Instruction: Generate impression based on findings.

Input: 60 years Male (DOB:7/27/1955)Reason: multifocal infarctions, suspect septic embolization History: as abovePROVIDER/ATTENDING NAME: RICHARD KRAIG RICHARD KRAIG A small focus of gyriform T2 and FLAIR hyperintensity is present along the right occipital lobe posteriorly at the inferior aspect of the right cuneus. There is associated gyriform T1 signal hyperintensity. There is no diffusion restriction associated with this. There is associated susceptibility effect. Small focus of susceptibility effect is present in the left occipital lobe along the left cuneus.A punctate foci of susceptibility effect and small foci of susceptibility effect scattered in the cerebellar hemispheres bilaterally.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are hemorrhagic lesions present in the occipital lobes bilaterally but more on the right occipital lobe and the left. There is gyriform pattern suggests these are related to a vascular event. I suspect the related to subacute embolic events.2.Multiple small foci of hemorrhage are present in the cerebellar hemispheres. It is possible these are related to embolic events with some hemorrhagic conversion.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: MRI liver to r/o HCC History: post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Ablation cavity in the right lobe of the liver measures 3.1 x 1.6 cm (series 10 image 47), unchanged.New ablation cavity from interval ablation of previous HCC inferiorly measures 3.8 x 2.5 cm. No nodular arterial enhancement or washout to suggest residual disease. Intrinsic T1 signal compatible with blood products.No new lesions.Cirrhotic morphology. Patent hepatic vasculature. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion in the pancreatic head is unchanged, measuring 1.3 x 0.9 cm (series 9 image 22), likely a side branch IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Prominent periportal and gastric hepatic lymph nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.New RFA ablation cavity with no specific evidence of residual disease.2.Stable additional RFA patient cavity with no specific evidence of recurrence.3.Stable probable IPMN.


Instruction: Generate impression based on findings.

Input: 20 years Male (DOB:2/2/1996)Reason: history of rhabdomyosarcoma s/p radiation therapy History: new onset memory loss; history of rhabdomyosarcoma s/p radiation therapyPROVIDER/ATTENDING NAME: ELISE OBERMAN TARA O HENDERSON The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cysts. The visualized portions of the right mastoid air cells are clear. The patient is status post left mastoidectomy .The left parotid gland is absent. The visualized portions of the orbits are intact.

Output: There is no evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: Clinical question: possible stroke. Signs and Symptoms: as above. Nonenhanced brain MRI:There is no evidence of an acute ischemic stroke.Examination demonstrate diffuse left hemispheric periventricular and subcortical FLAIR hyperintensity of brain parenchyma and to a lesser degree of the left basal ganglia associated with mild ex vacuo dilatation of left lateral ventricle suggesting chronic ischemic changes in the microvascular distribution. Compared to prior exam there is significant interval progression of finding in the left hemisphere.Very minimal similar finding on the right side is also noted. Significant discrepancy of the findings on the left suggest possibility of proximal large vessel vascular stenosis. There is mild left-sided medullary and degeneration.Cortical sulci are prominent for patient's stated age however without detectable signal abnormality.Images through posterior fossa demonstrate focus of encephalomalacia in the right middle cerebellar peduncle without significant change since prior exam. Also similar to prior exam there is prominence of cerebellar and vermian folia for patient's stated age of 49.The signal void of major intracranial arterial branches are identified. There is persistent low signal changes in the left vertebral and basilar artery with decreased caliber as was noted on prior MRI and CTA examinations.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Extensive left hemispheric periventricular / subcortical and to a lesser degree left basal ganglia FLAIR hyperintensity with volume loss suggesting progression of small vessel distribution ischemic strokes since prior MRI exam. Minimal similar changes in the right hemisphere is also noted. Stable focus of encephalomalacia/chronic stroke in the right middle cerebellar peduncle.3.Asymmetrical (L>R) extent of left hemispheric findings is suggestive of a larger proximal vessel stenosis or occlusion.4.Prominence of cortical sulci and cerebellar-vermian folia for patient of stated age and consistent with underlying parenchymal volume loss.5.Redemonstration of signal changes in the left vertebral artery and proximal basilar with decreased caliber consistent with findings on prior CTA examination.


Instruction: Generate impression based on findings.

Input: 31-year-old pregnant female. Evaluate for fetal abdominal wall defect. PELVIS:UTERUS, ADNEXA: Gravid uterus with fetus in cephalic presentation. Anterior placenta. Cervical cerclage is present. There is a 4 mm T2 hyperintense focus seen at or very close to the skin surface of the anterior upper abdominal wall near the midline (series 1101/27). This finding likely correlates with the reported cystic focus seen on 18 week fetal survey ultrasound. No liver or bowel herniation. Normal fetal cord insertion. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 10 mm left perineal T2 hyperintense, most likely a Bartholin's gland cyst (series 601/9)OTHER: No significant abnormality noted.

Output: Small, nonspecific anterior abdominal wall cystic lesion without any significant anterior abdominal wall defect.. No liver or bowel herniation.


Instruction: Generate impression based on findings.

Input: Reason: screen for HCC, presence of hemangioma History: Hep B, hx of hemangioma, RUQ pain. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal morphology, parenchymal signal intensity, and enhancement. There is redemonstration of a T2 hyperintense structure within segment 5 (series 3, image 24) which measures 10 mm, not significantly changed. This structure demonstrates peripheral nodular enhancement and likely represents a hemangioma. No suspicious hepatic lesions are identified.The hepatic vasculature appears patent.The gallbladder appears within normal limits. No biliary ductal dilatation.SPLEEN: A splenule is noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable right hepatic lobe lesion with imaging features suggestive of a hemangioma. No new hepatic lesions are identified.


Instruction: Generate impression based on findings.

Input: Reason: Tendonitis after trauma; left elbow pain History: left elbow pain LIGAMENTS: Although this examination was not optimized for detailed evaluation of the intrinsic ligaments of the elbow, the ulnar collateral ligament appears intact. The radial collateral ligament appears intact. The lateral ulnar collateral ligament appears intact.TENDONS: There is thickening and intermediate signal abnormality within the common extensor tendon at the level of the lateral epicondyle indicating mild tendinosis. No fluid-filled tear is evident. The flexor tendons appear intact. The biceps and brachialis muscles and tendons appear intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. There is osteophyte formation indicating mild osteoarthritis. There is a small amount of increased signal abnormality within the capitellum on fluid sensitive sequences which may reflect degenerative change (19; series 1401)SURROUNDING STRUCTURES: The ulnar nerve is normal in appearance.ADDITIONAL

Output: Tendinosis of the common extensor tendon and osteoarthritis of the elbow as described above.


Instruction: Generate impression based on findings.

Input: Rule-out progression of spondylosis after decompressive surgery. History of C5-C6 ACDF in 2000 and C3-C4, C4-C5, C5-C6 laminotomy with C3-C4 diskectomy and July 2013. Residual myelopathy. Intermittent neck pain radiating to bilateral upper extremities. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height with evidence of osseous fusion involving the C5 and C6 vertebral bodies. There is minimal retrolisthesis of C4 and C5. Alignment is otherwise maintained. There is T2 hyperintensity involving the C4 and C5 vertebral bodies which are likely on a degenerative basis.Again seen is abnormal T2 hyperintensity within the cervical cord at C3-C4, C4-C5, and C5-C6 levels with associated volume loss consistent with myelomalacia. Compared to 6/20/2013, interval decompression of the spinal canal is seen from C3 to C5. Diskectomy at C3-C4 is also seen. No significant residual spinal canal stenosis is demonstrated.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: Interval discectomy. No significant compromise to the spinal canal. There is mild to moderate bilateral neural foraminal narrowing worse on the left.C4-5: Small disc osteophyte complex again seen. No significant compromise to the spinal canal. Moderate to severe right and moderate left neural foraminal narrowing related to uncovertebral hypertrophy. C5-6: No significant compromise to the spinal canal. Minimal left foraminal narrowing. Dorsal ligamentum flavum thickening effaces the dorsal thecal sac. C6-7: No significant compromise to the spinal canal. There is mild to moderate bilateral neural foraminal narrowing.C7-T1: Mild disc osteophyte complex and uncovertebral hypertrophy. No significant compromise to the spinal canal. Mild left neural foraminal narrowing.Small disc bulges in the upper thoracic spine again seen. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Compared to 6/28/2013, interval discectomy at C3-4 and decompression of the spinal canal from C3 to C5 is seen. No significant residual spinal canal stenosis is appreciated.2. Again seen is abnormal T2 hyperintensity at C3-C4, C4-C5, and C5-C6 and consistent with myelomalacia.3. Multilevel neural foraminal narrowing again seen as detailed above, worst at C4-5 and similar to prior.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (10/6/2016), images from MRI guided biopsy of right breast and postprocedural right mammographic images (11/8/2016) performed at outside institution. BREAST MRI (10/6/2016):Per outside radiology report, breast MRI was performed as screening for high risk woman.The breast MRI was performed per a protocol, outlined in the outside radiology report.There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a lobulated mass measuring 8 x 8 x 10 mm (AP x LR x CC) at retroareolar region in the right breast. Distance between nipple and the mass is approximately 2 mm. There are no other abnormal enhancing lesions elsewhere in the right breast or in the left breast. No abnormal lymph nodes are identified in either axillary region.IMAGES FROM MRI GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/8/2016):Images from MRI guided biopsy right breast have been submitted. However there are no actual biopsy images. Post procedural right mammographic images show a marker clip placed at retroareolar region. The mass is not identified on the mammogram.Per outside pathology report, the result was malignant, invasive mammary carcinoma grade 3.

Output: Biopsy proven unifocal carcinoma in the right breast at retroareolar region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: The left frontal sinus is completely opacified with a peripheral rind of T1 isointensity to brain which enhances, with central T1 hyperintensity, likely representing obstructive inspissated secretions.There is a T1 isointense to brain and T2 hyperintense lesion in the left frontoethmoidal recess and the left anterior ethmoid, which is diffusely enhancing. There is dehiscence of the lateral wall of the frontoethmoidal recess at this level and there is an extraconal enhancing component along the medial aspect of the left orbit. There is mass effect on the extraconal left orbit, although the muscles remain discrete. There is also dehiscence of the left ethmoid roof. There is adjacent dural thickening of the left inferior frontal lobe.There is mucosal thickening of both maxillary sinuses, left more than the right.There are extensive paranasal sinus post-operative changes, including bilateral antrostomies which are patent.

Output: 1. There is a stable enhancing mass in the left frontoethmoidal recess, extending into the left anterior ethmoid sinus. Extra conal left orbital component with dehiscence of the lateral wall of the frontoethmoidal recess and left ethmoid roof. This mass is likely to represent recurrence of squamous cell carcinoma. MRI of the brain is recommended to assess for brain parenchymal involvement.2. Probable mucosal thickening of the left frontal sinus with associated obstructive inspissated secretions.3. Mucosal thickening of the maxillary sinuses bilaterally, left greater than right.


Instruction: Generate impression based on findings.

Input: 53 year old male with prior cervical spine injury. Evaluate for cervical spine injury. MRI C-Spine:The craniovertebral junction appears within normal limits. There are postsurgical changes of an anterior cervical discectomy and fusion spanning C4-C6. There is also evidence of a prior open door left-sided laminoplasty procedure from C4 through C6. There is straightening of the cervical spine and no evidence of subluxation. There is significant volume loss involving the cervical spinal cord particularly in its mid and lower cervical aspects. Abnormal T2 signal is evident in the cervical cord bilaterally at the C3-C4 level and more pronounced at the C4-C5, C5-C6, and C6-C7 levels. Findings are most consistent with myelomalacia and similar to prior study from 9/21/2010 which was prior to posterior decompression. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.Interspace observations in the cervical spine:C2-3: Right greater than left uncovertebral hypertrophy which contributes to right greater than left mild to moderate bilateral neural foraminal narrowing. No significant spinal canal stenosis.C3-4: Prominent disc osteophyte complex and prominent uncovertebral spurring. Moderate to severe bilateral neuroforaminal narrowing. Mild to moderate degree of spinal canal stenosis which is slightly less pronounced than priorC4-5: Significant uncovertebral spurring which contributes to severe left and moderate to severe right neural foraminal narrowing. No significant spinal canal stenosis.C5-6: Prominent uncovertebral and facet arthropathy. Moderate bilateral neural foraminal narrowing. No significant spinal canal stenosis.C6-7: Prominent disc osteophyte complex and facet arthropathy. Moderate to severe, right greater than left, bilateral neuroforaminal narrowing. Mild to moderate spinal canal stenosis which is slightly less pronounced than prior.C7-T1: No significant compromise to the spinal canal or neural foramina.MRI Cord compression protocol:Elsewhere within the spine involving the thoracic and lumbar levels, the vertebral bodies are appropriate in the overall alignment and height aside from straightening of the spinal curvature and mild L5 on S1 retrolisthesis The thoracic spinal cord has gross normal signal characteristics and overall morphology. Within the thoracic spine there are scattered degenerative changes including relatively more prominent disc bulges at the T1-T2 and T9-T10 level but without high-grade spinal canal stenosis or evidence of acute cord compression. These thoracic disc bulges are progressed since prior. Disc height loss at the T9-T10 level is also progressed since prior.There are multiple disc bulges involving the lower lumbar spine as well as prominence of the dorsal epidural fat at the L4-L5 level. There is moderate spinal canal stenoses suspected at the L3-L4, L4-L5, and L5-S1 levels based on the sagittal sequences. There is mild retrolisthesis of L5 on S1. Edematous marrow signal changes are noted at the L5-S1 level which are progressed since prior study from 2010. There is also moderate degree of neural foraminal stenoses from the L3-L4 to L5-S1 levels which appears worse.

Output: 1.Extensive myelomalacia involving the cervical cord which was present on prior MRI from 9/21/2010. No clear evidence of cord edema.2.Post-surgical changes of prior anterior instrumentation/fusion and posterior decompression with laminoplasties extending from C4 through C6. There is mild to moderate degree of spinal canal stenosis at the C3-C4 and C6-C7 levels which is slightly less pronounced than on prior.3.Limited cord compression protocol sequences obtained of the remainder of the thoracic and lumbar spine demonstrate no findings to suggest acute cord or acute cauda equina compression. There are however degenerative changes as described above with at least moderate spinal canal stenoses at L3-L4 to L5-S1 which appear worse since prior MRI from 9/21/2010. Dedicated thoracic and lumbar spine images can be obtained for more detailed evaluation as clinically indicated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 38 years old, with history of grade 2 oligodendroglioma status post radiation and chemotherapy. A region of T2 hypoerintensity involving the left frontal white matter and cortex with some cortical thickening is again seen. As on prior exams, the lesion shows central cystic degeneration. There has been no significant interval change in size or morphology. No pathologic enhancement is seen. Separate from the above described lesion, ill defined T2 hyperintensity in the periventricular white matter is unchanged and likely treatment related. No new areas of signal abnormality are seen. No significant mass effect or edema is detected. The ventricles maintain normal size and configuration. Thick enhancement along the right orbital roof is unchanged.

Output: 1.No change in the size or morphology of the treated left frontal lesion.2.Stable findings along the right orbital roof likely representing fibrous dysplasia.


Instruction: Generate impression based on findings.

Input: Back pain and fever. Lower extremity weakness. History of lung transplant. CERVICAL:There is sagittal straightening, which may reflect patient positioning. Vertebral body heights are preserved. There are fat-containing marrow lesions, most compatible with hemangiomas. There is mild multilevel disc desiccation in addition to height loss at C6-C7. Degenerative endplate changes are seen, most pronounced at C4-C5, where there is mild spinal canal stenosis. Even milder canal stenosis is present at the levels C3-C4 through C6-C7. The spinal cord shows normal signal. There is moderate-to-severe bilateral C3-C4 and bilateral C4-C5 neural foraminal stenosis with mild or mild-to-moderate bilateral C5-C6 and C6-C7 neural foraminal stenoses.THORACIC:Sagittal alignment is anatomic. The vertebral bodies are preserved in height and there is no suspicious marrow signal abnormality. There is mild upper thoracic disc desiccation and height loss. There is also mild right facet proliferative change at T10-T11 indenting the thecal sac. There is no significant disc protrusion. The spinal canal is preserved and the spinal cord is normal signal and morphology. Bilateral pleural effusion/thickening and pulmonary opacification are better assessed on the companion CT scan.LUMBAR:Sagittal alignment is anatomic. The vertebral bodies are preserved in height and there is no suspicious marrow signal abnormality. There is disc desiccation at L2-L3 through L4-L5 associated with mild disc height loss and a small bulge at L2-L3 and minimal height loss without significant bulge at the other 2 levels. Otherwise, the thecal sac is preserved. The conus medullaris tip is at L1-L2 level. The conus shows normal shape and signal.T12-L1 and L1-L2: No significant disc herniation. No spinal canal or neuroforaminal stenosis.L2-L3: There is a left paracentral disc extrusion which posteriorly displaces the traversing left L3 nerve root and causes mild left neural foraminal stenosis. There is mild-to-moderate facet arthropathy but no significant central spinal canal stenosis.L3-L4: There is a small disc bulge that is eccentric to the left along with bilateral facet arthropathy resulting in mild bilateral neural foraminal stenosis but no significant spinal canal stenosis.L4-L5: Severe right and mild-to-moderate left facet arthropathy along with a small disc bulge causing no significant central spinal canal stenosis and only mild left subarticular recess stenosis. There is also mild bilateral foraminal stenosis.L5-S1: There is no significant spinal canal or neural foraminal stenosis.

Output: 1.Multilevel cervical spondylosis causes mild spinal canal stenosis at C4-C5 and multilevel neural foraminal stenoses as described above.2.Thoracic spine shows minimal multilevel spondylosis but no spinal canal or neuroforaminal stenosis. 3.Relatively mild multilevel degenerative disease in the lumbar spine is most pronounced at L2-L3, where there is a left paracentral disc extrusion posteriorly displacing the traversing left L3 nerve root. Please correlate with left L3 radiculopathy.4.There is no abnormal spinal cord signal or compression. There is also no gross signs of spinal infection.5.Bilateral pleural effusion/thickening and pulmonary opacification are better assessed on the companion CT scan.


Instruction: Generate impression based on findings.

Input: 40 year-old female with family history of breast carcinoma in her mother at age 69 and a paternal aunt. History of bilateral breast implants. Known left breast fibroadenoma. Heterogeneous fibroglandular tissue with marked background parenchymal enhancement is noted bilaterally. Bilateral retropectoral saline implants are identified. The implants demonstrate normal contour with no evidence for rupture. At the approximate 1:00 position of the left breast, posterior depth, there is a 1.0 cm intermediate signal intensity nonenhancing mass best seen on the T2 weighted sequence, corresponding to the benign morphology mass on recent ultrasound, likely the patient's known fibroadenoma. A nonenhancing cyst is present at the 6 o'clock position of the left breast.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Benign morphology left breast mass, corresponding to the known left breast fibroadenoma. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 61-year-old female with pain in left knee. Evaluate for medial meniscus tear. MENISCI: There is a complex tear of the posterior horn of the medial meniscus consisting of a large radial component as well as additional longitudinal tearing through the periphery of the posterior horn near its root. There is additional globular increased signal intensity within the body of the medial meniscus indicating intrasubstance degeneration and possible undersurface fraying. The anterior horn appears intact. There is slight medial extrusion of the body of the medial meniscus. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the patella particularly involving the medial facet and median eminence with focal full-thickness degeneration centrally along the median eminence associated with underlying subchondral cyst formation. There is also moderate degeneration of the articular cartilage of the medial tibiofemoral compartment with a small full-thickness defects in the weightbearing cartilage. There is minimal edema in the underlying medial tibial plateau which we suspect is degenerative in etiology. The articular cartilage of the lateral compartment appears intact.LIGAMENTS: The cruciate and collateral ligaments are intact. There is mild edema along the superior band of the medial collateral ligament which could represent a mild sprain in the appropriate clinical context.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1. Complex tear of the medial meniscus.2. Osteoarthritic changes and other findings as above.


Instruction: Generate impression based on findings.

Input: Reason: brain metastasis, status post whole brain radiotherapy. There are several subcentimeter foci of abnormal supratentorial and infratentorial enhancement, which appear to be leptomeningeal in nature, perhaps with associated intraparenchymal extension with at least some of the lesions. The largest is located along the right prefrontal gyrus measuring approximately up to 9 mm. Additional subcentimeter foci of abnormal enhancement are present along the inferior right temporal lobe, anterior left temporal lobe, posterior left parietal lobe, and bilateral cerebellar hemispheres. There is no evidence of intracranial hemorrhage or acute infarct. There is confluent abnormal increased T2 signal within the periventricular white matter with additional focal areas of abnormal high T2 signal within the right frontal subcortical white matter, as well as the right posterior capsular region and corona radiata. There is also patchy high T2 signal within the pons, greater on the right. There are nonspecific punctate foci of susceptibility effect along the left sylvian fissure. There is mild cerebral parenchymal volume loss. The major cerebral flow voids are intact. There appears to be a small right sigmoid diverticulum. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple intracranial enhancing lesions suspicious for leptomeningeal metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right hip pain Note that the examination is markedly limited by motion artifact as well as by the patient's body habitus.ACETABULAR LABRUM: There is a linear focus of increased signal intensity overlying the anterior labrum which is best seen on series 9 image 15. This is favored to represent artifact versus a true tear although given the extensive motion, this is unclear.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Focus of increased signal intensity within the anterior labrum which is favored to be artifactual in nature given the extensive motion artifact and poor signal of the study although a small tear in this area cannot entirely be excluded. There is no evidence of gross labral detachment.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of brain, unspecified [C71.9] / Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: further eval of hemorrhagic mets History: metastatic cancer, worsened LE weakness Evolving multifocal bihemispheric mainly hemorrhagic lesions are seen on today's scan.Right thalamic and right hippocampal lesions' maximum measured diameter of each lesion appear to be decreased and there are evidence of peripheral hemosiderin deposition indicate evolving ICH.However, the right posterior temporal lesion shows development of cystic cavity adjacent to enhancing area the left superior temporal lesion appear to be increased in size since prior scan.There is interval development of right frontal burr hole with ventriculostomy tube inserted into the right lateral ventricle.There is no evidence of acute ischemic lesion.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Some hemorrhagic lesions show MR characteristics of evolving ICH with interval decrease in size but some (right posterior temporal and left superior temporal lesions) demonstrate interval increase in size.2. No acute ischemic lesion.3. Stable ventricle size.


Instruction: Generate impression based on findings.

Input: Left forehead nodule: band like headaches. There is a lentiform fat signal lesion in the left lateral frontal scalp that measures up to 4 mm in thickness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is a partially empty sella. 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, and mastoid air cells are grossly unremarkable. There is a left maxillary sinus retention cyst.

Output: 1. Small left frontal scalp lipoma.2. Nonspecific partially empty sella, which may represent pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: There are multiple foci of restricted diffusion throughout the right cerebral hemisphere predominantly in the deep white matter but also including the right basal ganglia as well as the right precentral gyrus. Foci of restricted diffusion along the corpus callosum are also noted. Mild diffusion restriction is also seen in the left posterior frontal and left parietal lobes. There has been evolution of the previously seen infarcts from MRI from 1/27/2016 involving the left frontal lobe.There is FLAIR hyperintensity associated with the above-mentioned infarcts. There are scattered foci of susceptibility effect compatible with chronic blood products which are similar to prior, particularly along the right lateral ventricle margin with additional areas including the left subinsular region, right lateral thalamus, and few foci involving the right pons and cerebellum. There is also a background of moderate degree of periventricular and subcortical FLAIR hyperintensity which is nonspecific but compatible with chronic small vessel ischemic disease. There is no intracranial mass or mass effect. No hydrocephalus. There is diffuse opacification involving the sphenoid sinus with frothy secretions and fluid levels as well as bilateral mastoid air cell opacification, which may be related to intubation. Mild paranasal sinus opacification elsewhere.MRA HEAD

Output: 1. Multiple acute infarcts in the bilateral, but predominantly right, cerebral hemispheres as described above. There has also been evolution of previously seen left posterior frontal infarct. Background of moderate chronic small vessel ischemic disease also noted.2. There is high-grade stenosis or near occlusion involving the right internal carotid artery, new since prior CT angiogram 1/26/2016. Extent of residual flow can be better assessed with CTA if clinically indicated. There is also significant attenuation/decreased flow involving the right middle cerebral artery and its branches compared to the left.3. Scattered foci of chronic hemorrhage appear similar to prior, relatively more prominent in the right periventricular white matter.


Instruction: Generate impression based on findings.

Input: There is a small focus of increased diffusion signal on series 3 image 18 in the right hemipons with focally decreased ADC signal. This area shows very subtle abnormal T2 signal abnormality. There is mild nonspecific T2 hyperintense signal abnormality in the periventricular and subcortical white matter, as well as the brainstem likely representing chronic microvascular ischemic changes. There is mild global volume loss commensurate with patient age with bilateral hippocampal volume loss (right greater than left), and slightly greater volume loss in the right temporal lobe. There is no hydrocephalus. There is no midline shift or herniation. The left V3 vertebral artery flow void is diminutive suggesting stenosis vs hypoplasia. There is a small left maxillary sinus air-fluid level with trace bilateral mastoid mucosal thickening. The skull and extracranial soft tissues are unremarkable.

Output: 1.Small recent (acute/subacute) right hemipontine infarct.2.Mild global parenchymal volume loss with slightly greater involvement of the right temporal lobe and right hippocampus. 3.Mild chronic microvascular ischemic changes.The finding regarding infarct was discussed with Dr. Emma Daisy over the telephone at 3:19 p.m. today.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a right parietal lobe enhancing nodule again measuring 10 x 11 mm. No other enhancing lesions are present.Postsurgical findings consistent with right parietal craniotomy and tumor resection are redemonstrated. Minimal curvilinear enhancement in the surgical bed appears similar to prior examination. Edema involving the parietal lobe is stable.No intra-axial or extra-axial fluid collections are visualized. The ventricles are normal in size. The basal cisterns are visualized. Small retention cysts are visualized in the left maxilla sinus. Partial opacification of the left mastoid air cells is redemonstrated.

Output: Redemonstrated is a right parietal lobe enhancing nodule again measuring 10 x 11 mm. No other enhancing lesions are present.


Instruction: Generate impression based on findings.

Input: Limited exam due to patient inability to cooperate. Severe motion artifact.Scattered acute diffusion abnormality abnormality is seen in the right caudate and bilateral internal capsule, left greater than right. There is possible blood product adjacent to the right temporal lobe. Poor quality axial T2 images suggestive of suprasellar hemorrhage within the tumor, and less likely clots in the subarachnoid space.

Output: Limited study. 1.Ischemic changes of the right caudate and bilateral internal capsule, left greater than right.2.Poor quality axial T2 images suggestive of suprasellar hemorrhage within the tumor.


Instruction: Generate impression based on findings.

Input: 48 years, Male, new right posterior headaches since one week. There is extensive susceptibility artifact and distortion obscuring much of the right parietal, temporal, and occipital lobes, as well as the right posterior fossa. Visualized portions of the brain demonstrate no significant signal abnormality, intracranial mass, or mass effect. No midline shift or herniation. No hydrocephalus or extra-axial collections. Visualized calvarium and extracranial soft tissues are unremarkable.

Output: Limited MRI of the brain as described above which was terminated due to extensive artifact. Visualized brain parenchyma demonstrates no evidence of intracranial mass effect or signal abnormality. If the hearing implant cannot be removed, CT may be helpful for visualizing the currently obscured areas in the brain.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: NSCLC brain mets hx. History: hx brain mets. Previously seen left anterior mesial temporal lobe nodular enhancing lesions with the susceptibility artifacts are seen and appear to be stable. However, due to different imaging of adjacent technique (currently 4 mm thickness on fat saturation T1 axial scan and 2 mm thickness on 3-D T1 postcontrast acquisition; the 3-D acquisition was acquired in 1 mm thickness on prior scan), precise interval evaluation is impossible.There is no other abnormal enhancement on this scan.Encephalomalacia with ex vacuo changes of left lateral ventricle of the left parietal lobe especially inferior parietal lobule are again seen, unchanged since prior scan.Left caudate nucleus and bilateral cerebellar hemispheric tissue losses indicate prior ischemic infarct are again seen, unchanged.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Stable looking left mesial temporal lobe punctate enhancing foci since prior scan. However, the examination can be repeated without additional charge for precise evaluation.2. No new abnormal enhancing lesion on this scan.3. Unchanged postoperative changes of the left parietal lobe lesion and chronic ischemic infarctions on the left caudate and bilateral cerebellar hemispheres.4. No acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Reason: pain History: pain ROTATOR CUFF: There is a full-thickness tear of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 18 mm in the AP dimension. There is minimal retraction. There is extension of this tear posteriorly to involve the anterior fibers of the infraspinatus. There is mild fatty atrophy of the supraspinatus. The infraspinatus muscle appears intact. There is thickening and intermediate signal intensity of the supraspinatus indicating mild tendinosis. There is increased intermediate signal intensity within the articular surface fibers of the subscapularis at the level of its insertion which may represent focal tendinosis or undersurface fraying. No full-thickness tear is evident. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Additionally note is made multiple round foci of decreased signal abnormality within the bursa on both T1 and T2-weighted images corresponding to the foci of ossification seen in recent radiographs. These findings likely represent loose bodies, with the largest measuring 14 mm in its largest diameter, situated along the anterior aspect of greater tuberosity. Mild osteoarthritis affects the acromioclavicular jointGLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Mild osteoarthritis affects the glenohumeral joint.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is circumferential fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the joint versus a very mild tenosynovitis. ADDITIONAL

Output: Full-thickness tear of the rotator cuff with minimal retraction. Multiple loose bodies within the subacromial subdeltoid bursa as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Prostate cancer. Abnormal bone scan findings. The images and the official report of the whole body bone scan performed at outside hospital are not available. The clinical note indicates bone scan shows questionable abnormalities in the lower spine and also a pelvic node measuring 2cm in size.The study quality is mildly degraded by motion.CERVICAL SPINE:Alignment is anatomic accounting for straightening. Vertebral bodies are preserved in height. Marrow signal is notable for mild degenerative change subjacent to the endplates, most pronounced at C5-C6 through C7-T1 which is also associated with mild-to-moderate disc height loss. There is also edema like marrow signal involving the left sided articulating pillars at L2-L3 which is probably related to facet arthropathy. There is no suspicious marrow lesion. The cervical spinal cord shows normal signal and only very minimal ventral flattening by the C4-C5 degenerative disc-osteophyte complex. There is hyperostosis/enthesopathy at the occipital attachment of the ligamentum nuchae.C2-C3: Minimal disc-osteophyte complex and moderate left and mild right facet arthropathy, causing minimal left neuroforaminal stenosis. Left facet arthropathy is associated with marrow edema in the corresponding left articulating pillars. No significant spinal canal or right foraminal stenosis.C3-C4: Minimal disc-osteophyte complex and mild uncovertebral and facet arthropathy. No significant spinal canal or foraminal stenosis.C4-C5: Disc-osteophyte complexes associated with a narrow based central disc protrusion/spurring minimally indenting the ventral aspect of the spinal cord without abnormal cord signal. Mild facet arthropathy with no significant foraminal stenosis.C5-C6 and C6-C7: Disc-osteophyte complex is eccentric to the right but no significant spinal canal stenosis. Mild-to-moderate facet and uncovertebral arthropathy contribute to mild bilateral foraminal stenosis.T7-T1: No significant spinal canal or foraminal stenosis.THORACIC SPINE:Alignment is anatomic. Vertebral bodies are preserved in height and there is no suspicious marrow abnormality. Areas mild disc height loss in the mid thoracic spine associated with a small disc-osteophyte complexes as described below. The spinal canal is otherwise fairly preserved. The thoracic spinal cord shows normal signal and shape. Focal T2-hyperintensity and contrast enhancement just adjacent to the left spinolaminar junction at T3-T4 level on sagittal imaging (image #18) is related to a vessel. A 9 mm well-circumscribed, T2-hyperintense, mildly T1-hyperintense lesion within the skin and T8-T9 level to the left of midline is most likely a sebaceous cyst.T1-T2: Minimal disc-osteophyte but no spinal canal or foraminal stenosis.T2-T3: No spinal canal or foraminal stenosis.T3-T4 and T4-T5: Minimal disc-osteophyte but no spinal canal or foraminal stenosis.T5-T6: Broad-based left paracentral disc protrusion but no significant spinal canal or foraminal stenosis.T6-T7: No spinal canal or foraminal stenosis.T7-T8: Narrow based central disc protrusion mildly narrows the spinal canal. No foraminal stenosis.T8-T9, T9-T10, T10-T11 and T11-T12: No significant disc herniation. No spinal canal or foraminal stenosis.LUMBAR SPINE:Alignment is notable for 7 mm of anterior subluxation of L5 relative to S1 associated with bilateral chronic appearing pars interarticularis defects. There is also lumbar straightening which may relate to patient positioning. The vertebral bodies are preserved in height. Marrow signal shows no suspicious focality. Mild degenerative marrow change is present subjacent to the L2-L3 and, to a lesser extent, L1-L2 endplates anteriorly. There is also edema like signal involving the marrow of the left L4 articulating pillar, which is probably reactive to facet arthropathy. Small Schmorl node is present along the inferior endplate of L2 also with minimal associated subjacent marrow change. Moderate size anterior osteophytes are present at L2-L3. The tip of the conus medullaris is at the upper most L2 level. The conus medullaris and included coronal part of the spinal cord show normal signal and shape.T12-L1: No disc herniation. Mild facet arthropathy. No spinal canal or foraminal stenosis.L1-L2 and L2-L3: Minimal disc bulge but no spinal canal or foraminal stenosis.L3-L4: Disc bulge flattens the ventral aspect of the thecal sac. Moderate facet arthropathy and mild ligamenta flava thickening. There is mild narrowing of the subarticular recesses but no nerve displacement and no central spinal canal stenosis. No significant foraminal stenosis.L4-L5: Disc bulge and severe bilateral facet arthropathy (with a small synovial cyst arising from the dorsal aspect of the left facet) cause no significant spinal canal stenosis but mild-to-moderate left and mild right foraminal stenoses. Edema like signal involving the marrow of the left articulating pillar is probably reactive to facet arthropathy. L5-S1: Spondylolisthesis and anterior subluxation are associated with anteroposterior elongation of the spinal canal. Severe facet arthropathy, associated with minimal effusion, results in moderate transverse spinal canal stenosis and moderate biforaminal stenosis. In addition to disc and covering by the subluxation, there is a tiny right paracentral disc protrusion with coronal migration which abuts the traversing right S1 nerve root.

Output: 1.The study is mildly motion degraded.2.There is no definite, destructive spinal osseous metastasis. Foci of edema-like marrow signal abnormality subjacent to the endplates, as described above, are most likely degenerative in nature. Also, similar signal abnormality involving the left L4 as well as the left C2-C3 articulating pillars is probably reactive to facet arthropathy.3.L5-S1 spondylosis and anterior subluxation along with severe facet arthropathy are associated with moderate transverse spinal canal and biforaminal stenoses. Tiny right paracentral L5-S1 disc protrusion abuts the right S1 nerve root. Please correlate with right S1 radiculopathy.4.There is no spinal cord signal abnormality.


Instruction: Generate impression based on findings.

Input: 31 years Female (DOB:9/6/1985)Reason: history of optic chiasm glioma History: history of glioma very subtle right inferior homonymous with no change when compared to fields from 2001. Optometrist noted pallor in the left optic disc.PROVIDER/ATTENDING NAME: JEFFREY W. NICHOLS JEFFREY W. NICHOLS The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for recurrence of the chiasmatic or optic nerve glioma.


Instruction: Generate impression based on findings.

Input: History of pancreatitis and pseudocyst in the past. Recently noted fluid collection status post IR drain. Evaluate for pancreatic duct leak. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity without a focal suspicious lesion. Status post cholecystectomy. The common bile duct measures 8 mm, likely related to postcholecystectomy state. It tapers smoothly distally. There is suboptimal contrast opacification limiting evaluation of the vasculature.SPLEEN: Perisplenic high T2-weighted signal intensity fluid collection measuring approximately 2.8 x 2.5 cm, not significantly changed in size from recent CT. Note is made of the gastro-cystostomy tract (series 601/26) which appears to communicate with the collection.PANCREAS: There are peripancreatic inflammatory changes. Long segment stricture of the main pancreatic duct extending from the body to the tail with mild upstream dilatation at the distal tail measuring 4 mm, similar in appearance to the prior. This dilated duct may communicate with the perisplenic pseudocyst although this is not definitively demonstrated. Note is made of the gastrocystostomy tract (series 601/24). There is a very small peripancreatic pseudocyst measuring 9 x 8 mm at the level of the pancreatic body (series 701/26), unchanged.Due to suboptimal contrast opacification evaluation for pancreatic necrosis is suboptimal.Following secretin administration there is a mild excretory response of the pancreas with fluid filling the proximal duodenum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: In the anterior pararenal space abutting the lateral chest wall there is a 2.9 x 1.4 cm fluid collection, slightly decreased from the prior study with drainage catheter noted extending to the subcutaneous soft tissues where there is mild induration.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Compared to the recent CT the perisplenic fluid collection is essentially unchanged and the left anterolateral pararenal space fluid collection is slightly decreased in size with drainage catheter in place.2.Persistent main pancreatic duct stricture with distal ductal dilatation. The pancreatic duct at the level of the tail may communicate with the perisplenic fluid collection but this is not definitive. The perisplenic collection does appear to communicate with the gastrocystostomy tract.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: r/o stroke History: left side arm heaviness, left side hearing loss There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is focal tissue loss on the left frontal periventricular white matter with T2/FLAIR high signal intensity.There is no evidence of abnormal enhancement.Scattered couple FLAIR high signal intensity lesions on bilateral white matter are non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement.3. Focal tissue loss on the left frontal periventricular white matter.


Instruction: Generate impression based on findings.

Input: 14-year-old male with trisomy 16 and hypoplastic dislocated shoulder.IMAGE ACQUISITIONS: CT of both shoulders without contrast enhancement processed in transverse, sagittal, and coronal planes. Left shoulder: As seen on prior radiographs, there is a deformed, angulated scapula with a dysplastic, shallow, and retroverted glenoid. The articular surface of the glenoid is essentially parallel to the axis of the medial aspect of the scapular body. The humeral head articulates with the glenoid, but appears slightly anteriorly subluxed. The coracoid process extends directly anteriorly from the dysmorphic neck of the scapula, resulting in a coracohumeral interval of over 2cm As seen on radiographs, the acromion is elongated and courses anterosuperiorly in relation to the humeral head. There is a linear lucency that partially traverses the acromion and has adjacent sclerosis; we are uncertain if this is an additional developmental defect or a stress fracture. The distal end of the clavicle is located superior to the ossification center of the acromion process.Right shoulder: There is a similar abnormal morphology to the right shoulder with a shallow, dysplastic, and retroverted glenoid that articulates with the humeral head. There is a small bone fragment along the posterior lip of the glenoid that may be posttraumatic in etiology. As with the left shoulder, the coracoid extends directly anterior from the scapular neck. The distal clavicle lies superior to the ossification center of the acromion.The spine is incompletely visualized, however, there is levoscoliosis of the cervicothoracic spine. Please refer to spine MRI for further spine report.

Output: Bilateral shoulder abnormalities as described above.


Instruction: Generate impression based on findings.

Input: Reason: history of seizures with fever, please eval for structural abnormality History: complex febrile seizure vs partial seizure with fever No abnormal signal is seen on the diffusion weighted images. Increased periventricular white matter T2 hyperintensity is noted. Small focus of T2 hyperdensity is also noted left parietal lobe subcortical white matter. There is a linear FLAIR signal extending from the white matter to the cortex of the right cerebellar hemisphere not seen on any other MRI sequence. This is nonspecific but a developmental venous anomaly is suspected. This may be better detected on enhanced imaging.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. The ventricles are slightly large. The basal cisterns are normal in size and configuration. No extra-axial fluid collection is identified.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.

Output: 1.Abnormal periventricular T2 signal and mild ventriculomegaly is nonspecific and may represent periventricular leukomalacia and less likely an underlying metabolic disease. Correlation with the patient's history is recommended.2.Linear FLAIR signal extending from the white matter to the cortex of the right cerebellar hemisphere is nonspecific but a developmental venous anomaly is suspected. This may be better detected on enhanced imaging.Findings paged to Dr. Cook at 1119 on 3/21/15.


Instruction: Generate impression based on findings.

Input: Female 8 months old with hypotonia and global developmental delay, rule out structural anatomical abnormality Exam is mildly motion degraded. There is mildly diminished volume of the supratentorial white matter, which is particularly more prominent in the bilateral periatrial regions. There is mild associated prominence of the ventricles without hydrocephalus. There is normal myelination and sulcation. There is no evidence of intracranial hemorrhage, mass, acute infarct, or other focal signal abnormalities. There is no midline shift or herniation. The major cerebral flow voids are intact. Orbits, sella, and extracranial soft tissue structures are grossly unremarkable.

Output: Mildly diminished supratentorial white matter volume. Otherwise, no focal structural abnormalities are appreciated.


Instruction: Generate impression based on findings.

Input: 25-year-old female with chronic abdominal pain, diarrhea, elevation of inflammatory markers ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific findings to account for the patient's symptoms. Small and large bowel appear within normal limits.


Instruction: Generate impression based on findings.

Input: Limited evaluation of the cervical spine with sagittal T1 and STIR sequences per cord compression protocol demonstrates evidence of diffuse metastatic disease. No compression fractures. No obvious epidural tumor. No evidence of cord compression.THORACIC SPINE

Output: 1. Diffuse osseous metastatic disease in the cervical, thoracic, and lumbar spine. 2. There are multiple compression fractures throughout the thoracic and lumbar spine with osseous retropulsion and epidural tumor as detailed above. Findings are worst at the T6 level where there is impression and deformity of the thoracic cord related to retropulsion and epidural tumor. No associated cord signal abnormality. Mild spinal canal narrowing is seen at T8, T9, T12 and L3. Allowing for differences in technique, osseous retropulsion and spinal canal narrowing appears similar to prior CT from 10/29/2014.3. Epidural tumor extending into the neural foramina is seen at multiple levels, relatively more prominent at the T6-T7, T12-L1 levels as well as the left L3-L4 level.


Instruction: Generate impression based on findings.

Input: 14-year-old female with history of embryonal rhabdomyosarcoma of the cervix, 8 months off therapy. Evaluate for signs of recurrent disease. The uterus is normal. The ovaries are not visualized similar to prior exam. Again seen are 2 tiny round areas of low signal intensity within the vagina unchanged. Nonspecific T2 hyperintensity of the vaginal introitus and labia persists and appears unchanged. There is persistent enhancement of the vaginal mucosa. Small amount of free pelvic fluid unchanged.Slightly increased T2 signal in the symphysis pubis is unchanged.

Output: No evidence of disease recurrence. Otherwise no significant interval change from prior exam.


Instruction: Generate impression based on findings.

Input: 76 year old man with bioprosthetic AVR and CABG. Referred to assess for change in ascending aorta dilation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 166 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 76 ml (normal range 47+/-19), the LV mass index is 31 g/m2 (normal range 85+/-15), and the LV mass is 60 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a transmural area of late gadolinium enhancement in the basal inferior and inferolateral walls. The pattern is consistent with prior myocardial infarction. These segments are not likely to be viable. There is no evidence of other late gadolinium enhancement and the remainder of the myocardium is viable. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 72 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveA bioprosthetic valve is noted in the aortic position. Mitral ValveThe mitral valve opens widely and there is mild 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 ascending aorta is aneurysmal (fusiform). The dimensions are:Ascending aorta: 46x41mmProximal Arch: 34x34mmMid Arch: 30x33mmDescending Aorta: 29x27mmPulmonary 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 FindingsSternal wires are noted, surgical bypass clips are noted. Elevated right hemi-diaphragm with colonic interposition between the diaphragm and liver as an anatomic variant. 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 left size with normal systolic function (LVEF 55%) with evidence of a transmural myocardial infarction involving the basal inferior and inferolateral walls.2. Normal right ventricular size and systolic function (RVEF 53%).3. Ascending aortic aneurysm with a maximum diameter of 46mm, which is slightly larger when compared to the CMR study from 1/14/2015. 4. Bioprosthetic aortic valve noted. 5. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Reason: Soft tissue mass fifth digit left foot History: left foot pain Severely limited examination secondary to extensive patient motion artifact. The examination was terminated early due to the patient's inability to further tolerate the examination per the technologist note. A skin marker was placed over the dorsal aspect of the proximal phalanx of the fifth digit of the left foot. Note is made of multiple foci of decreased signal abnormality along the dorsal and lateral aspect of the proximal phalanx of the fifth digit of the left foot which correspond to the foci of calcification seen on recent radiographs. There is also diffuse bone marrow signal abnormality within the proximal phalanx of the fifth digit and head of the fifth metatarsal which is nonspecific. There is fluid within the fifth MTP joint indicating a mild synovitis. No definite erosions are identified. There is a small amount of fluid within the first MTP joint. There is deformity of the proximal phalanx of the fourth toe likely reflecting prior remote trauma.

Output: Limited examination demonstrating nonspecific bone marrow signal abnormality within the fifth metatarsal head and proximal phalanx of the fifth digit with foci of calcification in the overlying soft tissues. These findings are incompletely characterized and nonspecific but may represent the sequela of gouty arthropathy, avascular necrosis, prior trauma, or infection/osteomyelitis.


Instruction: Generate impression based on findings.

Input: Brain MRI:The left AICA is visualized coursing in close proximity to and may be in contact with the cisternal portion of the left facial nerve but evaluation is limited by motion. The left AICA does not appear to enter the left porus acusticus. There is no gross evidence of a mass or abnormal enhancement of the visualized cranial nerves, including the trigeminal or facial nerves.The ventricles and sulci are normal in size. There are no mass effect or midline shift. No DWI abnormalities are identified. There are no extraaxial fluid collections. Scattered mild periventricular and subcortical T2/FLAIR hyperintensities are noted likely from the sequelae of mild chronic small vessel ischemic disease.Brain MRA:There is antegrade flow within the distal bilateral vertebral arteries, the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. Note is made of a normal variant dominant left vertebral artery, Hypoplastic right ACA, small right PComA and nonvisualized left PComA. No arterial stenoses, occlusions or aneurysms are identified.

Output: The left AICA incidentally courses in close proximity to and may contact the cisternal portion of the left facial nerve but full evaluation is limited by motion. No mass or abnormal enhancement is noted along the trigeminal or facial nerve distribution, within significant limitations of patient motion. Unremarkable MRA head.


Instruction: Generate impression based on findings.

Input: Altered mental status, AIDS (CD4 6), evaluate for mass or stroke or signs of CNS infection. Please note lack of contrast limits the evaluation for infection. However, there is no evidence of intracranial mass, abscess or empyema. There are patchy and scattered bilateral cerebral white matter T2/FLAIR hyperintensity which are nonspecific, likely relating to small vessel ischemic changes. There is a small focus of T2/FLAIR signal in the right middle cerebellar peduncle abutting the fourth ventricle, which is not well evaluated without intravenous gadolinium, which is nonspecific and may also be related to prior ischemia. There are small foci of susceptibility in the left frontal lobe as well as along the wall of the left lateral ventricle compatible with chronic microhemorrhages and are nonspecific in distribution. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is aerated secretion in the sphenoid sinuses, as well as mucus retention cysts in the bilateral maxillary sinuses. There is trace fluid in the bilateral mastoid air cells. The bone marrow signal is diffusely heterogeneous which is nonspecific.

Output: 1. Lack of contrast limits evaluation for intracranial infection. There is however no evidence of mass, abscess, or empyema.2. Scattered nonspecific cerebral T2/FLAIR white matter lesions are nonspecific, but most compatible with mild chronic small vessel ischemic disease. Small focus of T2/FLAIR hyperintensity along the right middle cerebellar peduncle abutting the fourth ventricle may also be related to the same but not well evaluated without contrast and remains nonspecific. If there remains suspicion for intracranial infection, consider post gadolinium sequences if renal function improves or lumbar puncture for further evaluation.3. Diffuse heterogeneity of the bone marrow signal is nonspecific. No frank osseous destructive lesions are seen.


Instruction: Generate impression based on findings.

Input: Other disorders of psychological development [F88] / Other symptoms and signs involving the musculoskeletal system [R29.898], Reason for Study: ^Reason: Please evaluate for abnormality to explain hypotonia, or for Chiari History: Global developmental delay. No evidence of acute ischemic or hemorrhagic lesion.No evidence of intra-axial or extra-axial mass lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No mass lesion.No evidence of Chiari malformation.


Instruction: Generate impression based on findings.

Input: Elevated PSA. Negative prior biopsies. PELVIS:PROSTATE:Prostate Size: 6.1 x 6.5 x 7.9 cm.Peripheral Zone: The peripheral zone is diffusely thinned. In the medial mid gland there is a 5 x 5 mm round focus of subtle T2-weighted hypointensity without associated restricted diffusion or enhancement, low suspicion. No suspicious focal lesion in the peripheral zone. Central Gland: Marked benign prostatic hyperplasia without a discrete suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No dominant suspicious lesion evident. 2.Marked BPH.


Instruction: Generate impression based on findings.

Input: Pain. Suspect medial meniscus injury. MENISCI: There is a small undersurface tear at the posterior horn of the medial meniscus. The lateral meniscus is within normal limits.ARTICULAR CARTILAGE AND BONE: There is mild chondral softening at the medial facet of the patella, without full-thickness defect or underlying bone marrow reactive changes. There is a full thickness defect with underlying bone marrow reactive changes at the deep flexion portion of the medial femoral condyle. The remainder of the cartilage and bone marrow is unremarkable.LIGAMENTS: The cruciate and collateral ligaments are intact and unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Small undersurface tear of the posterior horn of the medial meniscus.2. Focal areas of chondromalacia, as above.


Instruction: Generate impression based on findings.

Input: Redemonstrated is near-complete compression deformity of T12 centrally and anteriorly with retropulsion of fragments posteriorly abutting the distal thoracic cord causing anterior flattening, however without cord compression. These findings are unchanged when compared to the 2008 MRI.There are no acute fractures. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: Unremarkable and unchangedL2/3: Mild disc bulge, ligamentum flavum thickening, and mild bilateral facet hypertrophy which appears similar although there is new mild right lateral recess stenosis.L3/4: Mild disc bulge, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There are no stenoses. These findings are unchanged.L4/5: Grade 1 anterolisthesis L4 on L5, asymmetric bulge to the right with disc uncovering, ligamentum flavum thickening, severe bilateral facet hypertrophy, and small bilateral facet effusions. There is severe central, severe bilateral lateral recess, and moderate bilateral neural foraminal stenosis which have progressed.L5/S1:Unremarkable and unchanged

Output: 1.L2/3: New mild right lateral recess stenosis.2.L4/5: Severe central, severe bilateral lateral recess, and moderate bilateral neural foraminal stenosis, which have progressed.


Instruction: Generate impression based on findings.

Input: There is a large right-sided chest wall mass just anterior to the manubrium and sternum which is incompletely imaged, and seen on prior PET/CT to represent metastasis. Additionally, there is partial visualization of a larger right lateral chest wall mass.There is moderate to severe motion artifact which significantly limits evaluation. While there are are multiple enlarged lymph nodes in the right subpectoral region and axilla, with the largest lymph node in the right infraclavicular fossa measuring 16 x 10 mm. There is no significant mass-effect or compression of the brachial plexus/neurovascular bundle suspected however the branches of the right brachial plexus appear to course into the large lateral right chest wall mass.There is mild cervical spondylosis.

Output: 1.Moderate to severe motion artifact limited examination with no evidence for right brachial plexus compression. However the right brachial plexus branches appear to course into the area of the large right lateral chest wall mass.2.Large right-sided chest wall masses partly imaged, consistent with metastases. Also lytic left manubrial metastasis.


Instruction: Generate impression based on findings.

Input: Dedicated images through the sella demonstrate a slightly enlarged bony sella which is CSF density filled consistent with partially empty sella as there is minimal enhancing pituitary tissue along the floor identified. This appearance is stable since prior MRI from August 2015. No focal abnormal signal intensity or mass is seen within the pituitary gland. The pituitary stalk lies in the midline. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.Left Meckel's cave is slightly larger than the right, likely normal variant. Minimal fluid is also seen along the left inferior meatus.There is mild mucosal thickening in the visualized left maxillary sinus.

Output: Stable appearance of slightly enlarged bony sella (which may been referenced on the outside sinus CT), with partially empty appearance and therefore no enlargement of the pituitary gland itself, as questioned. This appearance is stable since August 2015 and is most often an incidental finding especially in the setting of other prominent subarachnoid spaces as noted in this patient, although the finding can be associated with pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Female 24 years old Reason: 24 y/o with recent diagnosis grade II endometrial cancer History: vaginal bleeding PELVIS:UTERUS, ADNEXA: The uterus measures 8.0 x 4.3 x 5.6 cm. The endometrial thickness is 2.1 cm. On the early postcontrast phase of imaging, there is subtle post contrast heterogeneous perfusion involving the right anterolateral aspect of the myometrium adjacent to the tumor. This normalizes on the more delayed phase of imaging. There is some heterogeneous loss of the junctional zone involving the posterior fundal aspect of the uterus likely representing areas of focal myometrial lesion.Tumor also extends into the lower uterus to the level of the internal cervical os.. No evidence of parametrial extension.Right ovary is normal. Left ovary has a fat containing mass measuring 5.4 x 5.1 cm on image 85/series 1103. Imaging features are compatible with dermoid cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Endometrial tumor as detailed above.2.5.4 cm left ovarian dermoid.


Instruction: Generate impression based on findings.

Input: Developmental delay and lack of expected normal physiological development in childhood. The cortical sulci are in proportion to the cerebral ventricles. Prominent perivascular spaces are demonstrated in the bilateral parietal lobes, right greater than left. No midline shift or mass effect is appreciated. The gray-white matter junction is preserved. There is no diffusion restriction to suggest acute ischemia. No abnormal gradient susceptibility is demonstrated. No intra-axial or extra axial fluid collections are visualized. Myelination appears appropriate for age.

Output: Prominent perivascular spaces in the bilateral parietal lobes, right greater than left, are nonspecific and may be an incidental finding. However rounded appearance of some especially can be associated with mucopolysaccharidosis. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: Female 54 years old Reason: Left shoulder rotator cuff tear History: Left shoulder pain ROTATOR CUFF: Supraspinatus tendinopathy, with no discrete rotator cuff tear identified.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Supraspinatus tendinopathy with no discrete rotator cuff tear. Large joint effusion.


Instruction: Generate impression based on findings.

Input: A 55 male with paroxysmal atrial fibrillation s/p ablation, family history of premature coronary artery disease. In 2010 because of atypical symptoms the patient was catheterized and found to have non-obstructive coronary artery disease. In 6/2015 he had another catheterization because of similar symptoms and was found to have an ostial left main stenosis of 40-50% with non significant FFR and minimal lumen area of 8mm2. The patient was referred to cardiac MRI for follow up.MEDICATIONS: rivaroxaban, Lipitor, lisinopril First Pass PerfusionDuring hyperemia, no perfusion defects were present. A mild dark rim artifact is noted.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 208 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 87 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 106 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 207 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 82 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is trace pericardial effusion.Extracardiac FindingsMild thyroid enlargement. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 58%).4. Normal RV size and systolic function (RVEF 60%).5. Mild biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 18 years old patient. Assess for postop bleed craniotomy in 11/19. The patient is status post left frontal craniotomy appeared and there is an extra-axial hemorrhagic fluid collection of present underneath the craniotomy flap with a fluid fluid level associated some air bubbles. It is adjacent to the high convexities and measures approximately 9 mm in thickness comparedA 1 cm hyperdense focus is present adjacent to the right chest appear frontal gyrus which has an extra-axial location. It was present on the MRI of 11/17/09.There is vasogenic edema present where the patient's known mass was paired this is edema pattern is stable since 11/19/09 MRI. There is some mass effect associated.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post left frontal craniotomy for tumor surgery.2.There is a left-sided subdural hemorrhagic fluid collection present with some mild mass effect apparent3.A 7mm extra-axial hyperdense focus is present adjacent to the right superior frontal gyrus. This could represent a small meningioma.


Instruction: Generate impression based on findings.

Input: Primary CNS lymphoma. Status post chemotherapy and stem cell transplant. Worsening right ocular ptosis. There is no acute infarct or acute intracranial hemorrhage. The confluent and patchy T2-hyperintense signal involving the periventricular and deep cerebral white-matter is not significantly changed since the previous examination. Similar involvement is present in the lateral aspect of the left cerebellar hemisphere. The frontal horn of the right lateral ventricle remains small while the remainder of the ventricular system as well as the other CSF-containing spaces remain enlarged reflecting underlying brain volume loss. There is no contrast-enhancing or space-occupying brain lesion. The cavernous sinuses are symmetric and the Meckel's caves are preserved. There is no abnormal leptomeningeal enhancement.There is mild anterior ethmoid sinus mucosal thickening. There are changes of previous bilateral cataract surgery but the orbits are otherwise unremarkable. There is no definite destructive skull lesion.

Output: 1.There is no new intracranial contrast enhancement or mass to suggest tumor recurrence.2.There is no acute infarct or intracranial hemorrhage.3.Unchanged brain white-matter abnormality perhaps representing a combination of sites of prior lymphomatous disease and some superimposed posttreatment change or chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: 63 years Male (DOB:3/25/1953)Reason: metastatic hnc History: metastatic hncPROVIDER/ATTENDING NAME: VASSILIKI SALOURA VASSILIKI SALOURA There is an extra-axial mass which involves the superior sagittal sinus posteriorly measuring approximately 68 x 15 x 24 mm. Inferiorly the torcula appears to be patent.There is a 4 mm enhancing focus present in the right cerebellar hemisphere. There is a 5 mm enhancing focus present in the right temporal lobe adjacent to the temporal horn of the left lateral ventricle. There is a 7 mm enhancing focus present in the left medial occipital lobe contiguous with the above described lesion. There is a punctate enhancing focus present in the left parietal lobe subcortical white matter. There is a punctate focus of enhancement along the right occipital lobe cortex. There is enhancing tissue behind the adjacent occipital calvarium associated with intervening loss of marrow signal suggesting that this mass extends through the occipital bone into the adjacent subcutaneous tissues.The cerebellum appears to be somewhat atrophic in appearance.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a mass involving the distal aspect of the superior sagittal sinus which has enlarged relative to prior exams. It appears to be associated with occlusion of the superior sagittal sinus. The lesion appears to extend through the adjacent occipital bone and infiltration into the adjacent subcutaneous tissues behind the occipital bone. MR or CT venography would help confirm the occlusion of the superior sagittal sinus. It appears not to have been present in October 2015 to the extent of visualization possible. Differential considerations include metastases, meningioma, lymphoma, granulomatous lesion as well as other neoplasms potential involving superior sagittal sinus. Given findings suspicious for brain metastases metastasis would be high on the differential.2.There are multiple lesions scattered in the cerebellum and supratentorial brain which are suspicious for metastatic disease. These are not readily appreciated on the prior CT exams.3.Cerebellar atrophy4.Examination is degraded due to patient motion artifact which may obscure more subtle abnormalities.5.An email was sent to Dr Saloura at the time of this dictation.


Instruction: Generate impression based on findings.

Input: 69-year-old male with family history of HCC and liver lesion seen on outside hospital imaging. ABDOMEN:LIVER, BILIARY TRACT: Small right hepatic lobe cysts. No suspicious hepatic lesions. Status post cholecystectomy. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant abnormality.


Instruction: Generate impression based on findings.

Input: Macro clinical ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is a mildly T2 hyperintense mass at the Klatskin point that measures 7.2 x 5.5 cm. This obstructs the biliary tree causing severe intrahepatic biliary ductal dilatation. At the periphery of the liver especially in the left lobe there are multiple T2 hyperintense cystic foci that show restricted diffusion and are suspicious for hepatic abscesses. There are other lesions in the liver that are mildly T2 hyperintense and is suspicious for metastatic disease.Patent vessel flow voids are present within the main portal vein indicating patency.Gallbladder contains multiple gallstones and is mildly distended. The gallbladder neck is obstructed by the Klatskin mass. There are trapped gallstones in the gallbladder neck.Distal common bile duct is normal in caliber.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology without pancreatic ductal dilatation. No focal pancreatic mass is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Upper abdominal small bowel is not distended.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild upper abdominal ascites.

Output: 1.Findings of a large mass at the Klatskin point with severe intrahepatic biliary ductal dilatation suspicious for a cholangiocarcinoma.2.Multiple cystic foci in the periphery of the liver near the dilated bile ducts most suspicious for hepatic abscesses.3.Scattered other lesions in the liver suspicious for metastatic disease.4.Cholelithiasis with gallbladder distention.5.Findings discussed with Dr. Wali at 11:40am by the radiology resident on call


Instruction: Generate impression based on findings.

Input: Acute mental status changes x 1 week There is no evidence of intracranial hemorrhage, mass, edema or midline shift. Areas of subcortical and periventricular white matter hypodensity indicate small vessel ischemic disease of indeterminate age. If there is concern for an acute stroke, an MRI may be considered for further evaluation.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease of indeterminate age. No acute intracranial findings.


Instruction: Generate impression based on findings.

Input: 66-year-old female with abnormal LFTs. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Severe cirrhotic morphology is again noted. No evidence of arterially enhancing and washing out lesions. The common hepatic artery, hepatic veins, main portal vein, left and right portal veins are patent.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large-volume ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right and moderate left pleural effusions.

Output: 1.Severe cirrhosis without any suspicious arterially enhancing and washing out lesions to suggest hepatocellular carcinoma.2.Large volume ascites.3.Small right and moderate-sized left pleural effusions.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with history of recurrent ovarian cancer and worsening right low back pain. Assess for spinal metastases, osseous abnormality, or disc abnormality. Spinal alignment is anatomic. Vertebral body heights are preserved. Uniform fatty marrow replacement from L2 down is likely related to radiation therapy.Schmorl's nodes are seen along the L3-4 endplates. More anteriorly along the L3 inferior endplate, there is a T1 hypointense, T2 heterogeneous mildly enhancing lesion which is nonspecific. Mild associated sclerosis is seen on prior CTs dating back at least to 2/19/2014.Aside from these findings, no other concerning areas of marrow signal abnormality are detected.The visualized spinal cord, conus and cauda equina are unremarkable. No pathologic intraspinal enhancement is suspected.Mild loss of disc height affects L3-4 and L4-5. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Mild bulging disc with a superimposed right foraminal protrusion. No significant generalized spinal canal stenosis. Moderate right foraminal narrowing. L3-4: Mild bulging disc. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Marked right facet hypertrophy. Mild left facet hypertrophy. Ligamentum flavum thickening. Mild laterally bulging disc. No significant spinal canal stenosis. No significant neuroforaminal narrowing. A right retrocrural pathologic lymph node is identified. Left renal pelvocaliectasis is also redemonstrated.

Output: 1.No definite evidence of spinal metastatic is seen. A nonspecific lesion within the anterior aspect of the L3 vertebral body showing heterogeneous T2 signal characteristics and mild enhancement seems to have been present at least as far back as early 2014. This could represent a benign lesion such as a hemangioma. Given the history of malignancy, though, at least one follow-up exam demonstrating stability would be reassuring.2.A disc herniation at L2-3 on the right causes a moderate narrowing of the right neural foramen.3.Marked right facet arthropathy is seen at L5-S1.4.No areas of high-grade spinal canal or foraminal stenosis are seen.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for spinal cord infarct. Signs and symptoms: 9-year-old male with history of epidural lipomatosis, status post T3 -- T8 laminectomies now with bilateral leg paralysis. Pre-and post-enhanced cervical and thoracic MRI:Examination demonstrates increased T2 signal intensity and caliber of the cord extending from C5 inferiorly through the entire thoracic cord and reaching the conus consistent with extensive cord edema. The signal abnormality of the cord is more centrally located which is suggestive of an ischemic process. There is subtle inhomogeneity of the signal intensity of the cord. Although there is no distinct signal changes of acute bleed, possibility of minimal petechial hemorrhage however cannot be entirely excluded.Post-infused images demonstrate very faint patchy foci of suspected enhancement within the cervical and lower thoracic cord. This finding likely reactive and may represent leakage of contrast from the vasculature rather than a mass or vascular lesion.The overall appearance of this finding is highly suspected of a cord infarct. Less likely possibility of transverse myelitis cannot be entirely excluded.Diffusion-weighted images are suboptimal however demonstrate increased signal intensity of the thoracic cord which does not appear to extend to the cervical cord. This appearance may suggest presence of a cord infarct and vasogenic edema.Postoperative changes of multi-level laminectomy and with expected epidural enhancement at the surgical site and enhancement of posterior soft tissues of the upper is noted.

Output: 1.New since prior exam is diffuse cord increased T2 signal intensity and caliber extending from C5 through the conus and highly suggestive of ischemic stroke. Ill-defined faint foci of inhomogeneity of the cord raises the remote possibility of minimal associated hemorrhage. There are also very faint ill-defined patchy foci of high density on post infused images in the cervical and lower thoracic cord which is history of present enhancement or leakage of contrast from the vasculature.


Instruction: Generate impression based on findings.

Input: Infant born at 30 weeks with concern for genetic anomaly; microcephaly, single nare, cannot open eyes: microcephaly, midface hypoplasia. There is fusion of the frontal lobes and thalami with a monoventricle, absence of the falx cerebri, no discernible corpus callosum or olfactory apparatus, and prominent posterior intracranial prominent cerebrospinal fluid space. There is diffuse absence of cerebral gyri and sulci, yielding a lissencephalic appearance. There is deficiency of myelination. The cerebellum is relatively intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. There is an azygous anterior cerebral artery. There is severe microcephaly and hypotelorism. There is a single blind-ended nostril associated with a tubular, proboscis-like appendage, just inferior to the level of the orbits. There is bilateral otomastoid fluid signal.

Output: Findings compatible with alobar holoprosencephaly and cebocephaly.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for structural abnormality, evaluate Chiari. Signs and symptoms: Headache, Chiari malformation on CT measuring 6 to 7 mm. Pre and post enhanced brain MRI:Examination demonstrates 13 mm herniation of cerebellar tonsil through the foramen magnum with flattening deformity of the tonsil consistent with Chiari malformation.Diffusion-weighted images are unremarkable.Examination otherwise demonstrate normal anatomic cord morphology and signal intensity of brain parenchymal on all MRI sequences.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is unremarkable.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses and their pattern of enhancement is unremarkable.There is a multi branch vascular enhancement in the left posterior frontal lobe highly suggestive of a congenital developmental venous anomaly. This finding is not associated with any susceptibility signal changes to suggest a cavernoma. Unremarkable enhanced images otherwise for any detectable abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern. Minute mucosal thickening of bilateral ethmoid sinuses however is noted.Nonenhanced complete spine MRI:Examination of cervical spine demonstrate above described Chiari malformation with flattening deformity of the tonsils. The signal intensity and caliber of cervical cord remains within normal and in particular no evidence of syrinx is detected. There is normal anatomical developmental vertebral column and without evidence of spinal canal or neural foraminal compromise.CSF flow study demonstrate presence of biphasic flow through the foramen of magnum anteriorly. There is significantly diminished flow posteriorly through the foramen magnum and no convincing flow through the fourth ventricle or the aqueduct. MRI of thoracic spine demonstrate normal anatomical development of vertebral column without spinal canal or neural foraminal compromise.There is normal signal intensity and caliber of the thoracic cord and without evidence of syrinx.MRI of the lumbar spine demonstrate normal anatomical developmental vertebral column without spinal canal or neural foraminal compromise. There is normal termination of the cord at lower L1 level. There is normal signal intensity of the cauda equina and in particular without evidence of fatty filum.Incidental note is made of significantly dilated bladder without detectable abnormality of the bladder wall.

Output: 1.Pre- and post enhanced demonstrate Chiari malformation with 13 mm herniation of cerebellar tonsils with resultant flattening deformity. A small left frontal lobe developmental venous anomaly is detected and unremarkable exam otherwise. Paranasal sinuses, mastoid air cells and middle ear cavities are well pneumatized.2.Nonenhanced MRI of spine redemonstrate Chiari malformation as detailed above. Unremarkable total spine MRI otherwise as detailed above. CSF flow study demonstrate biphasic flow anteriorly through the foramen magnum and significantly diminished flow posteriorly without detectable flow through the fourth ventricle or the aqueduct.


Instruction: Generate impression based on findings.

Input: Treated low grade neuroglial tumor: surveillance. There are postoperative findings related to left frontal craniotomy for tumor resection. There is an unchanged area of enhancement associated with an ovoid area that contains susceptibility effect along the anterior margin of the right frontal horn. There is also no significant interval change in the surrounding confluent areas of T2 hyperintensity in the bilateral frontal lobes, adjacent to the surgical cavity. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.

Output: Unchanged post-treatment findings in the frontal lobes without evidence of tumor progression.