Instruction: Generate impression based on findings.

Input: 28-year-old female with history of recent nasopharyngeal cancer status post chemo/RT. Please eval extent of disease. CT of soft tissues of the neck with infusion.Images through the skull base demonstrates a slight prominence of the left cavernous sinus compared to the right and also there are sclerotic changes of the sphenoid bone on the left side. Subtle erosive changes of the pterygoid bone on the left, specifically the medial leaf of the pterygoid bone is noted. combination of the above findings are highly suspected of possible extension of tumor into the skull base and the left cavernous sinus. These findings were present on the prior study. Further evaluation with an MRI examination is recommended.Chronic inflammatory sinus disease of the sphenoid sinus is also present which was also noted on the prior exam and demonstrates no interval change. There is complete opacification of bilateral mastoid air cells and middle ear cavities. These findings on the left were present on the prior study however the findings on the right are new since prior exam.In comparison to prior exam there is significant interval reduction in the size of previously noted left high nasopharyngeal tumor. On the current exam some subtle soft tissue swelling with edematous changes and without definitive enhancement is still is present. This finding extends anteriorly into the posterior choana of the left nasal cavity.No evidence of any pathologic adenopathy neck is detected.Limited images of the apices of the lungs are unremarkable. No additional areas of bony erosion or metastatic lesions is detected.CT of brain with infusion.No evidence of metastatic lesion of the brain parenchyma or the meninges is detected. The bony density of calvarium is unremarkable with the exception of findings described on the left side of the sphenoid bone/pterygoid adjacent to the patient's known tumor.

Output: 1.Significant reduction in the size of patient's known high left nasopharyngeal cancer with no definite measurable tumor on the current study.2.Erosive and sclerotic changes of the skull base involving the left pterygoid bone and left aspect of the body of sphenoid bone as detailed.3.The bony changes as well is a slight prominence of the cavernous sinus on the left raises the possibility of extension of tumor into the skull base and cavernous sinus. Further follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Female, 68 years old. Reason: 5 x 4 cm mass on posterior right thigh. Has a history of metastatic HCC with pulmonary metastasis. Please evaluate for etiology. History: see above There is low T1 signal and high T2 signal within the intramuscular mass in the right biceps femoris at the level of the mid femur. The mass exhibits heterogeneous enhancement but does not extend to the cortex. The mass measures 5.1 x 5.3 x 8.3 cm (series 16, image 7). The remaining soft tissues appear unremarkable. The vessels appear patent. The soft tissues of the left thigh and the left femur are grossly unremarkable as seen on the coronal view.

Output: Enhancing mass in the right posterior thigh which is suspicious for primary soft tissue sarcoma or metastatic carcinoma.


Instruction: Generate impression based on findings.

Input: 57-year-old female patient with newly diagnosed cervical cancer. Evaluate for disease status. PELVIS:UTERUS, ADNEXA: There is a 5.3 x 3.6 x 3.5 (craniocaudal by AP by transverse) lesion within the cervix demonstrating low T2 signal and enhancement compatible with tumor (image 18, series 601 and image 16, series 801). The lesion extends into the posterior wall of the lower uterine body. There is parametrial invasion along the posterior wall of the cervix, more predominately along the left side extending to the mesorectal fascia. The mass protrudes into the vagina and may involve the upper third of the vaginal wall.There is a focus of susceptibility artifact within the lower anterior uterine body.There is a solid lesion within the right ovary measuring 5.1 x 3.2 cm with more focal hypointense T2 components. This lesion demonstrates progressive enhancement on postcontrast imaging. The left ovary is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: There is a enlarged left common iliac station lymph node measuring 1.7 x 1.6 cm (image 362, series 1001), which is suspicious for metastatic adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cervical mass compatible with cervical cancer with parametrial invasion.2.Solid right ovarian lesion is non-specific but may represent an ovarian metastasis or a fibrous tumor such as a fibroma, fibrothecoma, or Brenner's tumor given low T2 components.3.Enlarged left iliac station lymph node is suspicious for metastatic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female 64 years old; Reason: r/o growth of nodule, adenopathy History: h/o thyroid nodule. 1.5 year follow up study RIGHT LOBE MEASUREMENTS: 4.9 x 1.6 x 2.0 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.1 x 1.1 cmISTHMUS MEASUREMENT: 0.2 cmRIGHT LOBE: There are at least three subcentimeter hypoechoic nodules in the anterior right lobe of the thyroid. There is a hypoechoic round nodule inferior and posterior to the right thyroid lobe measuring 2.3 x 1.5 x 1.5 cm, previously 2.0 x 1.4 x 1.7 cm. There is no demonstrable color Doppler flow.Reference right thyroid nodule measures 0.6 x 0.3 x 0.5 cm, previously 0.5 x 0.6 x 0.3. There is no demonstrable color Doppler flow.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: Right level 1B lymph node measures 1.1 x 0.4 x 0.7 cm. OTHER: No significant abnormality noted.

Output: 1.No significant change in a hypoechoic round nodule inferior and posterior to the right thyroid lobe. This may represent a parathyroid adenoma. Correlate with PTH.2.No significant change in the reference right thyroid nodule.3.No significant lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 70 year-old male with the history of recent CVA in the right MCA found unresponsive. Right frontal cortical hypoattenuation consistent with infarction noted on MRI of 2/21/2008. Periventricular hypoattenuation consistent with microangiopathic vascular disease demonstrated on prior MRI. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Right frontal infarction and white matter hypoattenuation compatible with microangiopathic vascular disease as demonstrated on prior MRI.


Instruction: Generate impression based on findings.

Input: History of low back pain and hip flexor weakness. Known metastatic cervical cancer, including lumbar mets from CT. Evaluate spinal and nerve root involvement. 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. Within the anterior and lateral portion of the right L2 vertebral body is an enhancing lesion extending into the adjacent right soft tissues with mass effect on and deviation of the right psoas muscle compatible with an osseous metastasis with soft tissue extension. There is thickening and enhancement right L2 nerve root compatible with perineural extension of the tumor towards the epidural space but there is no evidence of leptomeningeal involvement. Similarly within the anterior and lateral portion of the right L3 vertebral body is a osseous metastatic lesion with extension into the anterior and lateral right retroperitoneum. The right L3 nerve root is thickened and enhances indicating perineural extension of tumor towards the epidural space but there is no evidence of leptomeningeal involvement. There appears to be no involvement of the pedicles. There is no loss of vertebral body height and there is no neuroforaminal or spinal canal stenosis.There is high T2/STIR signal intensity involving the adjacent right paraspinal musculature with faint diffuse enhancement but there is no necrosis or evidence of a mass. These changes could be related to post radiation inflammatory changes if the patient has had recent radiation. Less likely is diffuse infiltration of tumor.Note is made of partially visualized liver lesions compatible with the patient's known metastases. There are also multiple retroperitoneal lymph nodes partially visualized which are better evaluated on the recent prior CT of the abdomen and pelvis.

Output: 1.Osseous metastatic lesions involving the anterolateral right L2 and L3 vertebral bodies with retroperitoneal soft tissue extension of tumor and findings compatible with likely perineural spread of tumor along the right L3 and L2 nerve roots. There does not appear to be epidural or leptomeningeal involvement, or neuroforaminal or spinal canal stenosis.2.High T2/STIR signal intensity and diffuse subtle enhancement of the right posterior paraspinal soft tissues which could indicate post radiation inflammation if the patient has received recent radiation treatment. Less likely is diffuse infiltration of tumor.3.Multiple liver lesions and retroperitoneal lymph nodes are partially visualized and better characterized on the recent previous abdominal pelvic CT.


Instruction: Generate impression based on findings.

Input: Pain after injury Due to the patient's body habitus, the high-definition MRI coil could not be used. An alternative coil was used, which slightly limits image quality and evaluation. MENISCI: There is abnormal signal separating the posterior horn of the medial meniscus from its expected tibial attachment indicating a complete or near-complete posterior root tear. Signal abnormality within the retracted root of the posterior horn fibers with corresponding mineralization seen on the recent prior radiographs likely represents a meniscal ossicle. There is extrusion medially of the medial meniscal body with globular increased internal signal indicating intrasubstance degeneration. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the weight-bearing portion of the medial compartment, with areas of the articular surface appearing devoid of cartilage and with mild degenerative signal abnormality in the underlying bone marrow. A small full thickness cleft is seen in the articular cartilage of the lateral tibial plateau. Moderate osteoarthritis affects the patellofemoral joint, with loss of cartilage particularly at the medial eminence and medial facet of the patella. Tricompartmental osteophytes are present. LIGAMENTS: The ACL is indistinct, although we suspect that we can trace a few fibers from the tibia to the femur. This likely represents chronic degeneration versus an old tear of the ACL. The PCL is intact, though we suspect mild chronic degeneration of the PCL as well. The MCL and LCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Near-complete to complete tear of the root of the posterior horn of the medial meniscus with a meniscal ossicle in the posterior horn.2. Cartilage degeneration as described above, most severe in the medial compartment.3. Poor visualization of the anterior cruciate ligament, which may represent chronic degeneration or an old tear.


Instruction: Generate impression based on findings.

Input: 84-year-old female with history of hepatocellular carcinoma status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Hepatic veins, portal veins, and hepatic artery are patent. Esophageal varices, similar to prior exam.Stable segment 6 ablation cavity with internal debris/hemorrhage. No suspicious enhancement to indicate residual/recurrent tumor.Previously seen subcentimeter arterially enhancing focus in segment 3 is not evident on the current exam. No new focal hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst with thin septation, unchanged. Subcentimeter left renal cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Esophageal varices.BONES, SOFT TISSUES: Fat-containing ventral hernia. L1 and L2 vertebral body hemangiomas. OTHER: No significant abnormality noted.

Output: 1.Stable right hepatic lobe ablation cavity without evidence of residual/recurrent tumor.2.Previously seen subcentimeter arterially enhancing focus in segment 3 is not evident on the current exam. No new focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: 22 day old female ex-24 week premature with abnormal head ultrasound. No acute intracranial hemorrhage.Again seen is a low attenuation it least partially extra-axial fluid collection overlying the superior right frontal lobe as was seen on multiple previous sonogram examinations. Additionally there appears to be a low density component within the parenchyma of the right frontal lobe which may reflect a parenchymal component. This collection is causing a mass effect with a left of midline shift of approximately 3 mm. Given the limitations of brain CT in newborns further characterization is limited. MRI could be obtained for further characterization of this abnormality.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Right frontal extra-axial and intraparenchymal collection causing left of midline shift as detailed above. Given the limitations of brain CT newborns, further characterization could be obtained with MRI.


Instruction: Generate impression based on findings.

Input: Compared to prior MRIs dating back to October 2012, there is no evidence of significant interval change in the size of a nonenhancing 1.8 x 1.6 cm T2 hyperintense lesion in the left frontal operculum with mild local mass effect. However, this lesion has enlarged mildly when compared to exams from 2011 earlier. Few scattered T2 hyperintense foci in the periventricular and subcortical white matter are unchanged. There is a probable small pontine capillary telangiectasia which appears slightly more prominent perhaps related to technical differences. There is an unchanged right cerebellar development of venous anomaly. The ventricles and sulci are unchanged. There is no acute infarct.

Output: Stable nonenhancing left frontal operculum lesion dating back to 2012; however, there has been mild interval enlargement when compared to more remote exams.


Instruction: Generate impression based on findings.

Input: Hip pain after injury BONE MARROW: There is a minimally displaced fracture of the left inferior pubic ramus. Additionally, there is symmetric marrow edema identified within the anterior acetabulum bilaterally of which the left side appears to be associated with a nondisplaced fracture. Marrow edema is also present along the left pubic symphysis. Furthermore, abnormal marrow edema is identified within the left ilium at the level of the sacroiliac joint.SOFT TISSUES: Abnormal edema is identified within the left obturator internus muscle which is likely reactive given the adjacent inferior pubic ramus fracture.JOINTS: Mild osteoarthritis affects the hips. There is no joint effusion.ADDITIONAL

Output: Minimally displaced fracture of the left inferior pubic ramus. Additional areas of marrow edema described above may represent additional sites of nondisplaced fractures particularly at the left superior acetabulum and along the left pubic symphysis. These findings can be further evaluated with CT as clinically warranted. An additional site of marrow edema within the left ilium along the sacroiliac joint may represent an insufficiency fracture.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for LESI, s/p lumbar surgery with continued LBP, right knee pain and left LE numbness History: evaluate for LESI, s/p lumbar surgery with continued LBP, right knee pain and left LE numbness 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. The patient is status post laminectomy and posterior fusion with instrumentation at the L3-4 level. There is atrophy of the paraspinous musculature in the lower lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level right slightly more than left.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge present at this level associated with ligamentum flavum hypertrophy. The fat at the lateral recess these is not effaced. There is fluid present within the facet joints left more than right.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.Status post lumbar surgery at L3-4. 2.There are degenerative changes present in the lower lumbar spine without significant compromise to spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 49 years, Female, progression of multiple sclerosis. Brain: Examination is obtained per demyelinating disease protocol and mildly motion degraded. There is a unchanged ovoid area of FLAIR hyperintensity and mild T1 hypointensity in the left inferior parietal subcortical white matter near the temporal lobe junction. No new lesion is appreciated. No abnormal enhancement is appreciated. Brain parenchymal volume is within normal limits. No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. Visualized extracranial soft tissues are unremarkable.Cervical spine: Examination is mildly motion degraded but demonstrates no definite new lesion since 8/29/2014. There is T2 hyperintense lesion involving the right lateral aspect of the cord at the C7-T1 level compatible with chronic demyelinating plaque. No new lesions or lesions with enhancement are appreciated. Additional apparent T2 hyperintense foci such as the C3-C4 level favored to be artifactual. Cervical cord volume is maintained.Vertebral body heights and alignment are maintained. Bone marrow signal is benign. No significant spinal canal or neural foraminal stenosis is seen at any level.Thoracic spine: Small T2 and STIR hyperintense lesions are suspected in the cord at the T8 and T9 levels. No abnormal enhancement. Cord volume is maintained. Vertebral body heights and alignment are maintained. Bone marrow signal is benign. No significant spinal canal or neural foraminal stenosis is appreciated.

Output: 1. Unchanged nonenhancing left parietal lesion. No new lesions to suggest demyelinating disease progression in the brain.2. Unchanged nonenhancing right lateral C7-T1 lesion. No new lesion in the cervical cord.3. There are two small nonenhancing thoracic cord lesions. No comparison thoracic MRI is available, but these are favored to be chronic.


Instruction: Generate impression based on findings.

Input: 5-year-old male status post trauma rule out bleed. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Within the posterior occipital bone there is a 1 mm of displacement without adjacent hemorrhage. The fracture line extends from the skull base through the occipital bone just above the transverse sinus. MRI/MRV may be considered as clinically indicated to determine involvement of the adjacent vascular structures.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Right posterior occipital bone fracture, displaced by approximately 1 cortex width with extension cranial to the transverse sinus. MRI/MRV may be considered as clinically indicated to determine involvement of the adjacent vascular structures.2. No acute intracranial abnormalities.


Instruction: Generate impression based on findings.

Input: Right frontal approach Omaya catheter with the tip not discretely visualized however appears to terminate in the right foramen of Monro. There is mild associated susceptibility along the right frontal scalp. The ventricles are stable in size. The basal cisterns remain patent. There is no midline shift or mass effect. Extensive symmetric periventricular and subcortical white matter FLAIR hyperintense signal similar in distribution to recent CT head but markedly progressed since previous MRI brain study on 3/19/2016. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: 1. Incomplete exam as above. Extensive symmetric periventricular and subcortical white matter FLAIR hyperintense signal similar to recent CT head however markedly progressed since prior MRI brain study of 3/19/2016. This is nonspecific but likely represents treatment-related changes given the symmetric distribution however evaluation is limited without intravenous contrast and other pathology is not excluded.2. Stable ventricular caliber with right frontal approach ventriculostomy catheter.


Instruction: Generate impression based on findings.

Input: There is moderate levolumbar scoliosis centered at L2-L3. There is left lateral translation of L3 on L4. The vertebral body heights are grossly preserved. There is severe loss of disc height and endplate degenerative changes at L3-L4 and L4-L5. The vertebral bone marrow signal is mildly heterogeneous with scattered foci of T1 hyperintense signal, likely representing focal fatty replacement or fat-containing hemangiomas. There is a T1 isointense and T2 hyperintense lesion in the T11 vertebral body that measures up to 17 mm. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Incidentally noted is a 4.5 cm right upper pole renal cyst. The abdominal aorta appears to be mildly ectatic and there is crescentic signal projecting over the lumen.T12-L1: Thickening of the ligamentum flavum. Mild left greater than right foraminal stenosis, but no significant spinal canal stenosis. L1-L2: Disc bulge, thickening of the ligamentum flavum and facet arthropathy, contributing to mild right neural foramen stenosis, but no significant spinal canal stenosis. There is also a sucentimeter posteromedially directed left facet synovial cyst. L2-L3: Disc bulge with superimposed left paracentral and left foraminal disc protrusions, thickening of the ligamentum flavum and facet arthropathy, contributing to moderate to severe right foraminal stenosis, effacement of the right lateral recess with impingement of the nerve roots and mild to moderate spinal canal stenosis. L3-L4: Disc bulge with superimposed central disc protrusion, thickening of the ligamentum flavum and facet arthropathy, contributing to moderate to severe right and minimal left foraminal stenosis and mild to moderate spinal canal stenosis, with impingement of the nerve roots in the left lateral recess. L4-L5: Disc bulge with superimposed central disc protrusion, thickening of the ligamentum flavum and facet arthropathy, contributing to moderate to mild right and severe left foraminal stenosis and effacement of the lateral recesses, with impingement of the nerve roots in the left lateral recess. L5-S1: Disc bulge, thickening of the ligamentum flavum and facet arthropathy, contributing to mild left foraminal stenosis. No significant spinal canal stenosis.

Output: 1. Advanced degenerative spondylosis of the lumbar spine with moderate levolumbar scoliosis, most prominent at L2-L3 and L3-L4, with lateral listhesis of L3 on L4 as well as mild to moderate spinal canal stenosis associated with apparent nerve root impingement and variable multilevel foraminal stenosis, as described in the findings section.2. A T1 isointense and T2 hyperintense lesion in the T11 vertebra that measures up to 17 mm may represent an atypical hemangioma or perhaps less likely a neoplastic process. Followup via an MRI with contrast may be useful.3. The abdominal aorta appears to be mildly ectatic and there is crescentic signal projecting over the lumen, which may be artifact rather than intramural thrombus. Nevertheless, a Doppler ultrasound may be useful for further evaluation.Findings were conveyed to Dr. Tung on 3/26/2015 by EPIC mail.


Instruction: Generate impression based on findings.

Input: Reason: pt with h/o chr abdominal pain and PD dilatation, evaluate for pancreatic ductal/parenchymal abnormalities or CP History: chronic abd pain,. ABDOMEN:LIVER, BILIARY TRACT: Right cystic lesion in the dome of the liver demonstrates thick peripheral enhancement and thin internal septations. Compared to as far back as prior 2011 examination, lesion has increased in size exam, measuring 3.9 x 4.5 cm (series 4 image 4), previously 3.5 cm. Mild intrahepatic and extrahepatic biliary ductal dilatation and irregularity, unchanged. Focal narrowing of the proximal common hepatic duct. The common bile that measures up to 1 cm. Hypointense focal defects in the biliary ducts likely represent pneumobilia as seen on prior CT. Post surgical changes of cholecystectomy. Diffuse heterogeneous enhancement of the liver.Hepatic vasculature patent.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic ductal dilatation measuring up to 0.7 cm. No definite mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cystic lesion in the dome of the liver with thick peripheral enhancement has grown compared to as far back as 2011. 2.Stable biliary and pancreatic ductal dilatation. 3.Heterogeneous enhancement of the liver.


Instruction: Generate impression based on findings.

Input: 28 years Female (DOB:3/26/1988)Reason: evaluate response to therapy in patient with metastatic breast cancer to brain. History: 3903PROVIDER/ATTENDING NAME: ANDREA LOUISE AMICO ANDREA LOUISE AMICO The CSF spaces are appropriate for the patient's stated age with no midline shift. On FLAIR MRI there is heterogeneous cortically based hyperintense lesion associated with heterogeneous contrast enhancement measuring 10 x 10 mm located along the medial aspect of the left paracentral lobule adjacent to the pars marginalis it previously measured 9 x 7 mm axial dimensions. The FLAIR signal abnormality is also larger on the current exam when compared to the prior exam.. Similar lesions are present in the right postcentral gyrus laterally where the enhancing component measures 10 x 15 mm axial dimensions and previously measured 12 x 9 mm. One in the right cerebellar hemisphere superiorly is also unchanged and measures 18 x 9 mm axial dimensions on other located in the right cerebellar hemisphere posteriorly and inferiorly measures 11 x 27 mm axial dimensions and is larger compared to prior exam when it measured 23 x 9 mm. Another lesion is present in the right occipital lobe measuring 10 mm x 6 mm axial dimensions along the inferior aspect of the cuneus previously measured 6 x 7 mm. Another is located along the right cingulate gyrus behind the splenium of the corpus callosum measuring 11 x 7 mm axial dimensions previously measured 7 x 11 mm. Another is located along the right superior frontal gyrus measuring 5 x 7 mm mm in diameter which previously measured 5 x 9 mm.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 in the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Multiple cortical based lesions are scattered in both hemispheres of the brain as well as the cerebellum. These are compatible with metastases which have increased in size based on contrast enhanced imaging when compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Follow up pituitary adenoma treated with cabergoline. There is overall interval decrease in size of the pituitary tumor, particularly the suprasellar component that extends along the planum sphenoidale, which no longer displays intrinsic T1 hyperintensity related to prior hemorrhage. Indeed, the tumor measures up to 27 mm in the craniocaudal dimension, previously 37 mm. There is consequently decreased massa effect upon the right gyrus rectus and optic apparatus. There is mild volume loss in the anterior gyrus rectus, perhaps related to chronic ischemia from mass effect. There is persistent extension of tumor in the bilateral cavernous sinuses, left greater than right, with encasement of the left cavernous internal carotid artery. The infundibulum is deviated to the right.

Output: Interval decrease in size of the pituitary macroadenoma, particularly the suprasellar component.


Instruction: Generate impression based on findings.

Input: Female, 2 years old, history of GBS meningitis with ventriculomegaly, cerebral cysts, monitor cyst post fenestration. A ventricular catheter traverses the right frontal lobe to terminate along the margin of the right lateral ventricle, grossly similar in position. Since the prior examination, a second catheter has been placed traversing through the right frontal lobe, coursing posteriorly, medially and inferiorly. This catheter traverses a dilated midline space at approximately the level of the cerebral aqueduct, ultimately terminating along the posterior margin of the fourth ventricle. Susceptibility at the catheter tip may represent an artifact or hemosiderin staining.The caliber of the frontal horns and widely splayed cavum septum pellucidum, in aggregate, has increased measuring up to 41 mm in maximum transverse dimension, previously 38 mm. Ventricular caliber at the level of the atrium has increased from 8 mm to 11 mm on the left, and decreased from 8 mm to 6 mm on the right. Caliber of the left temporal horn has also decreased. Caliber of the third ventricle has probably not changed.Numerous periventricular and choroid plexus cysts are redemonstrated. A cyst along the choroid plexus at the level of the right atrium has changed variably with one component slightly larger and another slightly smaller. A cyst along the medial right temporal lobe has not significantly changed in size. A cyst along the medial left temporal lobe has decreased in size.Dilatation through the region of the cerebral aqueduct is probably not significantly changed. Fourth ventricular cysts extending through the foramina of Luschka have not significantly changed in size.The pituitary region is unremarkable. The corpus callosum remains markedly thinned and deformed similar to prior. No restricted diffusion is seen. Scattered foci of parenchymal and ependymal susceptibility are unchanged and likely reflect sequelae of prior instrumentation and/or infection. Mild periventricular T2 hyperintense rimming also remains unchanged.

Output: 1.Interval placement of a new catheter which traverses the right frontal lobe, courses through the tentorial incisure at the level of the cerebral aqueduct, ultimately terminating in the region of the fourth ventricle. The pre-existing right frontal ventricular catheter is in stable position.2.Mild interval increase in the caliber of the ventricles at the level of the frontal horns and also at the left atrium. Ventricular caliber elsewhere is stable or decreased.3.Variably changing cysts along the choroid plexus at the level of the right atrium with some components slightly smaller and some slightly larger. The remaining cysts, including those along the temporal lobes and within the posterior fossa, are stable to smaller as discussed above.


Instruction: Generate impression based on findings.

Input: Paresthesias, evaluate for demyelinating disease.. Brain: There are approximately 10 T2/FLAIR hyperintense lesions in the bilateral periventricular and subcortical white matter. While some of these foci are nonspecific, morphology and distribution of several of the lesions is suggestive of chronic demyelinating disease. The current study is of higher resolution and previously seen lesions are better appreciated. No new lesion is definitively appreciated to suggest progression of demyelinating disease since 10/24/2014. No infratentorial lesions are definitively appreciated. No significant burden of T1 hypointense lesions. Brain parenchymal volume is preserved.No intracranial mass or mass effect. Ventricles and sulci are normal. No extra-axial collections. Bone marrow signal and extra soft tissues are grossly unremarkable.Cervical spine: Focus of T2 signal abnormality involving the right dorsal aspect of the cord at the right C2 level is again seen. No additional lesions in the cervical cord are appreciated. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. Minimal spondylotic changes are present including tiny disc protrusion at the C5-C6 level. There is no spinal canal or foraminal stenosis within the cervical spine at any level. The paravertebral soft tissues are unremarkable.

Output: 1. Multiple, approximately 10, supratentorial white matter lesions are not significantly changed since 10/24/2014 allowing for differences in technique. The distribution and morphology of several of the lesions is suggestive of chronic demyelinating disease.2. Unchanged T2 hyperintense lesion in the right dorsal cervical cord at the C2 level is compatible with a chronic demyelinating plaque. No new lesions in the cervical cord are appreciated.


Instruction: Generate impression based on findings.

Input: There has been interval expected evolution of sequela of hypoxic ischemic injury, with essentially severe cystic degeneration of the majority of the brain parenchyma bilaterally with sparing of the posterior fossa and brainstem. The basal ganglia, caudate, and thalami are relatively preserved, with scant scattered cerebral hemispheric tissue elsewhere, predominantly along the ventricular margins and the diminutive occipital as well as temporal lobes.There has been interval increased size of the left holohemispheric subdural collection, with with its contents demonstrating prominent T1 hyperintensity to gray matter and conspicuous T2 hyperintensity greater than CSF. This now measures up to 14 mm in greatest thickness, with flattening of the subjacent cystic appearing tissue. There appears to be a septation deep within this collection. Linear intrinsic T1 hyperintensity with diffusion restriction and susceptibility remain along this septation along the surface of the encephalomalacic tissue, likely relating to chronic blood products. Scattered punctate foci susceptibility remaining along the left greater than right frontal convexity likely relate to sequela of previous subarachnoid blood products.In the right frontal extra-axial space, there is also increased prominence of the now 8 mm thick collection which is also T1 hyperintense to gray matter, although remaining essentially isointense to gray matter on T2-weighted imaging. There is also mass effect from this smaller collection upon the right frontal tissue. These are consistent with evolving blood products. Is significant ex vacuo dilatation of the lateral and third ventricles.Intracranial flow-voids associated with the circle of Willis are diminutive in size likely relating to the extensive tissue loss.

Output: 1.Interval expected evolution of previous sequelae of hypoxic ischemic injury, with essentially near complete cystic and cephalization of the cerebral hemispheres with relative sparing of the deep gray nuclei and portions of the temporal and occipital lobes.2.Conspicuous increased size of left much greater than right subdural collections containing blood products with mild mass effect.3.Minimal susceptibility remaining from previous scattered convexity subarachnoid hemorrhage.4.Associated ex vacuo dilatation of the lateral and third ventricles.


Instruction: Generate impression based on findings.

Input: 56 years, Female, Reason: rectovaginal fistulae eval History: rectovaginal fistulae eval. PELVIS: UTERUS, ADNEXA: Postsurgical changes of total abdominal hysterectomy. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are postsurgical findings with surgical clips at the anorectal junction. In this region, there is a small outpouching extending from the 12 o'clock position anteriorly to the posterior wall of the vagina which likely represents a fistulous communication.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Fistulous communication between the vagina and the anorectal junction.


Instruction: Generate impression based on findings.

Input: Female, 78 years old, with weakness. A focus of mildly restricted diffusion measuring up to 1 cm is seen in the left cerebellar hemisphere with mild associated FLAIR hyperintensity. No other definite areas of restricted diffusion are seen.Extensive scattered parenchymal encephalomalacia is noted, mostly affecting the right cerebral hemisphere with lesions in the frontal, parietal and temporal lobes. There is corresponding T2 hyperintensity compatible with gliosis, and volume loss in the form of ventricular ex vacuo dilatation and widening of the sulci. Several small foci of encephalomalacia are also noted in the bilateral cerebral hemispheres.No evidence of significant parenchymal edema or generalized mass effect is seen. No abnormal extra-axial fluid or intracranial hemorrhage is suspected. No pathologic parenchymal or extra-axial enhancement is seen.

Output: 1.Small focus of late acute or subacute ischemia in the left cerebral hemisphere.2.Extensive chronic territorial ischemic disease affecting predominantly the right cerebral hemisphere.3.No definite additional acute intracranial abnormalities.


Instruction: Generate impression based on findings.

Input: 82 years, Female, suspected vascular dementia. Prior ischemia seen on CT. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. There is a chronic infarct involving the right posterior frontal corona radiata extending inferiorly into the right putamen. There is ex vacuo dilatation of the right lateral ventricle. There is rim of susceptibility effect involving the infarct compatible with chronic blood products.There is moderate degree of patchy T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which is nonspecific, but compatible with chronic small vessel ischemic disease. There is moderate degree of global cerebral volume loss without a particular lobar distribution. Moderate volume loss involving the cerebellar hemispheres is also noted.There is a right maxillary sinus mucus retention cyst. There is also mild left maxillary sinus opacification. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. Chronic infarct involving the right frontal corona radiata which extends into the putamen. There is associated susceptibility effect indicating prior hemorrhage in this region.2. Moderate chronic small vessel ischemic disease.3. No intracranial mass, mass effect or hydrocephalus.4. Moderate supra and infratentorial parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: 47 year-old female with strong family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Anhancing intramammary lymph node is present at posterior 9 o'clock position.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of brainClinical question: preop planning for tumor resection. Pt has unspecified tumorSigns and Symptoms: preoperative planning There is redemonstration of an extra-axial mass which involves the right planum sphenoidale as well as the anterior and medial aspect of the right middle cranial fossa which displaces the adjacent right frontal and temporal lobes. It measures 36 x 30 mm axial dimensions and has not changed since the prior exam. It is associated with a vasogenic pattern of edema in the right frontal lobe, right medial temporal lobe and right external capsule. It displaces the right internal carotid artery medially and the right middle cerebral artery posteriorly. It abuts the right cavernous sinus and right optic nerve. It displaces the right optic nerve medially.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 some mucosal thickening in the maxillary sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.An extra-axial mass adjacent to the right frontal and temporal lobes most likely represents a meningioma. It displaces adjacent structures.2.Please note this is a limited exam for the purpose of stereotactic guidance


Instruction: Generate impression based on findings.

Input: Evaluate temporal lobe abscess: headaches, recurrent mastoiditis. History of mastoiditis status post tympanomastoidectomy and craniotomy with post-auricular incision with draining fistula tract. There are postoperative findings related to right tympanomastoidectomy and temporal craniotomy with diffuse enhancement of the overlying subcutaneous tissues and in the bone marrow surrounding the mastoid bowl, as well as high T2 signal in the mastoid bowl and few remaining right mastoid air cells. There is a peripherally enhancing lesion with diffuse T1 and T2 hypointensity and susceptibility effect, which corresponds to previously demonstrated calcifications, in the right inferior temporal lobe overlying the tegmen mastoideum that measures 12 mm in diameter with extensive surrounding edema. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact, including the right sigmoid and internal jugular veins. The orbits are grossly unremarkable.

Output: Postoperative findings in the right temporal region with a lesion in the right inferior temporal lobe that is compatible with a residual abscess, perhaps with granuloma formation, as well as suggestion of osteomyelitis and mastoiditis in the region of the right mastoidectomy cavity along with overlying cellulitis and/or treatment effects.


Instruction: Generate impression based on findings.

Input: Right facial droop, dysarthria. There is an area of restricted diffusion and high T2 signal in the left corona radiata that measures up to approximately 20 mm. There is no evidence of associated hemorrhage. There is a background of extensively diffuse cerebral white matter T2 hyperintensity bilaterally. There is diffuse cerebral and cerebellar volume loss. There is no midline shift or herniation. There is a right thalamus developmental venous anomaly and associated punctate cavernous malformation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. Small acute infarct in the left corona radiata in a background of chronic small vessel ischemic disease. 2. Right thalamus developmental venous anomaly and associated punctate cavernous malformation.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with history of grade III oligodendroglioma with 1p19q deletion, s/p surgery, proton beam RT, and now on TMZ. Redemonstrated is evidence of right frontal lobe tumor resection. The surgiccal cavity is unchanged in size and morphology. Dural thickening along the craniotomy is expected and stable. Continued interval reduction is seen in the amount of wispy curvilinear enhancement along the posterior cavity margin, likely post-operative in nature. Heterogeneous thickened tissue which remains in the left frontal lobe, extending into the genu of the corpus callosum, had also not significantly changed. No new parenchymal thickening or pathologic enhancement is seen.Ill defined T2 hyperintensity has progressed bilaterally in the centrum semiovale, more so on the left. These areas are associated with no mass effect and no elevated rCBV. The changes are therefore likely related to treatment.No new mass effect or edema is seen. No new intracranial hemorrhage or fluid collections are seen. The ventricular system is patent and stable in size.

Output: Mild progression of white matter signal abnormality most compatible with treatment effect. No evidence of tumor progression is seen.


Instruction: Generate impression based on findings.

Input: Clinical question: Surgery aborted due to brain swelling. Evaluate for cause of brain swelling? Signs and symptoms: Brain swelling CT of brain without the infusion:The examination demonstrates expected postoperative changes of a left posterior temporal -- parietal craniotomy. There is no evidence of hemorrhage. There is no detectable cerebral edema. Prominence of cortical sulci and underlying encephalomalacia as was noted on prior MRI is again identified. There is no evidence of mass effect, midline shift or hydrocephalus.

Output: 1.Expected postoperative changes of left parietal craniotomy.2.No evidence of underlying hemorrhage, edema, mass effect or midline shift.


Instruction: Generate impression based on findings.

Input: 65 years, Female, multiple sclerosis, evaluate for progression. Brain: There are multiple T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter with distribution and morphology compatible with known demyelinating disease. Differences in technique limit comparison; there are few small lesions involving the bilateral frontal and parietal subcortical white matter which are present on current high-resolution study and not evident on prior MRI from 4/14/2012 and 11/8/2010. The relatively largest lesions involving the right periatrial white matter as well as the right posterior pericallosal lesions are again seen and demonstrate T1 hypointensity. No new large lesions are demonstrated. No infratentorial lesions are definitively appreciated. No lesions with enhancement to suggest active demyelination. A right frontal developmental venous anomaly is incidentally noted. Brain parenchymal volume is within normal limits for age. No intracranial mass effect. No hydrocephalus or extra-axial collections. Calvarium and extracranial soft tissues are unremarkable. Cervical: Again seen are multiple T2 hyperintense lesions in the cervical cord including the right lateral C2 level, dorsal C2-C3 level, and left dorsal lesion extending from the C5-C6 to the C7 level, which is also associated with focal volume loss. No associated enhancement is seen. No new lesion is seen. The previously seen lesion in the cord at T3 is again seen and partially imaged on the sagittal sequence.Vertebral body heights and alignment are maintained. Mild degenerative changes are again seen with small disc disc protrusions at the C3-C4 to C5-C6 levels without significant spinal canal or neural foraminal stenosis. Foci of T1 hyperintensity compatible with small hemangiomas or focal fat. No suspicious osseous lesions are evident. Paraspinous soft tissues are unremarkable.

Output: 1. Multiple T2/FLAIR hyperintense lesions are compatible with known chronic demyelinating disease. Differences in technique with prior study from 4/14/2012 limited precise comparison; however, there are small lesions which are present on the current high-resolution study and not seen on prior. Comparison is technically better with MRI from 11/8/2010 with more definitive evidence of a few small lesions which are new since then. Overall there is minimal interval progression of disease in the brain. No new large lesions are evident.2. Unchanged multiple T2 hyperintense lesions in the cervical cord and upper thoracic cord compatible with chronic demyelinating disease. No new lesions.


Instruction: Generate impression based on findings.

Input: Lateral elbow pain LIGAMENTS: The radial collateral ligament is intact. There is increased signal and thickening of the common extensor tendon adjacent to the lateral epicondyle. This is best seen on the coronal PD fat sat image 11/24.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. Specifically, the lateral epicondyle is normal in marrow signal.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Partial tearing of the of the common extensor tendon at the origin near the lateral epicondyle. The lateral of the condyle itself is normal marrow signal. No additional abnormalities are identified within the elbow.


Instruction: Generate impression based on findings.

Input: 59 year old female with biopsy-proven sarcoidosis (bronchoscopic LN biopsy with non-necrotizing granulomas) and palpitations referred to rule out cardiac involvement. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 63 ml/m2 (normal range: 65+/-11), the LVEDV is 140 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 62 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is a subtle region of subepicardial late gadolinium enhancement involving the basal inferior and inferolateral walls which spares the endocardium and is atypical for prior myocardial infarction. This has not changed from previous CMR done1/2014. The finding could suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 58 ml/m2 (normal range 69+/-14), the RVEDV is 140 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 78 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 mild-moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMediastinal and hilar lymphadenopathy noted. 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. Normal LV size and systolic function (LVEF 56%).2. There is a subtle region of late gadolinium enhancement involving the basal inferior and inferolateral walls which spares the endocardium and is atypical for prior myocardial infarction. This could suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process; however, this finding has not changed from previous CMR dated 1/2014.3. Normal RV size and systolic function (RVEF 50%).4. Moderate LA dilation.


Instruction: Generate impression based on findings.

Input: Reason: right hip avn History: right hip pain There is increased signal abnormality within the anterior superior labrum likely representing a combination of degeneration and degenerative tearing. There is curvilinear signal abnormality within the right femoral head indicating avascular necrosis. There is flattening of the superior femoral head indicating subchondral collapse/fracture. There is bone marrow signal abnormality within the superior and medial right acetabulum which may be degenerative in etiology, although this could also represent additional foci of avascular necrosis. There is also a small focus of signal abnormality within the superomedial left femoral head also likely representing avascular necrosis. There is no evidence of subchondral collapse affecting the left hip. The alignment is anatomic. No additional bone marrow signal abnormality is identified. There is a small right hip joint effusion likely related to the aforementioned avascular necrosis of the right femoral head. There is fatty atrophy of the imaged musculature of the right hip. Severe degenerative disc disease affects image lower lumbar spine.

Output: Findings indicating bilateral femoral head avascular necrosis, right greater than left. There is deformity of the right femoral head indicating subchondral collapse/fracture. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Previous MRI with possible left sided arteriovenous malformation: seizures. MRI: there is a subcentimeter curvilinear area of T2 hyperintensity, enhancement, and susceptibility effect in the posterior limb of left internal capsule. Otherwise, there is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant steno-occlusive lesions, arteriovenous malformations, or aneurysm.

Output: 1. A lesion in the posterior left internal capsule likely represents a small developmental venous anomaly.2. No evidence of arteriovenous malformation, within the limits of MRA.


Instruction: Generate impression based on findings.

Input: 66 year old male patient with renal mass on CT. Evaluate for a pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is a 1.5 x 2.0 cm lobulated, septated cystic lesion within the head of the pancreas (image 55, series 1304), which appears to communicate with the main pancreatic duct (image 56, series 1304). An additional lobulated, septated cystic lesion within the head/uncinate process measuring 2.3 x 2.2 cm (image 72, series 1304) also appears to communicate with the pancreatic duct. There is no suspicious enhancement of either lesion. The main pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 6.7 x 4.8 x 4.4 cm multiseptated right upper pole renal sinus cyst without suspicious features or enhancement. A subcentimeter lesion within the left lower pole is not hyperintense on T2 images, but is too small to fully characterize. Multiple additional bilateral T2 hyperintense lesions likely represent cysts. No evidence of hydronephrosis. RETROPERITONEUM, LYMPH NODES: Susceptibility artifact within the infrarenal IVC secondary to an IVC filter. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two dominant cystic pancreatic lesions without suspicious features which appear to communicate with the pancreatic duct likely represent sidebranch type IPMNs.2.Complex left renal sinus cyst without suspicious enhancement. No hydronephrosis.


Instruction: Generate impression based on findings.

Input: Dysequilibrium, evaluate for posterior circulation infarct. There is no evidence of acute infarction, intracranial hemorrhage, or mass. There is mild scattered periventricular and subcortical T2 hyperintensity. There is also a subcentimeter focus of encephalomalacia in the left thalamus. There is mild diffuse cerebral volume loss. 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. There are bilateral staphylomas. There is a subcentimeter Thornwaldt cyst.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Mild scattered periventricular and subcortical T2 hyperintensity is suggestive of chronic small vessel ischemic disease and a subcentimeter focus of encephalomalacia in the left thalamus is suggestive of a chronic lacunar infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Meningioma, 6 month follow up for changes. There is an extra-axial enhancing left lateral skull base mass centered along the left petrous apex with extension into the cavernous sinus left prepontine cistern and along the left tentorial leaflet. There is associated hyperostosis and permeation of tumor into the underlying bone. The mass also protrudes in the sella, traverses the left lateral wall of the sphenoid sinuses, and extends into the left optic canal. Overall, the mass measures up to approximately 7 cm. Although the mass has not significantly changed since 2014, it appears to have increased slightly in size since 2013. There is mass effect and a patchy area of high T2 signal in the inferior left temporal lobe, which is compatible with vasogenic edema. There is encasement of the left cavernous carotid artery with diffuse narrowing of the flow void. The ventricles are normal in size and configuration. There is no significant midline shift. There is staphylomatous deformity of the bilateral globes. There is mild high T2 signal within the left mastoid air cells suggestive of fluid or mucosal thickening. There appears to be filler material within the bilateral nasolabial folds.

Output: An extra-axial enhancing left lateral skull base mass centered along the left petrous apex with extension into the cavernous sinus left prepontine cistern and along the left tentorial leaflet with associated hyperostosis and permeation of tumor into the underlying skull, as well as encasement of the left cavernous carotid artery, and vasogenic edema in the left temporal lobe is compatible with a meningioma. Although the mass has not significantly changed since 2014, it appears to have increased slightly in size since 2013.


Instruction: Generate impression based on findings.

Input: Right foot pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. Specifically, there is no evidence of abnormal signal within the midfoot to suggest avascular necrosis.ADDITIONAL

Output: Mild nonspecific edema of the plantar musculature. There is no evidence of muscle tear or plantar fasciitis.


Instruction: Generate impression based on findings.

Input: 62 year old male with elevated PSA. Evaluate for prostate carcinoma. PELVIS:PROSTATE:Prostate Size: 4.8 x 2.5 x 3.6 cm (TR x AP x CC)Peripheral Zone: There is extensive decreased T2 signal abnormality with associated restricted diffusion and enhancement in the left posterior base of the peripheral zone of the prostate gland which is suspicious for prostate carcinoma. This extends into the left base and mid body anteriorly as well. There is an additional focus of enhancing signal abnormality in the left posterior apex of the peripheral zone of the prostate gland which is also suspicious for prostate carcinoma.Note is made of multiple foci of signal abnormality with restricted diffusion and enhancement in the right mid body and base of the peripheral zone of the prostate which are also suspicious for prostate carcinoma. Seminal Vesicles: There appears to be extension of signal abnormality in the left posterior base to the level of the left seminal vesicle which raises the question of seminal vesicle involvement by tumor. Extracapsular Extension: There is a capsular bulge along the aforementioned areas of signal abnormality which is suspicious for extensive extracapsular extension with involvement of the left seminal vesicle and probable extension to involve the neurovascular bundle. BLADDER: There is concentric thickening of the bladder suggestive of chronic outlet obstruction.LYMPH NODES: No evidence of lymphadenopathy. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple foci of signal abnormality in the left base, body, and apex of the peripheral zone of the prostate gland, suspicious for prostate carcinoma. There is apparent extracapsular extension and probable involvement of the left seminal vesicle. No evidence of lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Exam severely limited due to patient motion. CERVICAL SPINE: Multiple small osseous lesions are again seen in the cervical spine consistent with known multiple myeloma. Example lesions involve the anteroinferior C2 and posterolateral and anteroinferior C5 which are not significantly changed from the previous exam.Lack of contrast somewhat limits evaluation. However, no evidence of epidural mass or cord compression related to tumor is seen. There is moderate spinal canal stenosis at C4-5 and C5-6 and mild canal narrowing at C3-4 and C6-7 related to degenerative disease with disc-osteophyte complexes and ligamentum flavum buckling better seen on prior. Appearance is grossly stable. There is questionable T2 signal abnormality from C4 to C6 which is unchanged. Moderate to severe left C6-7 neural foramen narrowing is similar to prior.THORACIC and LUMBAR SPINE: Multiple small lesions also seen scattered in the thoracic spine. Again seen is a relatively prominent T3 antero-inferior lesion similar to the prior MRI.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. Motion degradation limits evaluation of the epidural tumor. There is however compared to 1/22/2015, significant decrease in extent of epidural soft tissue with thin in residual epidural soft tissue seen in the right aspect of the spinal canal extending from the lower T12 to the L2-L3 level. There is significant interval improvement in mass effect on the conus and upper cauda equina. Extension of epidural soft tissue through the neural foramen on the right at T12-L1, L1-L2, and L2-L3, again seen. Significant decrease in soft tissue involving the right paraspinous musculature and psoas muscle again noted.No significant spinal canal or foraminal stenosis within the upper and mid thoracic spine.Previously seen T2 hyperintensity and swelling of the distal thoracic cord/conus is improved.Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is minimal L5-S1 retrolisthesis, alignment is otherwise maintained. Small osseous lesions are again seen such as at the dorsal L3 vertebral body compatible with known myeloma. L2 lesion with T1 hyperintensity most compatible with a benign hemangioma. No large lesions or compression fractures.Degenerative changes are also seen in the lumbar spine with disk desiccation at L5-S1. There is moderate right and mild left L4-L5 neural foramina stenosis and mild to moderate right and mild left L5-S1 neural foramina stenosis related to disk bulge and facet arthropathy. No spinal canal stenosis is seen inferior to the mid L3 level.

Output: 1. Very motion degraded exam of the spine. Compared to 1/22/2015, there is some decrease in extent of epidural soft tissue in the lower thoracic and upper lumbar spine likely related to combination of treatment effect and decrease in hemorrhagic component of the tumor. Residual epidural soft tissue is again seen in the right aspect of the spinal canal extending from the lower T12 to the L2-L3 level. There is interval improvement in mass effect on the conus and upper cauda equina. Extension of epidural soft tissue again seen extending into the neural foramina on the right at T12-L1, L1-L2, and L2-L3. Decrease in soft tissue involving the right paraspinous musculature and psoas muscle also noted.2. Multiple myeloma with small scattered osseous lesions in the cervical, thoracic and lumbar spine. No large destructive osseous lesions or compression fractures.


Instruction: Generate impression based on findings.

Input: History of lumbar discectomy, evaluate for abnormality, disc herniation. Recurrent pain down left leg. Right calf numbness and toe cramping. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is grossly maintained. Bone marrow signal is benign. The conus medullaris is normal in position. Postsurgical changes of prior discectomy at L4-L5 with small laminotomies are noted.Lumbar spinal canal appears mildly narrowed congenitally with superimposed degenerative changes, as described below. L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is mild disc bulge with central disc protrusion which effaces the ventral thecal sac and lateral recesses right greater than left. There is bilateral facet arthropathy and ligamentum flavum thickening. There is mild central canal stenosis. No significant neural foraminal narrowing.L3-L4: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy contribute to mild to moderate spinal canal stenosis at this level. Minimal bilateral neural foraminal narrowing.L4-L5: Mild disc bulge without evidence of recurrent disc herniation at this level. Moderate bilateral facet arthropathy is noted. There is mild left neural foraminal narrowing and minimal right neural foraminal narrowing. No significant spinal canal narrowing, markedly improved since prior.L5-S1: Mild disc bulge, ligament of flavum thickening, and facet arthropathy resulting in mild central spinal canal stenosis. There is mild left neural foraminal narrowing and minimal right neural foraminal narrowing.Paraspinous soft tissues demonstrate postsurgical changes in the posterior paraspinous soft tissues at L4-L5 but otherwise unremarkable.

Output: 1. Postsurgical changes in the lumbar spine at L4-L5 without findings to suggest recurrent disc herniation or residual stenosis at this level. 2. There appears to be mild congenital narrowing of the lumbar spine with superimposed degenerative changes with mild to moderate spinal canal stenosis at L2-L3 (with disc extrusion) and at L3-L4. Minimal to mild multilevel neural foraminal narrowing. No high-grade spinal canal or high-grade neural foraminal stenosis is appreciated at any level.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain and spinal cord(198.3)Malignant neoplasm of other parts of bronchus or lung. Malignant neoplasm of bronchus and lung, unspecified site. Other malignant neoplasm without specification of site. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a small left occipital lobe lesion which enhances following contrast administration and is surrounded by hyperintense signal on FLAIR and T2 images. It currently measures 5 mm diameter and previously measured 5 mm diameter.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. These were also present on the prior exam and have not substantially changed.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 some mucosal thickening in the left sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A left occipital lobe lesion is stable on the current exam when compared to the prior exam.. 2.Periventricular white matter lesions are present of the moderate degree which are stable since the prior exam. These are nonspecific. They could be vascular related or related to prior treatment.


Instruction: Generate impression based on findings.

Input: Female 47 years old Reason: R shoulder pain, previous rotator cuff surgery, eval for recurrent tear History: as above ROTATOR CUFF: Postsurgical changes related to prior rotator cuff surgery. The supraspinatus is thickened consistent with tendinosis. There is undersurface tearing along the distal tendon and at the insertion with a full-thickness component approximately 1.5 cm from the insertion with minimal retraction of undersurface fibers. The supraspinatus muscle appears unremarkable. Fluid is identified within the subacromial subdeltoid bursa. Fluid completely surrounds the surgical anchor and threads along its length without clear evidence of anchoring within the bone. SUPRASPINATUS OUTLET: Moderate osteoarthritis of the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Normal glenohumeral joint alignment. No evidence of glenoid labrum tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Supraspinatus tendinosis with undersurface tearing and a full-thickness tear approximately 1.5 cm from the insertion with minimal retraction of undersurface fibers.2. Fluid completely surrounds the surgical anchor and threads along its length without clear evidence of anchoring within the bone.


Instruction: Generate impression based on findings.

Input: Follow-up prolactinoma: headaches and irregular menses. The pituitary gland enhances slightly heterogeneously, but no discrete tumor is discernible. The pituitary gland is not enlarged and there is no mass effect upon the optic apparatus or cavernous sinuses. The posterior pituitary bright spots is not conspicuous, however. The infundibulum is intact and located in the midline. There are subcentimeter nasopharyngeal retention cysts. There are foci of T2 hyperintensity in the imaged portions of the cerebral white matter.

Output: 1. The pituitary gland enhances slightly heterogeneously and the posterior pituitary bright spot is not apparent, but no discrete tumor is discernible to suggest an adenoma, and no evidence of pituitary apoplexy.2. Nonspecific foci of T2 hyperintensity in the imaged portions of the cerebral white matter. Follow up via a dedicated brain MRI may be useful.


Instruction: Generate impression based on findings.

Input: 60-year-old female with history of endometrial hyperplasia without atypia and cervical dysplasia. Evaluate for adenomyosis. PELVIS:UTERUS, ADNEXA: Asymmetric juntional zone with the zone measuring approximately 14 mm. There are subendometrial T2 hyperintense foci compatible with cystic foci. T2 hypointense lesion in the anterior uterus with mild enhancement measuring up to 2.7 cm compatible with a leiomyoma.The endometrial stripe measure up to 4 mm. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings consistent with adenomyosis and leiomyoma.


Instruction: Generate impression based on findings.

Input: Prepared encephalocele. Rhinorrhea. Question CSF leak. There is a large defect at midline involving the floor of the anterior cranial fossa through which a combination of CSF and dysplastic brain parenchyma extend to completely fill the nasal cavity. The herniated, dysplastic brain parenchyma also shows cystic change, which likely represents cystic encephalomalacia. Linear T2 hypointense structure (probably graft material from previous repair) is oriented higher anteriorly than posteriorly. There is an apparent, 9-mm in transverse diameter defect posterior to this presumed graft and anterior to the body of sphenoid. Through this defect, there is apparent direct communication between the nasal cavity and the anterior cranium. Multiple foci of susceptibility effect are related to previous repair or calcifications.T2 hyperintensity and volume loss involving the inferior aspect of the frontal lobes is probably gliosis and encephalomalacia, possibly relating to previous repair. The large nasoethmoidal cephalocele and the encephalomalacia/gliosis in the frontal lobes are associated with expected ex vacuo enlargement of the frontal horns of the lateral ventricles, left more than right. The frontal horn of the left lateral ventricle is pulled inferiorly towards the encephalocele opening as well. These parenchymal changes are associated with expected anterior thinning of the corpus callosum. The olfactory bulbs are not well delineated. The remainder of the brain shows no significant abnormality. The pituitary gland and infundibulum are normal. There is mild hypertelorism and orbital deformity which are better appreciated on the comparison CT scan. The optic nerves, chiasm and tracts are normal. The left internal carotid artery is small and shows attenuated flow-related signal/loss of signal up to the supraclinoid segment where it is joined by a large left posterior communicating artery which provides the flow to the left middle and anterior cerebral arteries. The flow void in the left M1 segment is partially attenuated compared to the normal right one, which may reflect slower flow. The sylvian branches are fairly symmetric and normal. These left internal carotid artery findings are probably related to prenatal thrombosis/injury given the that left petrous carotid canal is very small. The right anterior cerebral artery and its branches are smaller than on the right but show no focal stenosis. The vertebral arteries included are symmetric and normal. There is a small fenestration along the proximal basilar artery which is otherwise normal. In addition to the large left posterior communicating artery, there is a smaller right posterior communicating artery as well. The included downstream segments of the posterior cerebral arteries included are symmetric.The nose is markedly deformed without normal anatomic landmarks or features. As discussed above, the nasal cavity is entirely occupied by the cephalocele. While the hard palate is present, there is no soft palate. There is asymmetric, right more than left, enlargement of the palatine and pharyngeal tonsils. The nasopharynx is partly filled with secretions but the patient is intubated. There is T2 hyperintensity in the mastoid cells and middle ear cavities. The inner ears are unremarkable. Mucosal thickening in the maxillary sinuses may part relate to obstruction of outflow by the large nasoethmoidal cephalocele.Please refer to the companion CT scan for better assessment of the osseous structures involved.

Output: 1.While there are changes suggesting previous repair, there is still a large anterior encephalocele containing CSF and dysplastic likely partially encephalomalacia brain parenchyma occupying the nasal cavity. 2.The presumed graft along the floor of the anterior cranial fossa is deficient posteriorly with a 9 mm left paramedian defect as described above.3.Apart from expected changes in the frontal lobes related to the large nasoethmoidal cephalocele and its repair, the brain shows no significant abnormality. 4.Markedly attenuated flow in the left internal carotid artery is probably related to antenatal insult as described above. A left posterior communicating artery provides flow to the left anterior and middle cerebral arteries. Please see above for more details.


Instruction: Generate impression based on findings.

Input: Male 30 years old status post OLT in 1987 for biliary atresia admitted with conjugated hyperbilirubinemia and diarrhea. Evaluate for biliary dilation. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of liver transplant. Nodular, cirrhotic liver morphology. Atrophic right hepatic lobe with reticular T2 hyperintensity is consistent with fibrosis. There is compensatory hypertrophy of the left lobe.Again seen is multifocal intrahepatic biliary ductal stricturing and dilatation. The common duct is not well seen which may be related to technique particularly as there is no upstream biliary ductal dilatation. The overall appearance is concerning for multifocal strictures.There is a new subcentimeter intrinsically T1 hyperintense, mildly enhancing lesion in hepatic segment 2 (series 18, image 24) with no washout is nonspecific, attention on follow-up imaging is recommended. The hepatic vasculature is patent.SPLEEN: Mild splenomegaly measuring 16 cm in craniocaudal dimension.PANCREAS: Unchanged mild narrowing of mid-body main pancreatic duct with stable upstream ductal prominence. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst. Stable mild prominence of the left collecting system.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small bilateral pleural effusions and associated atelectasis.

Output: 1. Cirrhotic liver morphology with right hepatic lobe fibrosis.2. Accounting for differences in technique stable multifocal intrahepatic biliary stricturing. The common duct is not well seen which may be related to technique as there is no upstream biliary ductal dilatation.3. Small bilateral pleural effusions.4. Mild splenomegaly.5. Additional findings as above.


Instruction: Generate impression based on findings.

Input: Brain metastases from colon or breast cancer status post stereotactic radiation. There are postoperative findings related to craniotomy involving portions of the right parietal and temporal bones. There is unchanged high T2 signal in the treatment bed, but no associated enhancement. There is encephalomalacia in the left parietal lobe and left basal ganglia. There are also scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute intracranial hemorrhage or acute infarcts. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is mild fluid signal within the right mastoid air cells. There are bilateral lens implants.

Output: 1. Stable post-treatment findings without evidence of intracranial tumor recurrence. 2. Chronic left parietal lobe and left basal ganglia infarcts.


Instruction: Generate impression based on findings.

Input: Neck pain due to lifting at work. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from straightening which may be in part positional. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Minimal disc osteophyte complex. Minimal narrowing of the spinal canal. Mild left neural foraminal stenosis. Right neural foramen is patent.C5-6: There is a disc osteophyte complex including a small left paracentral extrusion component. There is mild indentation of the ventral cord, left greater than right. There is overall mild to moderate spinal canal stenosis. There is also moderate right and mild left neural foraminal stenosis related to uncovertebral hypertrophy.C6-7: Small disc osteophyte complex with mild spinal canal stenosis. There is left-sided uncovertebral hypertrophy with moderate left-sided neural foraminal stenosis. There is mild right neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine with up to mild-to-moderate spinal canal stenosis at the C5-C6 level particularly involving the left aspect of the spinal canal. 2. There is also mild or mild-to-moderate neural foraminal stenosis at the C4-C5, C5-C6, and C6-C7 levels. Additional details as above.


Instruction: Generate impression based on findings.

Input: Reason: altered mental status, evaluate for CVA or other lesions History: as above MRI BRAIN: There is an area of restricted diffusion in the left frontal lobe involving the middle and inferior frontal gyri. Additional, smaller areas of restricted diffusion are noted along the right insula and external capsule as well as the left periventricular white matter of the occipital horn. Microhemorrhages in both thalami appear increased from the prior exam. Periventricular FLAIR signal abnormality is consistent with small vessel ischemic disease. There are old lacunar infarcts in both thalami in addition to the left ventral pons. There is no evidence of a mass. Parenchymal volume loss appears to preferentially affect the parietal and temporal lobes. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.MRA BRAIN: The exam is significantly limited by patient motion artifact. There is intracranial atherosclerotic disease without evidence of significant major vessel stenosis. The right ICA is larger than the left. There are multiple intracranial aneurysms including a 2.5 mm proximal basilar aneurysm, 3 mm right P-comm aneurysm, 3 mm right sub hypophyseal right ICA aneurysm and 3 mm ACOM aneurysm. There is also a 1 to 2 mm outpouching arising from the left cavernous ICA, which likely represents a small aneurysm verus prominent infundibulum. The right ACA is dominant. The middle cerebral arteries appear normal. There is a fetal origin of the right PCA. The left vertebral artery is dominant. The right vertebral artery primarily supplies the PICA. The basilar artery appears normal. There is no evidence of flow-limiting stenosis.MRA NECK: There is a separate origin of the innominate, left common carotid and left subclavian arteries from the aortic arch. The origin of the left vertebral artery is not well-seen but the remainder of the vessel is well opacified. The origin of the right vertebral artery is widely patent. The distal right vertebral artery is attenuated but remains opacified. The common and cervical internal carotid arteries are normal in course. There is mild narrowing of the proximal left ICA without evidence of significant stenosis by the NASCET criteria.

Output: 1.Areas of restricted diffusion in the middle and inferior left frontal gyri and additional, smaller areas of restricted diffusion in the right insula and external capsule as well as the left periventricular white matter of the occipital horn are consistent with acute cerebral infarcts in multiple territories. 2.Multiple intracranial aneurysms including a 2.5 mm proximal basilar aneurysm, 3 mm right P-comm aneurysm, 3 mm right sub hypophyseal right ICA aneurysm and 3 mm ACOM aneurysm. There is also a 1 to 2 mm outpouching arising from the left cavernous ICA, which likely represents a small aneurysm verus prominent infundibulum.3.No evidence of flow-limiting stenosis in the head or neck. There are intracranial atherosclerotic changes present.4.There are microhemorrhages present in the thalami which have accumulated further since the previous exam from 20115.Old lacunar infarcts in the brainstem and basal ganglia.6.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 7.The left vertebral artery is not readily identified. It's possible this is artifactual appearance though the possibility of a left vertebral artery stenosis cannot be excluded.


Instruction: Generate impression based on findings.

Input: Evaluate for lesion, inflammatory changes: concern for transverse myelitis, decreased lower extremity sensation, wide based gait. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct, within the limits of artifact, from what may be dental hardware. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable, although metal artifact obscures portions of the right face region.Spine: The spinal cord displays normal signal and morphology. The tip of the conus medullaris is positioned at the L1 level and the cauda equina nerve roots are unremarkable. There is no evidence of abnormal enhancement or tumors. There is mild straightening of the cervical spine alignment in the sagittal plane. The vertebral column alignment is otherwise within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: No evidence of intracranial or spine lesions to suggest an inflammatory process.


Instruction: Generate impression based on findings.

Input: 21 year-old woman with history of lateral knee pain. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is mildly increased signal of the medial facet of the patella without discrete tear or defect of the articular cartilage. Articular cartilage of the tibiofemoral compartments is intact. The marrow and cortical signal in the underlying bone is normal.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Fraying of the articular cartilage over the medial facet of the patella, otherwise no additional finding to explain the patient's pain.


Instruction: Generate impression based on findings.

Input: Thumb pain The proximal phalanx is adducted relative to the first metacarpal which distorts the anatomy of the first metacarpophalangeal joint and limits evaluation of the ligamentous structures. A low signal intensity structure that I believe to be the ulnar collateral ligament proper is seen extending from the dorsal aspect of the first metacarpal head to the base of the proximal phalanx. It appears thickened, but I cannot tell if this is simply due to redundancy related to patient positioning or the sequela of prior trauma. I am not convinced of a full-thickness injury to the ligament or a Stener lesion. The accessory ulnar collateral ligament likewise appears thickened and redundant which may be due to patient positioning. There is increased signal intensity within the radial collateral ligament at its attachment to the metacarpal head that may reflect chronic degeneration or sequela of prior injury. I am not convinced, however, that there is a full thickness tear of this ligament. Small cysts are seen within the underlying metacarpal head. I suspect that there is degeneration of the articular cartilage along the radial aspect of the metacarpophalangeal joint. The sesamoid bones appear intact.The ligaments of the interphalangeal joint of the thumb appear intact.The tendons of the thumb appear intact. Other than the aforementioned cysts in the neck of the first metacarpal, bone marrow signal intensity is within normal limits. Please note that this study does not include the first carpometacarpal joint.

Output: Evaluation of the ligaments of the first metacarpophalangeal joint is limited due to abduction of the proximal phalanx relative to the first metacarpal. Focal increased signal intensity within the radial collateral ligament at its attachment to the first metacarpal head suggests chronic degeneration or perhaps sequela of prior trauma, although I am not convinced that there is a full-thickness tear of this ligament. The ulnar collateral ligament appears thickened which may reflect a prior sprain or partial-thickness tear, but this may simply be due to redundancy as a result of suboptimal positioning. We will attempt to have the patient return for repeat images with better positioning of the first MCP joint at no charge, assuming the patient can tolerate this positioning.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 72-year-old female with history of spinal stenosis with acute worsening of pain. The visualized calvaria and skull base are radiographically normal.Cervical spine alignment is anatomic. Vertebral body heights and density is within normal limits. The foramen magnum is unremarkable.C2-3 is unremarkable.C3-4 demonstrates neuroforaminal compromise bilaterally with mild central spinal stenosis and ventral hypertrophic changes.C4-5 demonstrates mild spinal stenosis and ventral hypertrophic changes with neuroforaminal narrowing but laterally.C5-6 demonstrates bilateral neuroforaminal narrowing, and advanced degenerative disk disease.C6-7 demonstrates bilateral neuroforaminal narrowing, and advanced degenerative disk disease.C7-T1 demonstrates bilateral neuroforaminal narrowing.T10-11 and T11-12 demonstrates severe degenerative disk disease and near complete loss of disk height.T10/11 demonstrates significant neuroforaminal compromise.T12-L1 is unremarkable.L1-2 is unremarkable.L2-3 shows degenerative disk disease with hypertrophy of the posterior elements.L3-4 demonstrates a large diffuse bulging of disk density material that extends to the ventral epidural space greater on the left which may represent diffuse disk bulge or hypertrophic changes. For further elucidation of this level an MRI may be considered. Advanced degenerative disease is noted with sclerotic end plate changes and vacuum phenomenon. Neuroforaminal compromise is noted bilaterally and a high suspicion for central spinal stenosis.L4-5 demonstrates advanced degenerative disease with vacuum phenomenon. There is complete right neuroforaminal compromise by lateral hypertrophic changes. There is a high suspicion for a tight central spinal stenosis.The L5-S1 shows advanced degenerative disease and a significant diffuse disk bulge. Neuroforaminal compromise affects the right side. The left neuroforamina remains patent.

Output: Multilevel degenerative disk disease, neuroforaminal compromise and spinal stenosis as described above.


Instruction: Generate impression based on findings.

Input: 57 years, Female, post brain biopsy. History of breast cancer and AML. Again seen are postsurgical changes of biopsy of left occipital intraparenchymal hemorrhagic lesion via burr hole. There has been evolution of the signal features of the blood products as well as slight decrease in size of the lesion, which measures approximately 2.2 x 2.8 x 2.3 cm, previously 3.2 x 3.2 x 3.1 cm. Surrounding vasogenic edema has resolved. There is intrinsic T1 hyperintensity related to late subacute hematoma without definite enhancement.No restricted diffusion to suggest acute ischemia. There is a punctate focus of susceptibility in the right ventral pons likely representing a chronic microhemorrhage. No new intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is a 9 x 7 mm small pineal cyst which remains unchanged. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes and/or posttreatment-related changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. No destructive lesions within the calvarium.

Output: 1. Interval evolution of left occipital intraparenchymal hematoma with decrease in size and resolution of surrounding edema. There is no convincing evidence of metastatic disease in the brain; however, given the hemorrhagic nature of the lesion which may potentially obscure enhancement, consider an additional follow-up study. 2. Punctate focus of chronic microhemorrhage in the right pons.


Instruction: Generate impression based on findings.

Input: New daily headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

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


Instruction: Generate impression based on findings.

Input: Reason: to r/o vp shunt malfunctioning History: pineal tumor, progressing, vp shunt in situ Suboccipital midline craniectomy is redemonstrated. Extensive bilateral cerebellar and left occipital cortical calcification is again identified and with no interval change. Finding are secondary to post therapy changes.There is filling of the subarachnoid space in the posterior fossa with high attenuation material which extends into the basal cistern. This is noted in the subarachnoid space at the level of foramen magnum, ambient cistern, prepontine cistern, and cerebellar pontine angles. These findings are believed to represent worsening of previously noted extensive pachymeningitis and possible carcinomatosis. There is suggestion of mass effect on the medulla secondary to above findings. Further follow-up with a dedicated MRI examination will significantly better characterize the above findings.Unchanged course and position of right lateral ventricular catheter. The shunt appears to partially traverse the right lateral ventricle. No change in the normal size of ventricular system since prior study. Diffuse low attenuation of the bilateral hemispheric white matter is stable since prior exam. This finding is believed to represent post therapy changes and surgical intervention for placement of multiple prior ventricular catheter placement.There is no hemorrhage, edema, mass effect or midline shift. The calvarium and soft tissues of the scalp are within normal limits. Air-fluid levels within the maxillary sinuses bilaterally. The mastoid air cells are clear.

Output: 1.High attenuation content within the subarachnoid space in the posterior cranial fossa with extension into the suprasellar cistern. Findings are believed to represent interval worsening of patient's known extensive pachymeningitis and possible carcinomatosis.2.Further evaluation with an infused MRI examination is recommended.3.Stable size of shunted supratentorial ventricular system.4.Stable extensive bihemispheric white matter low-attenuation believed to represent post therapy changes.5.Therapy related calcification within the cerebellum bilaterally and left occipital cortex with minimal interval worsening.


Instruction: Generate impression based on findings.

Input: Ms. Marler is a 64 year old female on neoadjuvant therapy. Mild parenchymal enhancement is noted bilaterally.The index cancer now measures 1.7 x 1.0 x 1.3 cm, compared to 1.8 x 1.1 x 1.4 cm. The posterior satellite continues not to be visible on today's exam. The total area of abnormal enhancement now measures 4.3 cm, compared to 6.0 cm (in the AP direction). The lateral benign intramammary lymph nodes are unchanged. In the left axilla, the reference lymph node now measures 0.8 x 0.5 cm, compared to 0.8 x 0.7 cm. Other lymph nodes are also smaller when compared to priors. There is no new abnormal enhancement seen in either breast. No new abnormal axillary lymph nodes are identified in either axillary region. A vascular port is again present in the right chest wall.

Output: 1. Decreasing size of index cancer and other abnormal enhancement in the left breast. 2. Decreasing size of left axillary lymph nodes.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 80 year-old male, concern for renal cell carcinoma, right renal mass 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: Multifocal right renal masses. The largest lower pole mass measures 11.5 x 9.7 cm. There is enhancing tumor thrombus extending into the renal vein and IVC to the level of the IVC filter. The tumor abuts and is inseparable from Gerota's fascia as well as the renal sinus fat. An additional exophytic right upper pole mass measures 3.4 x 4.2 cm.The left kidney is not visualized and presumably absent. RETROPERITONEUM, LYMPH NODES: IVC filter is noted. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multifocal right renal masses, consistent with renal cell carcinoma. Tumor thrombus extends into the renal vein and IVC to the level of the IVC filter. 2.The left kidney is not visualized and presumably absent.