocampal gyrus. Volume loss involving the left hippocampus is noted. There is FLAIR hyperintensity involving the left hippocampus and to a much greater degree in the left parahippocampal gyrus. Old right temporal burr hole is also noted.Few scattered T2 hyperintense foci in the white matter are nonspecific. No intracranial mass or mass effect. Mild ex vacuo dilatation of left lateral ventricle. No hydrocephalus. No abnormal parenchymal or leptomeningeal contrast enhancement. Major intracranial vessels are patent. The orbits are normal. Mild ethmoid and maxillary mucosal thickening. Mastoid air cells are clear.

Output: 1.Multifocal encephalomalacia involving the left parietal, left temporal, and left occipital lobes which may represent sequela of prior trauma.2.Asymmetric volume loss involving the left hippocampus with mild FLAIR hyperintensity, which may be related to direct injury seen more extensively in the adjacent left parahippocampal gyrus versus secondary mesial temporal sclerosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: BRCA2 positive, strong family history of breast cancer and ovarian cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. There are a few scattered enhancing foci, and these can also be seen on prior studies. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 89-year-old female, Jehovah's Witness, status post 2 falls at home yesterday. Evaluate for bleed. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse hyperdensities within a periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Round focus of low attenuation in the left cerebellum consistent with previous stroke.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: Chronic changes as described above, no acute findings. If there is clinical concern for acute ischemia, an MRI may be considered


Instruction: Generate impression based on findings.

Input: Multiple sequences are degraded by motion artifact. As on the previous exams the left aspect of the sella is empty. The pituitary stalk leads to a homogeneously enhancing tissue within the right aspect of the sella which likely represent pituitary gland unchanged in size and appearance. No new or enlarging mass within the sella.MRA HEAD

Output: 1.Motion degraded current and prior MRA studies demonstrate a 2-3 mm right supraclinoid ICA aneurysm which is not significantly changed dating back to 8/15/2012. 2.Motion degraded current and prior pituitary studies demonstrate no new or enlarging mass within the sella.


Instruction: Generate impression based on findings.

Input: Female, 38 years old. Reason: Patient with hypercalcemia and hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 5.6 x 1.7 x 1.2 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.3 x 1.0 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous echotexture, without focal lesion.LEFT LOBE: Heterogeneous echotexture, without focal lesion.ISTHMUS: Heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: A hypoechoic structure posterior to the inferior pole of the left thyroid lobe measures 0.8 x 0.4 x 0.4 cm, solid, with minimal internal vascularity.LYMPH NODES: Benign-appearing cervical lymph nodes are identified.OTHER: No significant abnormality noted.

Output: A hypoechoic structure posterior to the inferior pole of the left thyroid lobe correlates with the area of possible increased uptake seen in this location on prior nuclear medicine scan, and may represent a parathyroid adenoma.


Instruction: Generate impression based on findings.

Input: Other specified disorders of brain [G93.89], Reason for Study: ^Reason: evaluate for residual tumor History: s/p posterior fossa tumor resection Redemonstration of post resection findings of the posterior fossa lesion including occipital craniotomy site suboccipital fluid collections, residual air within 4th ventricle, some blood products and dilated but much improved ventricular system, unchanged since prior scan.Nodular and somewhat linear shaped enhancing lesions seen on prior scan at the superior and posterior aspect of the resection cavity are again seen on this scan, unchanged since prior. Diagnostic possibilities including focal residual tumor and adjacent venous structures. Follow up imaging is recommended.There is no evidence of another abnormal enhancing lesion on this scan.There is no evidence of acute ischemic or hemorrhagic lesion. The ventricles, sulci and cisterns are dilated but unchanged since prior scan. The midline structures and cranial-cervical junction are normal except about 5.8mm downward herniation of cerebellar tonsils which is unchanged since prior scan. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Redemonstration of focal nodular and somewhat linear enhancing lesions on the superior and posterior aspect of the posterior fossa lesion resection cavity as described above, unchanged since prior scan.2. Postoperative no unusual finding.3. No evidence of new abnormal enhancing lesion. No acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Reason: R sacral mass--abscess vs leukemic infiltrate History: low back pain, CML in blast crisis, mass on CT Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the sacral lesion.

Output: Sacral bone biopsy of a right sided sacral lesion under CT guidance. A total of 9 samples were delivered for analysis as detailed above.


Instruction: Generate impression based on findings.

Input: History of urothelial cancer status post right nephroureterectomy. Surveillance examination. 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: Status post right nephroureterectomy. There is a stable large left renal sinus cysts measuring 11.1 cm in maximum dimension, previously 11.2 cm. Previously noted hydronephrosis has resolved. No enhancing or suspicious genitourinary mass lesion.RETROPERITONEUM, LYMPH NODES: No significant interval change in infrarenal aortic aneurysm which measures 3.9 x 3.7 cm, previously 4.0 x 3.3 cm.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No focal suspicious osseous lesion.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No suspicious osseous lesion.OTHER: No significant abnormality noted.

Output: 1.Post surgical changes from right nephroureterectomy without evidence of recurrent or metastatic disease.2.Stable infrarenal abdominal aortic aneurysm.


Instruction: Generate impression based on findings.

Input: A 63 year old male with history of Lymphoma, s/p chemotherapy 20 years ago, intersitial lung disease, paroxysmal atrial fibrillation, chronic systolic heart failure. Referred to cardiac MRI for evaluation of function and etiology. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 48 ml/m2 (normal range: 74+/-15), the LVEDV is 96 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 49 ml (normal range 47+/-19), the LV mass index is 20 g/m2 (normal range 85+/-15), and the LV mass is 40 g (normal range 164+/-36). There is mild hypokinesis at the basal to apical segments of the inferoseptal and inferior walls. There is dys-synchronic myocardial contraction. There is late gadolinium enhancement at the inferior and inferoseptal walls at the mid and apical segments in a mid wall/subepicardial pattern These gadolinium enhancements are atypical for myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.T1 times were mildly increased at the mid and apical septum (range between 1080-1100).No iron overload was noted.No intracavitary thrombus was noted.Left AtriumThe left atrium is normal in size (90ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 68 ml/m2 (normal range 82+/-16), the RVEDV is 137 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 72 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is question of trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size (35 x 37 mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (27 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is prominent pericardial fat.Extracardiac FindingsCalcified mediastinal lymph nodes, specifically within the anterior mediastinum, most consistent with treated lymphoma.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 with mildly reduced systolic function, the LVEF is 48%. There is mild hypokinesis at the basal to apical segments of the inferoseptal and inferior walls. There is dys-synchronic myocardial contraction. 2. There is mild late gadolinium enhancement at the inferior and inferoseptal walls at the mid and apical segments in a mid wall/subepicardial pattern. These gadolinium enhancements are atypical for myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. T1 times were mildly increased at the mid and apical septum.3. No iron overload was noted.4. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 48%.


Instruction: Generate impression based on findings.

Input: Reason: stage IVb lung adenocarcinoma EGFR exon 21 L858R mutation, on Tarceva, evaluate response. History: h/o small brain mets There are subcentimeter foci of subtle enhancement in the right superior frontal gyrus (series 11 image 26), right posterior cingulate sulcus (series 11 image 23), and right sylvian fissure (series 12 image 9). These lesions have mild intrinsic T1 hyperintensity and questionable susceptibility artifact. There is no associated edema of the adjacent brain parenchyma, which may suggest that these lesions are leptomeningeal in location. Nonspecific scattered punctate FLAIR hyperattenuation is noted in the subcortical and periventricular white matter.There is a round, intrinsically T1 hyperintense, 7 mm lesion in the anterior sella situated above the pituitary gland. The lesion does not enhance beyond its intrinsic T1 hyperintensity. The native pituitary gland is evident inferior to this lesion.No abnormal diffusion restriction. No gross intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or midline shift. No extra-axial fluid collections. The ventricles, sulci, and cisterns are normal in size without evidence of hydrocephalus. Gray-white matter differentiation is preserved. Nonspecific mucosal thickening of the left ethmoid air cells. Otherwise paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable.

Output: There are subcentimeter foci of subtle enhancement in the right superior frontal gyrus, right posterior cingulate sulcus, and right sylvian fissure. These lesions have mild intrinsic T1 hyperintensity and questionable susceptibility artifact. There is no associated edema of the adjacent brain parenchyma. Findings are suspicious for the presence of intracranial metastases, potentially leptomeningeal in nature.Incidental note is made of an intrinsically T1 hyperintense lesion within the anterior sella situated above the native pituitary gland. This could represent a Rathke cleft cyst, or perhaps an adenoma which has undergone proteinaceous or hemorrhagic degeneration.


Instruction: Generate impression based on findings.

Input: Pain, flexion unable to be performed Mild scattered osteoarthritic changes, more pronounced involving the thumb, radiocarpal joint and triquetrolunate articulation. Specifically no focal additional abnormalities to suggest a soft tissue lesion, however serial imaging and/or even MRI may be needed given patient history

Output: Mild osteoarthritic changes


Instruction: Generate impression based on findings.

Input: Viral hepatitis C, cirrhosis, please evaluate for HCC ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Not well seen on prior study is curvilinear hypointense signal in main portal vein extending towards confluence with SMV, see postcontrast image 145 series 9 and image 242 series 9 as well as image 22 series 6 (in latter case, normal T2 signal void at this level appears compromised). Status post cholecystectomy.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: Prominent cardiophrenic and periportal lymph nodes most likely reactive in setting of cirrhosis.BOWEL, MESENTERY: Thick-walled hepatic flexure of colon likely reflects underlying portal colopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate ascites.

Output: 1. Cirrhotic liver morphology. No suspicious liver lesion.2. Not well seen on prior study is curvilinear hypointense signal in main portal vein extending towards confluence with SMV, suspicious for nonocclusive portal vein thrombus, may be further evaluated with dedicated ultrasound imaging. 3. Additional findings as above.


Instruction: Generate impression based on findings.

Input: History of metastatic prostate cancer. Pathology demonstrated left base medial and left mid medial carcinoma. PELVIS:PROSTATE:Prostate Size: 3.3 x 5.1 x 4.3 cmPeripheral Zone: Dominant lesion in the posterior left apex measuring 1.3 x 1.0 cm (series 801/14) extending into the left mid gland demonstrating T2 weighted hypointensity, restricted diffusion and early arterial enhancement. The lesion abuts the posterior fibromuscular stroma without definite extracapsular extension.Central Gland: No significant abnormality.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The dominant left apex to left mid gland lesion abuts the left posterolateral capsule without definite extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.3 cm left lesion compatible with carcinoma extending into the left mid gland without definite extracapsular extension.


Instruction: Generate impression based on findings.

Input: There are multiple segmentation anomalies throughout the cervical spine including butterfly and hemivertebrae as well as multiple vertebrae that are shortened in the AP dimension but are only partially imaged on the counting scout view. There is also 4 level segmentation anomaly involving the mid thoracic spine with 2 hemivertebra. There is a mild apex rightward curvature centered at the cervicothoracic junction and there appear to be 12 ribs bilaterally. Please note that the presence of multiple segmentation anomalies makes accurate level counting difficult and close attention on follow-up imaging and any future potential procedures is recommended. There is a single midline pelvic kidney. There are postoperative findings related to prior cord untethering. When counting from below, the conus terminates at the inferior L2 level. The filum measures 3 mm in thickness and demonstrates T1 hyperintensity extending from L3 through L4 (again when counting from below). There is anterior translation of the conus upon prone positioning. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: 1.Multiple partially imaged cervical as well as mid thoracic segmentation anomalies without associated cord abnormality. Please note these anomalies limit accurate level counting.2.Postoperative findings related to prior cord untethering. There is filar thickening and fibrofatty infiltration but anterior translation of the conus upon prone imaging. The conus terminates at the inferior L2 level when counting from below.3.Single pelvic kidney.


Instruction: Generate impression based on findings.

Input: 72 year old woman with new heart failure, referred for further ischemic evaluation.MEDICATIONS: ASA, Coreg, lisinopril First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact was noted. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 28%, the LV end diastolic volume index is 123 ml/m2 (normal range: 65+/-11), the LVEDV is 194 ml (normal range 109+/-23), the LV end systolic volume index is 88 ml/m2 (normal range 18+/-5), the LVESV is 139 ml (normal range 31+/-10), the LV mass index is 85 g/m2, and the LV mass is 135 g. LV dysfunction is global with regional variation. The native myocardial T1 relaxation time is 1150ms, suggesting the presence of mild, diffuse underlying interstitial fibrosis.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 68 ml/m2 (normal range 69+/-14), the RVEDV is 108 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 56 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. The thoracic aorta is severely tortuous. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThe hepatic T1 time is reduced suggesting that there may be hepatic iron overload present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia; however, the diagnostic sensitivity of vasodilator stress testing may be reduced in patients with severe LV dysfunction.2. No prior myocardial infarction. The entire myocardium is viable.3. Severely dilated with severely reduced systolic function (LVEF 28%) without evidence of late gadolinium enhancement. Increased native myocardial T1 relaxation times are noted and suggest that there may be mild diffuse interstitial fibrosis present.4. Normal RV size with mildly reduced systolic function (RVEF 48%).5. Severe left atrial dilation.6. Mild to moderate mitral regurgitation.7. Mild aortic regurgitation.8. 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: 47-year-old male with cavernous malformation. There is a 6 mm diameter lesion with extensive peripheral susceptibility effect and punctate central T1 and T2 hyperintensity in the white matter anterior to the frontal horn of the left lateral ventricle, unchanged in appearance, without perilesional edema. There is perhaps a tiny adjacent developmental venous anomaly. There are no other similar appearing lesions. Redemonstrated are a few scattered punctate foci of T2 hyperintensity in subcortical white matter locations without mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The brainstem and cerebellum 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The right globe is elongated with a scleral buckle and lens implant.

Output: 1.Stable 6 mm diameter lesion in the white matter anterior to the frontal horn of the left lateral ventricle likely represents a cavernous malformation. 2.Stable minimal punctate white matter T2 hyperintense foci, statistically most likely due to small vessel disease.


Instruction: Generate impression based on findings.

Input: H/o strokes. The previously seen right occipital hypoattenuation appears less when compared to prior exam. There appears hypoattenuation in the right cerebellum, which is compatible with findings on the prior MRI. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: Stable right posterior cerebral artery territory subacute stroke. Otherwise unremarkable CT head.


Instruction: Generate impression based on findings.

Input: Hemangioma of intracranial structures [D18.02], Reason for Study: ^Reason: CCM Protocol, 3T Scanner, QSM/permeability, known DVA and cavernoma, please evaluate History: tingling in hands, feet, weakness in L arm, numbness on L side of tongue, severe pain About 8mm sized round T2 low signal intensity, T1 iso intensity with significant susceptibility artifacts indicating cavernous malformation at the right inferoanterior basal ganglia and adjacent developmental venous anomaly. There is no evidence of surrounding edema of the lesion.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no other abnormal enhancement except the DVA.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRISpinal cord signal intensity is normal.The spine alignment is anatomic.Bone marrow and spinal cord signal intensity are normal.There is central focal disc protrusion which abuts thecal sac at the level of C56 with mild bilateral ligamentum flavum thickening result minimal spinal canal narrowing. No neuroforaminal stenosis is seen at this level.Diffuse bulging of disc is seen at the level of C45.Other cervical disc levels appear to be within normal limits.

Output: 1. About 8mm sized right inferoanterior basal ganglia cavernous malformation associated with DVA.2. No other lesion is seen.3. Central disc herniation (focal protrusion) at the level of C56 and diffuse bulging of disc at the level of C45 as described above.


Instruction: Generate impression based on findings.

Input: There is stable reversal of the normal cervical lordosis. There is mild disk narrowing at C5-6. The vertebral body and disk heights are otherwise well-maintained. There is mild multilevel disc desiccation. No worrisome focal marrow signal abnormality is appreciated. There is no pathological cord enhancement.There is a small left intradural extramedullary mass likely meningioma at the C1 level (image 33, series 709) measuring 9 x 5 mm, unchanged from prior exam. At the right C2-C3 neural foramen, there is an enhancing mass measuring approximately 17 x 8 mm, also stable (image 26, series 2001). Along the left C3-C4 neural foramen, there is an enhancing dumbbell-shaped mass approximately measuring 25 x 10 mm, previously 26 x 10 mm. The medial lobule measures 10 mm. Overall, the lesion is stable from most recent comparison, but demonstrates mild interval increase in size when compared to more remote study from 6/23/2014. In particular, the lobulated intraspinal component demonstrates increased convexity and measures 10 mm, previously measured 7 mm. There is again significant mass effect on the cord at this level.There is stable disc osteophyte complex at C5-C6 causing mild effacement of the ventral thecal sac and mild-moderate central spinal canal stenosis. There is mild left greater than right foraminal narrowing. There is persistent trace T2/STIR hyperintensity within the right ventral cord, likely minimal myelomalacia. There is also a minimal disc bulge with central prominence at C6-C7 with mild impression on the ventral thecal sac. No significant spinal canal or neural foramina narrowing. Remaining levels demonstrate no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. There are multiple small nodular lesions within the soft tissues of the neck bilaterally; majority of them likely reflect lymph nodes, although some of them may relate to schwannomas, grossly unchanged from the prior exam. Redemonstration of previously demonstrated pontine encephalomalacia, partially imaged. There is a partially imaged left vestibular schwannoma measuring 7 x 7 mm, grossly unchanged from prior. There is a partially visualized left infratentorial plaque-like dural-based enhancing lesion measuring 13 x 8 mm, previously 14 x 8 mm may likely represent meningioma unchanged.At the left T4-T5 foramen, there is a 6 x 6 mm enhancing T2 hyperintense likely schwannoma, unchanged from prior.There is a small enhancing T1 hypointense, T2 hyperintense anterior right chest wall lesion, which appears slightly higher than the expected location of the nipple.The right submandibular gland demonstrates questionable hyperenhancement, nonspecific.MRI brachial plexus: There is no significant asymmetry or abnormal signal involving the brachial plexus on the right. There are no masses or lymphadenopathy identified. There are no compressive masses demonstrated. There is no axillary lymphadenopathy. There are no signal abnormalities along the course of the right brachial plexus or neurovascular bundle. There is trace fluid in the glenohumeral joints.

Output: 1. Stable schwannoma involving right C2-C3 neural foramen. The left C3-C4 neural foramen schwannoma appears grossly unchanged compared to the prior exam, but interval more rounded configuration and mild enlargement of the medial intraspinal component compared to 6/23/2014 study.2. Stable left C1 intradural extramedullary meningioma.3. Partially imaged stable left infratentorial meningioma and grossly stable left vestibular schwannoma.4. Mild spondylotic changes in the cervical spine, without significant neural foraminal narrowing. Mild-moderate spinal canal stenosis at C5-C6 with right ventral minimal myelomalacia.5. No definite abnormality involving the right brachial plexus.6. Questionable mild hyperenhancement of the right submandibular gland, nonspecific. Please correlate clinically for possible recent sialadenitis.7. Enhancing nodule along right anterior chest wall, which appears slightly higher than the expected location of the nipple. Correlate clinically with direct inspection for possible dermal lesion.


Instruction: Generate impression based on findings.

Input: Female 14 years old Reason: evaluation of ischiorectal abscess History: ischiorectal abscess PELVIS:UTERUS, ADNEXA: Uterus is normal in appearance and is anteverted. Bilateral ovarian cysts are noted, likely physiologic.BLADDER: The bladder is distended and normal in appearance.LYMPH NODES: No adenopathy.BOWEL, MESENTERY: Stool is present throughout the visualized colon and rectum.BONES, SOFT TISSUES: Perianal soft tissues there is T2 hyperintense reticular signal consistent with edema. In the right ischiorectal fat there is a 1.3 x 0.8 cm peripherally enhancing collection consistent with small abscess (image 52 series 401).OTHER: Small amount of free pelvic fluid, likely physiologic.

Output: 1.Small peri-anal abscess in the right ischiorectal fat.2.Edema in peri-anal soft tissues, which could be due to cellulitis.


Instruction: Generate impression based on findings.

Input: 58 year old male with history of complex coronary disease with previous PCI to the LAD and PDA, with known anomalous left circumflex coronary artery and persistent stable angina, referred for cardiac MRI vasodilator stress testing. MEDICATIONS: aspirin, metoprolol, rosuvastatin, ticagrelor, amlodipine, ranolazine First Pass PerfusionDuring hyperemia, a small transmural perfusion defect is noted in the basal anterolateral wallViability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 151 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 70 ml (normal range 47+/-19), the LV mass index is 33 g/m2, and the LV mass is 67 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 70%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 45 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There 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 normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. A small transmural perfusion defect/ "ischemia" present in the basal anterolateral wall during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with low normal systolic function (LVEF 54%).4. Normal RV size and systolic function (RVEF 70%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Assess integrity of R thumb UCL History: R thumb pain over UCL, ligament laxity, history of injury 3/2016 The ulnar collateral ligament appears intact. The radial collateral ligament proper can be followed from the first metacarpal head to the base of the proximal phalanx, however, there is increased signal intensity within its dorsal fibers as well as mild edema within the adjacent base of the proximal phalanx. These findings suggest a partial tear of the ligament and perhaps a small avulsion fracture. The collateral ligaments of the interphalangeal joint of the thumb appear normal. The remaining visualized bone and soft tissue structures appear normal.

Output: Abnormal signal intensity within the dorsal fibers of the radial collateral ligament as well as edema within the adjacent base of the first proximal phalanx suggesting a partial-thickness tear and perhaps an avulsion fracture. This could be further evaluated with radiographs. The ulnar collateral ligament appears normal.


Instruction: Generate impression based on findings.

Input: MRI brain:The patient is status post Chiari I decompression surgery with resection of the C1 arch and posterior fossa craniectomy. CSF flow at the level of foramen magnum is appropriate and stable.There is patchy T2 and FLAIR signal hyperintensity within the pons. This is unchanged since the prior exam.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is redemonstration of a small right paramedian disc protrusion at the T11-T12 level which is stable compared to prior exam. There is a Schmorl's node present at T11-T12.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a well-circumscribed lesion present within the L3 vertebral body which is bright on T1 and suppresses on the inversion recovery images which most likely represents a vertebral body hemangioma. It is stable compared to the prior exam.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.The patient is status post Chiari I decompression.2.There is no evidence for syrinx or ventriculomegaly.3.There are mild degenerative changes present in the lower thoracic spine. These are stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Clinical question: History of ovary and cancer with brain metastases. Status post resection and cavity SRS. Interval evaluation. Signs and symptoms: As above. Pre-and post-enhanced brain MRI: No diffusion weighted abnormalities.Significant interval improvement in postoperative changes of left parietal tumor resection.There is also decrease in edema surrounding the surgical cavity since prior exam. A collapsed surgical cavity containing blood product and minimal fluid measures at approximately 6.6 x 18-mm. It demonstrate thin linear loculated internal enhancement. The measurements of the enhancement are at 12 times 22.6-mm. The measurements of the enhancing lesion on sagittal post enhanced (series 1203) on image 60 are at 19 x 22 mm.There is no detectable new foci of parenchymal signal abnormality or abnormal enhancement or parenchymal/leptomeninges.New since prior exam is a small left frontal and parietal subdural collection measuring approximately 5.9 mm in the frontal and approximately 3 mm in parietal region.

Output: 1.Significant interval improvement of postoperative changes of tumor resection of left parietal lobe.2.Interval significant decreased size of the surgical cavity which demonstrate thin linear loculated enhancement as detailed/measured above.3.New since prior exam is a thin left frontal and parietal subdural collection measuring approximately 5.9 mm in frontal and 3mm in parietal.


Instruction: Generate impression based on findings.

Input: SCLC treated with 6 cycles chemotherapy. There is a well-circumscribed, diffusely enhancing pineal lesion measuring up to 8 mm in diameter, which is not significantly changed from the prior exam. There is minimal cerebral white matter T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. There is otherwise no intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Stable appearing enhancing pineal mass, which may represent a lung cancer metastasis versus a primary pineal tumor. No new intracranial enhancing lesions are identified.2. Minimal non-specific cerebral white-matter T2 hyperintensity suggestive of chronic microvascular ischemia.3. No evidence of intracranial hemorrhage or acute infarct.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with bilateral arm weakness and pain. With lumbosacral spondylosis and myelopathy. Cervical:Straightening of the cervical lordosis is seen. Vertebral body heights are preserved. Mild scattered degenerative endplate signal alteration is evident. No worrisome marrow signal abnormality or evidence of marrow edema is seen.The visualized spinal cord demonstrates normal caliber, morphology and signal characteristics. No epidural collections are seen.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis.C5-6: Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Incidental noted is made of a cystic space in the left insula/basal ganglia. A partially empty sella is also demonstrated.Lumbar:Spinal alignment is anatomic. Vertebral body heights are preserved. No concerning marrow signal abnormality is detected.Visualized spinal cord, conus and cauda equina are within normal limits. No epidural collections are suspected.T11-12: Mild endplate degenerative signal abnormality. No spinal canal or foraminal stenosis.T12-L1: Unremarkable.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Facet hypertrophy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L4-5: Facet hypertrophy with a small effusion on the right. Ligamentum flavum thickening. Disc bulging. Mild spinal canal narrowing without nerve root crowding. Mild bilateral foraminal narrowing. L5-S1: Facet hypertrophy. Small right foraminal disc protrusion. No significant spinal canal or foraminal stenosis.

Output: 1.Mild degenerative disc findings in the cervical spine without significant canal stenosis or foraminal narrowing.2.Mild degenerative findings in the lower lumbar spine. This results in a mild generalized spinal canal stenosis and mild bilateral foraminal narrowing at L4-5.


Instruction: Generate impression based on findings.

Input: Reason: knee pain History: pain MENISCI: There is increased signal within the lateral meniscus indicating intrasubstance degeneration. Horizontally oriented signal within the lateral meniscus extends to both the femoral and tibial articular surfaces suggesting degenerative horizontal tears. There is also thinning of the free edge of the posterior horn of the lateral meniscus likely representing additional chronic attritional tearing. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: Residual red marrow within the distal femur, proximal tibia and fibular head may reflect changes secondary to the patient's anemia. Small cysts are seen posteriorly within the intercondylar eminence of the tibia.LIGAMENTS: There is a tiny focus of cartilage degeneration along the posterior aspect of the medial femoral condyle but we see no fluid-filled defects. There is also mild degeneration of the articular cartilage of the lateral tibial plateau with mild degenerative signal abnormality in the underlying subchondral bone. EXTENSOR MECHANISM: There is edema within the subcutaneous fat anterior to the patella and proximal tibia.ADDITIONAL

Output: 1. Degeneration and degenerative tearing of the lateral meniscus.2. Mild osteoarthritis.3. Nonspecific soft tissue edema anteriorly and other findings as above.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with breakthrough seizures and bilateral spasticity due to prior intracranial hemorrhage, ischemic stroke and microhemorrhages. An 8 mm mildly diffusion restricting lesion is seen within the left corona radiata. A larger region of mild restricted diffusion, spanning approximately 2 cm, is seen in the anterior medial right occipital lobe.Extensive patchy and focal areas of T2 hyperintensity are seen within the cerebral hemispheres and the cerebellum with a distribution which is overall similar to the prior examination. Very mild local edema is seen in the anterior medial right occipital lobe. Otherwise, no significant mass effect is detected.No evidence of acute intracranial hemorrhage is seen. Numerous scattered punctate foci of susceptibility are seen throughout the brain compatible with chronic microhemorrhage appearing similar to prior. A more extensive region of hemosiderin staining along the right thalamic contour may relate to a prior hemorrhagic lesion. Ventricular size and contour are unchanged.

Output: 1.An area of late acute or subacute right PCA distribution ischemia is seen involving the anterior medial occipital lobe.2.A late acute or subacute small vessel ischemic stroke is evident in the left corona radiata.3.Evidence of extensive prior ischemia with scattered microhemorrhage is grossly unchanged.


Instruction: Generate impression based on findings.

Input: 48 year old female for breast cancer screening. History of left excisional biopsy 7/2009 for benign papilloma. Family history of breast cancer diagnosed in mother age 49. There is extreme amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.Again seen are stable multiple bilateral enhancing masses and foci, including two reference mid 10 o'clock and anterior 4 o'clock left breast enhancing lesions. Multiple bilateral small cysts are also stable. No new or suspicious abnormal enhancement in either breast.No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Other symptoms and signs involving cognitive functions and awareness [R41.89], Reason for Study: ^Reason: ICH History: ICH Brain MRIThere is ventricular shape right basal ganglia ICH (18.1 mm: RL x 20.8 mm: AP x 23.6 mm: CC) with the surrounding edema and minimal mass effect toward the right lateral ventricle. On gradient echo images, there are multifocal round susceptibility lesions on bilateral basal ganglia, bilateral thalami bilateral parietal lobe and temporal lobes which may indicate chronic petechial hemorrhage lesions.There is also linear shape susceptibility lesion on the left external capsule indicating chronic hemorrhagic lesion with focal encephalomalacia.There is no evidence of acute ischemic lesion.Underlying brain shows scattered patchy FLAIR high signal intensity lesions on bilateral periventricular white matter indicating non specific small vessel ischemic disease.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. Acute ICH at the right basal ganglia, posterior aspect of the putamen with surrounding edema with minimal mass effects toward right lateral ventricle.2. Multifocal brain parenchymal chronic hemorrhagic lesions (hemosiderin deposition) including left external capsule lesion as described above.3. Non specific small vessel ischemic disease.4. No evidence of acute ischemic lesion.5. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: Pain in right shoulder Mild osteoarthritic changes with minimal narrowing and sclerosis. Small osteophytes. Questionable mild flattening of the humeral head is demonstrated. Correlation with the opposite shoulder or even MRI may be helpful if early AVN is a consideration. Similar mild changes of AC joint are also observed with associated possible widening. Dissociation cannot be excluded and weighted views following physical exam and correlation may be indicated.

Output: Mild osteoarthritis with minimal flattening of the humeral head shape raising concern for early AVN. Please see detail provided


Instruction: Generate impression based on findings.

Input: Clinical question: Multiple sclerosis. Please perform dedicated multiple sclerosis protocol (Dr.Javed). Signs and symptoms: Tremor, fatigue and paresthesia. Pre and post enhanced brain MRI:There are no prior exams for comparison.Examination demonstrates normal anatomical development, morphology and signal intensity of brain parenchyma on all acquired MRI sequences. There is no finding to suggest demyelinating disease. Post contrast images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.

Output: Negative pre and post enhanced brain MRI utilizing dedicated multiple sclerosis protocol.


Instruction: Generate impression based on findings.

Input: Reason: Hx of urinary retention with known adnexal mass. Also with urethral lesions on cystoscopy. Eval for urethral mass. History: As above Please note that postcontrast images were not obtained due to low GFR.PELVIS:UTERUS, ADNEXA: Fat containing right adnexal lesion measures 4.6 x 3.5 cm in transverse dimension and 5.1 cm in craniocaudal dimension (601/30, 901/26), similar in size to the prior CT. Small nabothian cysts.BLADDER:There is been interval placement of a Foley catheter and decompression of the bladder. The kidneys are not visualized, however there is decreased ureteral dilatation compared to the prior CT.There is significant dilatation of the urethra with lobulated periurethral increased T2 signal measuring approximately 3.8 x 4.1 cm in transverse dimension (701/17) and 3.0 cm and craniocaudal dimension, possibly fluid. This abnormal signal extends from the proximal urethra inferiorly. There is a fistulous communication with the mid to lower vagina, which contains a small amount of fluid.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Significant urethral dilatation with lobulated periurethral increased T2 signal which is of uncertain etiology, neoplasm cannot be excluded. Postcontrast images were not obtained due to low GFR.2.There is fistulous communication between the anterior vagina and urethra.


Instruction: Generate impression based on findings.

Input: Male, 79 years old, with neck pain and radiculopathy. The normal cervical lordosis is mildly reversed. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen.Except as discussed below, the visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected. Multiple bilateral perineural root sleeve cysts are seen within the neural foramina in the lower cervical spine.C2-3: Mild facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Ligamentum flavum thickening. Mild to moderate generalized spinal canal stenosis with slight deformation of the spinal cord but no cord signal abnormality. Mild left foraminal narrowing. C4-5: Facet hypertrophy. No significant spinal canal stenosis. No significant foraminal narrowing. C5-6: Mild posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis with slight flattening of the ventral cord but no cord signal abnormality. Mild bilateral foraminal narrowing. C6-7: No significant spinal canal or neuroforaminal stenosis. C7-T1: No significant spinal canal or neuroforaminal stenosis.

Output: Multilevel degenerative findings are seen, most notably at C3-4 where there is a mild to moderate generalized spinal canal stenosis, and at C5-6 where there is a mild generalized spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Toe nodule Within the interspace between the first and second toes at the level of the first proximal phalanx is a lobulated soft tissue lesion measuring approximately 3 x 1.4 x 2.9 cm in the greatest AP, transverse, and craniocaudal dimensions. This lesion abuts the surface of the proximal phalanx however there are no discrete osseous changes. This does not appear to arise from the joint space although this is unclear. Following contrast administration, there is thin multilobulated peripheral enhancement without discrete solid focus. There is associated soft tissue edema and fluid surrounding the lesion within the interspace and along the dorsum of the head of the proximal phalanx. No additional lesions are identified. There is mild subcutaneous edema of the foot particularly dorsally along the heads of the proximal phalanges but also within the plantar soft tissues. The remaining bone marrow signal is normal. Osteoarthritis affects the first MTP joint. There is a mild amount of fluid signal surrounding the flexor hallucis longus tendon.

Output: Nonspecific multilobulated cystic lesion within the interspace of the first and second toes demonstrating thin peripheral enhancement without discrete solid focus.


Instruction: Generate impression based on findings.

Input: 60 years Male (DOB:3/9/1956)Reason: hx brain cyst by CT. Eval cyst or abnormality History: none- surveillance post CTPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is a cystic lesion present within the posterior aspect of the lumen are positive. This splays the internal cerebral veins and displaced the vein of Galen. It measures approximately 21 x 23 x 22 mm in size. It follows spinal fluid on all pulse sequences including diffusion. There is no associated contrast enhancement. This was also present on the CT from 8/16/2016 and is unchanged in sizeNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst along the superior aspect of the left maxillary sinus. This mucous retention cyst is associated with hyperdense appearance on CT and a central hypointense appearance on T2 with a mildly hyperintense appearance on T1. This most likely represents some inspissated secretions.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Arachnoid cyst within the velum interpositum.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: new daily headache, prior surgical clipping of the right PICA aneurysm. No evidence of acute ischemic or hemorrhagic lesion on this scan.There is prior ventriculostomy tube track through the right frontal lobe.Significant metallic artifacts on the distal right vertebral artery area indicating prior surgical clip related artifacts. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.The right maxillary sinus shows fluid collection.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate non visualization of the distal right VA, thus evaluation of the prior surgical clip area cannot be evaluated.Otherwise, normal ICAs, MCAs and ACAs. Left VA and basilar artery appear to be normal.

Output: 1. No evidence of new ischemic or hemorrhagic lesion.2. Evaluation of the distal right VA is not possible due to metallic artifacts.3. Otherwise no evidence of intracranial arterial aneurysm or arterial luminal stenosis or irregularity on this MRA.4. Opacification of the right maxillary sinus.


Instruction: Generate impression based on findings.

Input: Altered mental status. Gait abnormalities. Question CVA. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is strong clinical concern for an acute stroke, an MRI may be considered for further evaluation. There is no evidence of intracranial hemorrhage, mass or midline shift. Vascular calcification is noted of the intracranial carotid arteries.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. If there is strong clinical concern for acute stroke, an MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Back pain, trauma and 2010, Limited evaluation of the cervical spine on the scout sagittal T1 sequence unremarkable.Thoracic: Vertebral body heights in the thoracic spine are normal. Alignment is normal. Bone marrow signal is within normal limits. There is no significant disk disease, spinal canal, or neural foramina stenosis within the thoracic spine. Thoracic cord is normal in signal and contour.Lumbar:For the purposes of numbering, there are 5 lumbar type vertebral bodies. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L5 on S1. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the T12-L1 level.Mild multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is disk desiccation and minimal bulge. Mild right neural foraminal stenosis. No significant spinal canal or left neural foraminal narrowing. L3-L4: There is an annular fissure and small right foraminal disk protrusion. There is mild to moderate narrowing of the right neural foramina and contact of the right exiting L3 nerve root. No significant spinal canal or left neural foraminal stenosis.L4-L5: Minimal disk bulge. No significant spinal canal or neural foraminal stenosis.L5-S1: Minimal disk bulge. Mild anterolisthesis. There is mild right and mild to moderate left neural foraminal stenosis. The left foraminal disc contacts the left L5 nerve root. No spinal canal stenosis. Mild fluid distention involving the posterior elements on the right. Possible pars defect can be better evaluated with CT or oblique radiographs.Paraspinous soft tissues are within normal limits.

Output: 1. No significant disk disease, spinal canal, or neural foramina stenosis in the thoracic spine. No compression fractures in the thoracic or lumbar spine.2. Mild anterolisthesis of L5 on S1. There is mild right and mild to moderate left neural foramina stenosis at L5-S1. May consider oblique lumbar radiographs or CT for evaluation of possible L5 pars defect.3. Mild degenerative changes at additional levels as detailed above with associated mild to moderate right L3-L4 and mild right L2-L3 neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Right intranasal mass asses for intracranial invasion: right nasal congestion. There is a lobulated and heterogeneous mass within the right nasal cavity that measures up to 55 mm in length. There is mucosal thickening and fluid in the right maxillary and ethmoid sinuses, as well as mucosal thickening in the right frontal sinus, a left maxillary sinus retention cyst, and fluid in the bilateral sphenoid sinuses. There is deviation of the nasal septum to the left. There are secretions in the nasopharynx. There are bilateral lens implants. There is a chronic lacunar infarct in the right basal ganglia and scattered foci of nonspecific cerebral white matter T2 hyperintensity.

Output: 1. Preoperative planning MRI demonstrates a mass centered in the right nasal cavity with superimposed obstructed sinonasal inflammatory disease, likely both acute and chronic.2. Chronic lacunar infarct in the right basal ganglia


Instruction: Generate impression based on findings.

Input: Reason: Pancreatic cyst surveillance surveillance plus family history History: history [prostate CA ) ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. No intra or extrahepatic biliary ductal dilatation. Gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: There is a 9 mm cystic lesion in the pancreatic body which may represent a branch type I p.m. and.ADRENAL GLANDS: No adrenal nodularity or thickening.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: Small 9 mm pancreatic body lesion may represent a branch type IPMN.


Instruction: Generate impression based on findings.

Input: Right-sided pulsatile tinnitus. Brain:There is no evidence of acute infarct or intracranial hemorrhage. There is a 12 mm T2/FLAIR-hyperintense lesion involving the deep right parietal white-matter which is nonspecific and may reflect sequela of previous ischemia or inflammation/infection. Smaller T2/FLAIR-hyperintense lesions are present in the periventricular frontal white-matter and most probably reflect mild chronic microvascular ischemia. There is no midline shift or brain herniation.There is trace mucosal thickening in the paranasal sinuses. The skull is mildly diffusely thickened but without a focal lesion. There is a partially empty sella which is incidentally noted and a normal variant.While this study is not optimized for internal auditory canal assessment, there is no obvious mass in the cerebellopontine angles or internal auditory canals. There is also no gross vascular abnormality in the region.Cranial MRA:There is no flow-limiting intracranial arterial stenosis or aneurysm. Partially azygos A2 segments incidentally noted which is a normal variant. The posterior cerebral arteries are fetal-type in origin, which is also a common normal variation. There is an symmetric venous structure in the region of the right condylar canal which drains into the internal jugular vein. It has a flow-related signal that is higher than the adjacent right transverse sinus/internal jugular vein but lower than the arteries. This is of uncertain significance but may reflect an early draining vein if there is an underlying arteriovenous fistula.

Output: 1.There is no acute infarct or intracranial hemorrhage. Mild changes of chronic microvascular ischemia.2.Right parietal white-matter lesion is nonspecific but may reflect sequela of previous ischemia or infection/inflammation. 3.There is an asymmetrically prominent emissary vein in the region of the right condylar canal draining into the jugular vein as described above. This finding is of uncertain significance but raises possibility of early draining vein in the setting of a dural arteriovenous fistula.


Instruction: Generate impression based on findings.

Input: Difficulty walking, limited range of motion. Patient also has history of lumbar stenosis. Cervical: Examination is slightly motion degraded. Vertebral body heights in the cervical spine are normal. There is exaggeration of the normal cervical lordosis from C2 to C4 and and mild anterolisthesis of C3 on C4 and C4 and C5. There is mild to moderate spinal canal stenosis at C3-C4 with effacement of the ventral and dorsal thecal sac. No cord signal abnormality seen. Osseous fusion involving the posterior elements at C2-C3 and C4-C5 on the left which is likely on a degenerative basis.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant spinal canal stenosis. There is moderate left neural foramina stenosis related to uncovertebral hypertrophy and facet arthropathy. No significant right neural foramina stenosis.C3-4: There is mild anterolisthesis and small central disk protrusion. There is mild ligamentum flavum thickening dorsally. There is mild to moderate spinal canal stenosis with effacement of the ventral and dorsal thecal sac at this level. There is moderate to severe left neural foraminal narrowing related to left-sided facet arthropathy and uncovertebral hypertrophy. There is mild distention of the left facet joint. No cord signal abnormality.C4-5: No significant spinal stenosis. There is intervertebral disk calcification better seen on CT. There is severe left foraminal stenosis. No significant right foraminal narrowing.C5-6: No significant compromise to the spinal canal or right neural foraminal narrowing. There is moderate left neural foraminal stenosis.C6-7: Small disk osteophyte complex with mild spinal canal stenosis. There is mild to moderate left neural foramina narrowing and minimal right neural foramina narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.Right vertebral artery flow void is diminished which may be related to proximal stenosis. Paraspinous soft tissue structures appear within normal limits.Lumbar:There are 5 lumbar type vertebral bodies. Severe multilevel degenerative changes are again seen which are similar to prior, with prior exam limited by motion degradation. Mild endplate compression deformities of L2 and L3. Severe (approximately 50%) loss of vertebral body heights at L4. There is no associated increased T2 signal to indicate a recent compression fracture. No interval also vertebral body height compared to 8/20/2014. There is grade 1 retrolisthesis of L2 on L3. Facet arthropathy affects the entirety of the lumbar spine and is most severe at L4-5. Note is made of fatty atrophy of the lower lumbar paraspinal muscles. The bone marrow is diffusely heterogeneous. The conus medullaris terminates at the L1 level. There is mild apparent clumped appearance of the nerve roots at multiple levels which is likely related to extrinsic canal stenosis.T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: Diffuse disk bulge asymmetric to the right. Minimal left and moderate right neuroforaminal stenosis. No spinal canal stenosis.L2-L3: Diffuse disk bulge with a central disk protrusion that in conjunction with ligamenta flava thickening creates moderate spinal canal stenosis. Moderate left and severe right neuroforaminal stenosis.L3-L4: Mild disk bulge and thickening of the ligamentum flavum. Mild to moderate spinal canal, mild left neuroforaminal stenosis, and mild to moderate right neuroforaminal stenosis. L4-L5: Diffuse disk bulge and ligamentum flavum thickening creates mild spinal canal and mild to moderate bilateral neuroforaminal narrowing.L5-S1: Central disk protrusion. No significant spinal canal stenosis. Minimal bilateral neural foraminal narrowing.There is mild atrophy involving the paraspinous musculature. Paraspinous soft tissues are otherwise unremarkable.

Output: 1. Multilevel degenerative changes in the cervical spine relatively worse at C3-C4 signal changes effacement of the ventral and dorsal thecal sac and mild to moderate spinal canal stenosis. No cord signal abnormality. There is mild anterolisthesis at this level. Prominent facet arthropathy and osseous fusion on the left at C2-C3 and C4-C5 are better seen on recent CT.2. There is multilevel neural foraminal narrowing at multiple levels particularly on the left as detailed above and better assessed on CT from 8/20/2014.3. Degenerative changes affect the lumbar spine most notably at L2-3 and L3-4 where there is up to moderate spinal canal stenosis. There is severe right L2-3 neuroforaminal stenosis. No significant change since 8/20/2014.4. Multiple chronic-appearing compression deformities in the lumbar spine. No interval loss of height compared to 8/20/2014 or bone marrow edema.


Instruction: Generate impression based on findings.

Input: 64-year-old male with a history of mycobacterium infection in the right wrist now clinically worse with increased edema, erythema, reevaluate infection. Presents with right wrist pain. Evaluation is limited due to the small area of coverage as well as poor fat suppression on the fluid sensitive sequences and poor T1 weighting. Again seen is an enhancing intramedullary mass in the distal ulna extending from the articular surface into the distal diaphysis, off of the field of view of this study, compatible with the stated history of mycobacterium infection. The infection extends through the volar cortex of the distal end of the ulna into the soft tissues forming a collection volar to the ulnar margin of the pronator quadratus. Additional foci of cortical penetration and soft tissue extension are noted both volarly and dorsally along the distal ulnar metadiaphysis. Please note that the proximal extent of this lesion is not included on the field-of-view of this study. There is additional enhancement and edema of the soft tissues surrounding the ulna, indicating inflammation. There is mild enhancement of the distal radioulnar and radiocarpal articulations indicating synovitis. Please note that we cannot exclude the possibility of a septic arthritis. There is mild enhancement of the radial styloid which may represent infection or reactive edema. There is enhancement within the medial margin of the triquetrum which may represent an erosion, although this was present on the prior study. There also appears to be mild enhancement of the midcarpal joint. Also again seen is abnormal signal intensity within the base of the third metacarpal, however, on the current study we see this signal abnormality and enhancement extend into the distal diaphysis of the third metacarpal where it penetrates the volar and medial cortex, extending into the soft tissues between the third and fourth metacarpals and deep to the flexor tendons of the middle finger.

Output: 1. Osteomyelitis of the distal ulna with extension into the surrounding soft tissues.2. Osteomyelitis of the third metacarpal with extension into the soft tissues between the third and fourth metacarpals deep to the flexor tendons of the third finger.3. Please note that the full extent of the infection is not included on the field-of-view on this study. The patient may return for additional imaging of the forearm and hand if clinically warranted.


Instruction: Generate impression based on findings.

Input: 44-year-old male history of left parietal temporal lobe grade normal excised in 2003. Very poor quality exam due to extensive motion artifacts. Large area of encephalomalacia in the left posterior temporal with ex vacuo dilatation of the left lateral ventricle is again demonstrated with no interval change. Focal area of encephalomalacia in the right frontal lobe along its inferior aspect is again identified and with no interval change. Large left parietal craniotomy is again noted. Considering provided clinical history of malignancy an MRI examination of brain is recommended.No evidence of hemorrhage, edema, midline shift, hydrocephalus is detected. Punctate calcification within the thalamus on the left remains a stable.

Output: No definite evidence of new finding since prior study of 2003.


Instruction: Generate impression based on findings.

Input: 53 year old female with sjogren's, diabetes, hypertension and known coronary artery disease with history of chronic total occlusion of right coronary artery (s/p PCI 12/2015) presenting for evaluation post interventionMEDICATIONS: aspirin, atorvastatin, bumetanide, carvedilol, lisinopril, clopidogrel, ranolazine, spironolactone First Pass PerfusionDuring hyperemia, there is a perfusion defect ("ischemia") in the RCA territory, specifically there are perfusion defects in mid to basal inferior and inferolateral walls. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 91 ml/m2 (normal range: 65+/-11), the LVEDV is 185 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 74 ml (normal range 31+/-10), the LV mass index is 29 g/m2, and the LV mass is 60 g. There is basal to mid inferior and possibly inferolateral hypokinesis. Native T1 time approximately 1110 ms (LV cavity 1550 ms). There is diffuse late gadolinium enhancement noted in the subendocardial and mid myocardial region isolated to the inferior wall suggesting myocardial infarction, fibrosis, inflammation, or infiltration. This was seen on previous CMR in 2014, however it appears similar to slightly improved. This specific area is likely to be viable along with the remaining myocardium. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 73 ml/m2 (normal range 69+/-14), the RVEDV is 148 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 53 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There 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 normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, there is a perfusion defect ("ischemia") in the RCA territory, specifically there are perfusion defects in the mid to basal inferior and inferolateral walls. 2. There is diffuse late gadolinium enhancement noted in the subendocardial and mid myocardial region isolated to the inferior wall suggesting myocardial infarction, fibrosis, inflammation, or infiltration. This was seen on previous CMR in 2014, however it appears similar to slightly improved. This specific area is likely to be viable along with the remaining myocardium. 3. Normal LV size and systolic function (LVEF 60%).4. Normal RV size and systolic function (RVEF 64%).


Instruction: Generate impression based on findings.

Input: 56-year-old female with medial joint line pain. Evaluate meniscus. MENISCI: There is branching signal abnormality within the body of the medial meniscus, indicating a complex tear with a displaced flap of meniscus within the medial gutter beneath the body of the meniscus. There is globular increased signal which extends from the body into the posterior horn of the medial meniscus representing intrasubstance degeneration. The signal also extends to the femoral articular surface, indicating additional degenerative tearing. There is also intrasubstance degeneration within the anterior horn of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness degeneration of the articular cartilage along the medial facet of the patella with relative sparing of the articular cartilage along the lateral facet. There are small patellofemoral osteophytes. There is full-thickness cartilage loss along the weightbearing portion of the medial femoral condyle and near full-thickness cartilage degeneration along the weightbearing portion of the medial tibial plateau. There is mild subchondral edema type signal within the medial aspect of the medial tibial plateau and medial femoral condyle, which is likely degenerative in etiology. The articular cartilage in the lateral compartment is relatively preserved. There are small medial compartment osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: 1. Complex tear of the medial meniscus with displacement of meniscal tissue into the medial gutter as described above.2. Osteoarthritis of the knee.3. Baker's cyst.


Instruction: Generate impression based on findings.

Input: Metastatic lung ca, with a possible L2 lesion. There is a 12 mm wide superior endplate intravertebral disc herniation at L2 with associated mild bone marrow enhancement. There is also vacuum phenomenon in the posteroinferior L2 vertebral body. Otherwise, there is no evidence of metastatic disease in the lumbar spine. There is multilevel degenerative spondylosis with up to mild spinal canal and neural foraminal stenosis at L2 through S1. The vertebral body heights are preserved and the lumbar spine alignment is anatomic. The imaged portions of the spinal cord are unremarkable. There is a partially-imaged left adrenal mass.

Output: 1. Superior endplate intravertebral disc herniation at L2 with associated mild reactive bone marrow changes in the setting of multilevel degenerative spondylosis, but no evidence of metastases involving the lumbar spine.2. Partially-imaged left adrenal mass. Please refer to the recent body CT report for additional details.


Instruction: Generate impression based on findings.

Input: There is susceptibility artifact related to patient's partial dentures which limits assessment of the right inferior frontal lobe on the diffusion-weighted sequence. There is however no evidence of acute ischemia. There are patchy foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate chronic small vessel ischemic disease. These changes are minimally worse since prior with, for example, interval increased T2 signal noted in the left parietal periventricular white matter.No intracranial mass or mass effect. Punctate focus of susceptibility consistent with chronic microhemorrhage in the left thalamus is again seen. The ventricles and sulci are within normal limits for patient's advanced age. Posterior fossa structures are grossly unremarkable. No extra-axial fluid collection is identified. Calvarium and extracranial soft tissues are grossly unremarkable.MRA HEAD

Output: 1. No evidence of acute infarct. Moderate chronic small vessel ischemic disease which is minimally worse since 3/24/2015. Brain parenchyma is otherwise unremarkable for age.2. No significant stenosis in the intracranial vasculature.3. 1 to 2 mm aneurysms involving the right A1-A2 junction and the right P1 segment. These findings are grossly unchanged since 3/24/2015.


Instruction: Generate impression based on findings.

Input: Reason: 64 yo with biliary dilation noted on MRI History: abd pain ABDOMEN:LIVER, BILIARY TRACT: There is dilatation of the common bile duct to the level of the ampulla measuring up to 1 cm, similar to the prior exam. Soft tissue prominence at the ampulla is unchanged. Severe intrahepatic biliary ductal dilatation is unchanged. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintensities, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dilatation of the common bile duct to 1 cm and severe intrahepatic biliary ductal dilatation is stable. There is soft tissue prominence at the ampulla which is also unchanged.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with history of cervical chordoma status post treatment with proton radiotherapy, under good control, but with recent neurologic decline including frequent falls and left-sided weakness and proximal lower extremity weakness. Status post C2-C7 decompression and fusion. Assess for ischemia, postoperative changes. Sequelae of recent laminectomy from C2 through C6 are demonstrated. Posterior fusion instruments have also been placed from C2 to C7. As a result of the procedure, the previously seen cervical spinal canal stenosis has been relieved and the progressive kyphotic angulation of the spine has improved. A small amount of fluid is evident within the posterior soft tissues along the dura at C2 and C3. A surgical drain is evident in the operative bed.The marrow space of the cervical spine shows diffuse fatty infiltration compatible with prior radiation therapy. Superimposed on this is marrow replacement involving C3, C4, and C5, with small foci in the remaining vertebral bodies extending down to T1.As above, the spinal canal has been well decompressed and the spinal cord is no longer frankly impinged by disc osteophyte disease. However, extensive central cord T2 hyperintensity spanning from the obex down to the upper thoracic region has not significantly changed from the recent prior exam.C2-3: Spinal canal decompression. No significant foraminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Moderate to severe foraminal narrowing. Spinal canal decompression. Note is made of a cystic lesion which appears to protrude into the paraspinal soft tissues from the right neural foramen which may represent a perineural root sleeve cyst, unchanged from prior.C4-5: Posterior disc-osteophyte complex formation. Moderate to severe foraminal narrowing. Spinal canal decompression. C5-6: Posterior disc-osteophyte complex formation. Moderate bilateral foraminal narrowing. Spinal canal decompression. C6-7: Posterior disc-osteophyte complex formation. Moderate bilateral foraminal narrowing. Spinal canal decompression. C7-T1: Posterior disc-osteophyte complex formation. Mild bilateral foraminal narrowing. No significant spinal canal stenosis.

Output: 1.Sequelae of extensive cervical spine laminectomy and posterior instrumented fusion. Previously seen spinal canal stenosis has been relieved, and the progressive cervical kyphosis has been partially corrected.2.The spinal canal is now well decompressed and no areas of spinal cord impingement are seen. However, extensive central cord T2 signal abnormality persists, similar to the prior examination, extending from the obex down to the thoracic region. The differential for this finding would include cord ischemia with or without a component of compressive myelopathy. Radiation related myelopathy would be less likely given the history of proton therapy, but correlation with radiation timing and treatment fields should be made to better judge this possibility. Additional inflammatory etiologies may also be considered as appropriate for the clinical history.3.On a background of prior radiation marrow change, patchy areas of marrow replacement persist from C3 through C5 predominantly, but with small foci in the remaining visualized cervical vertebral bodies. These lesions may reflect residual or treated chordoma.


Instruction: Generate impression based on findings.

Input: 1 month of numbness/tingling pain on lateral/medial right thigh with decreased sensation noted on exam. Plain films show decreased vertebral body height of T7 tule out fracture verse infection of possible mass as cause of symptoms. There is irregularity along the superior and inferior endplates of the T7 vertebral body with slight loss of vertebral body and adjacent disc space heights, but no associated abnormal enhancement or edema. The vertebral body and disc space heights are otherwise preserved. The vertebral column alignment is within normal limits. There is no evidence of mass lesions. There is no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris is positioned at the L1-2 level. The cauda equina nerve roots are unremarkable. The paravertebral soft tissues are unremarkable.

Output: Irregularity along the superior and inferior endplates of the T7 vertebral body may represent incipient intravertebral disc herniation or may be post-traumatic in nature rather than an infectious or neoplastic process.


Instruction: Generate impression based on findings.

Input: 56-year-old female patient with glioblastoma multiforme. Evaluate for GBM status post RT/TMZ/bev. 4 week Redemonstration of postsurgical changes related to a right parietotemporal craniotomy for partial tumor resection from the right temporal lobe. Again seen is extensive enhancement surrounding the resection cavity, with the area of thick enhancement appearing mildly increased particularly along the superior margins of the tumor within the right temporooccipital lobe and extending to the right splenium. However, there is significant interval decrease in surrounding abnormal T2 signal along with diffusion abnormality, predominantly within the superior aspect of the right temporal lobe and parietooccipital lobe. This results in decreased mass effect and midline shift which now measures approximately 4 mm, previously 13 mm. Right uncal herniation is improved. An additional satellite nodule along the lateral surface of the right lateral temporal lobe is unchanged. Prominent left temporal horn periventricular T2 signal is unchanged. Linear and nodular susceptibility artifact surrounding the resection cavity is not significantly changed.

Output: 1. Post-surgical changes in the right temporal lobe related to partial resection of known GBM. Compared to 5/1/2015, there is significant decrease in FLAIR hyperintensity/edema particularly superior to the enhancing lesion consistent with response to Avastin therapy. There is however some interval increase in thick enhancement particularly surrounding the trigone of the right lateral ventricle, which given recent radiation therapy may represent treatment change; close follow-up, however, is recommended. 2. Improvement in mass effect, midline shift, and right uncal herniation.3. Unchanged right lateral temporal lobe satellite lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for changes in MRI (? Evolving CVA versus metastases). Signs and symptoms: Abnormal brain MRI. History of extra CNS breast cancer. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates interval resolution of hematoma in the left posterior temporal and parietal region with resultant resolution of subtle associated mass effect. There is resultant development of hemorrhagic encephalomalacia and with mineralization of overlapping cortex at this site. Mild interval increased size of left trigone of the lateral ventricle is also noted. There is no mild linear enhancement of the cortex at the site is present. Findings are consistent with a previously known hemorrhagic ischemic stroke and without no evidence of metastatic lesion of the brain parenchyma or the leptomeninges. Calvarium also demonstrates normal signal intensity without detectable abnormal enhancement.Diffuse periventricular and a left frontal cortical foci of FLAIR hyperintensity consistent with chronic small vessel ischemic strokes and a left frontal chronic cortical stroke remains similar to prior exam.Unremarkable images through the orbits and including axial fat sat post enhanced series.Normal signal intensity of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.

Output: 1.Interval complete resolution of left posterior temporal-parietal hemorrhage with resultant development of regional hemorrhagic encephalomalacia.2.No evidence of parenchymal, leptomeningeal or calvarial metastatic lesions.3.Negative diffusion weighted images extensive chronic small vessel ischemic strokes and chronic left frontal ischemic stroke.


Instruction: Generate impression based on findings.

Input: Reason: Patient with large right renal mass concerning for extension into the IVC. Has new SOB and need MRI for surgical planning History: As above. ABDOMEN: Limited exam without the use of intravenous contrast.LUNG BASES: Bilateral small to moderate size pleural effusions, greater in the left. 1.1 x 1.2 cm left lower lobe pulmonary nodule (series 801 image 48) suspicious for metastases. Please see separately dictated MRI chest performed on the same day. Retrocrural lymph node measures 1.3 x 1.4 cm (series 801 image 32).LIVER, BILIARY TRACT: Several mildly T2 hyperintense intense, T1 hypointense lesions with restricted diffusion and ill-defined margins in the right lobe of the liver suspicious for metastases. The largest in segment 8 measures 2.0 x 1.9 cm (series 801 image 34). Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: In the expected location of the right adrenal gland, there is a 3.9 x 3.6 x 5.3 cm heterogeneous mass with restricted diffusion and signal characteristics similar to the separate right renal mass (series 801 image 31, series 701 image 22). The normal right adrenal gland is not visualized. The left adrenal gland is unremarkable.KIDNEYS, URETERS: In the right lower pole, there is a large heterogeneous mass with well-defined margins and restricted diffusion measuring 10.4 x 8.2 x 8.7 cm (series 801 image 16, series 701 image 22). There is extension of this mass into the left renal vein and IVC (series 801 image 23-28; series 701 image 14). The tumor extends superiorly just proximal to the level of the intrahepatic IVC and inferiorly to the level of L3. Moderate to severe left hydronephrosis that extends to the pelvis, outside the field of view. Nonspecific urothelial wall thickening of the proximal left ureter. RETROPERITONEUM, LYMPH NODES: Aortocaval lymph node measures 2.3 x 2.8 cm (series 801 image 21). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered perineural or synovial cysts. Focal T2 hyperintense, T1 hypointense lesion in the left L1 posterior vertebral body with extension into the pedicle suspicious for metastasis. OTHER: No significant abnormality noted.

Output: 1.Large right renal mass suspicious for renal cell carcinoma with extension into the right renal vein and IVC. 2.Retroperitoneal lymphadenopathy. 3.Probable hepatic, pulmonary, and osseous metastases.4.Moderate to severe left hydroureteronephrosis that extends into the pelvis. No obstructive lesion identified within the abdomen, although the pelvis is not imaged. Nonspecific proximal ureteral wall thickening.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with multiple sclerosis. Assess for progression. Given differences in imaging technique, there does not appear to be a substantial change in the size or number of T2 hyperintense lesions within the periventricular and juxtacortical white matter, and to a lesser extent the brainstem. As before, many of these lesions involve the corpus callosum or callososeptal interface and many are oriented radially with respect ventricles. Most correlate with moderate T1 hypointensity. No definite evidence of any new lesion is seen. Brain volume is preserved. No evidence of edema or mass effect is detected. Ventricular size and morphology remain within normal limits.

Output: Numerous lesions are redemonstrated compatible with multiple sclerosis. No significant interval change in lesion size or number is suspected.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: Abnormal morphology and increased signal intensity of the posterior horn of the medial meniscus reflects complex tearing. There is increased signal within these anterior horn of the lateral meniscus which may reflect intrasubstance degeneration although no lateral meniscal tear is identified. ARTICULAR CARTILAGE AND BONE: Extensive full-thickness cartilage loss is noted within the medial femoral condyle and medial tibial plateau with associated reactive marrow change. Mild diffuse thinning of the lateral compartment articular cartilage is also noted.There is full-thickness cartilage loss of the articular surface of the lateral patellar facet with diffuse loss of the medial patellar facet. There is a full-thickness loss are also noted within the femoral trochlea, particularly medially and inferiorly.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus.2. Severe articular cartilage loss of the patellofemoral and medial compartments.3. Joint effusion with possible prepatellar bursitis.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:10/23/1943)Reason: progression of WM lesions? History: gait decline history of multiple sclerosisPROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON There is a moderate to marked degree of periventricular and subcortical T2 and FLAIR signal intensity lesions which were also present on the prior exam from 2012. Comparing the 2 exams a not changed substantially.There are punctate foci of T2 and FLAIR signal hyperintensity in the basal ganglia, thalami and brainstem which were also present on the prior exam and do not appear to have progressed significantly when compared.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple lesions in the brainstem and basal ganglia and thalami which are stable. Given the patient's clinical history of multiple sclerosis these could very well represent prior demyelinating plaques. Please note that the lacunar infarcts may have a similar appearance.2.There is a moderate to marked degree of periventricular and subcortical white matter lesions which were also present on the prior exam and have not changed significantly. Given patient's clinical history much of this may represent demyelination, however, vascular related lesions can have a similar appearance.3.There is no evidence for acute cerebral ischemic infarction.4.Examination is mildly degraded due to motion artifact which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 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. The right PCOM is larger than the left. There maybe a tiny fenestration within the ACOM.Focal cystic encephalomalacia is again noted in the left inferior parietal lobe laterally, just adjacent to the sylvian fissure.MRA NECK

Output: 1. Unremarkable MRA of the head, with redemonstration of left inferolateral parietal encephalomalacia.2. Limited MRA neck images with no gross abnormality.


Instruction: Generate impression based on findings.

Input: Sarcoma No bony or soft tissue abnormalities visualized.

Output: Normal radiographs of the radius and ulna.