Instruction: Generate impression based on findings.

Input: 78-year-old male with a gait disorder and traumatic SAH and question of NPH. MRI brain: There is susceptibility effect along the right anterior lateral temporal convexity and frontotemporal operculum compatible with prior subarachnoid hemorrhage as seen on CT. There is also evidence of trace subdural hematoma along the right frontotemporal convexity without mass effect and probably present on prior CT although difficult to appreciate due to its size.Again demonstrated is moderate periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic disease. No evidence of acute infarct. There is lateral ventricular and focal areas of sulcal prominence which appear slightly disproportional to the degree of volume loss and could indicate a communicating hydrocephalus/NPH pattern. There is no abnormal parenchymal or meningeal enhancement aside from along the right cerebral convexity which may be reactive to the trace subdural hematoma. No intracranial mass or mass effect. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal scattered paranasal sinus mucosal thickening and a right maxillary sinus mucus retention cyst.MRI C-spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Interspace observations:C2-3: Mild right greater than left facet hypertrophy. No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex which contacts the ventral cord. Mild facet arthropathy with mild left neuroforaminal narrowing. No right neuroforaminal narrowing or spinal canal stenosis.C4-5: Small disc osteophyte complex which contacts the ventral cord. Mild facet arthropathy. Mild left neuroforaminal narrowing. No right neuroforaminal narrowing or significant spinal canal stenosis.C5-6: Disc osteophyte complex which mildly indents the ventral cord and ligamentum flavum thickening contributing to minimal spinal canal narrowing. Mild left greater than right facet and uncovertebral hypertrophy. Mild/moderate left neural foraminal narrowing. No right neural foraminal narrowing.C6-7: Mild facet hypertrophy and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.

Output: 1.Trace subarachnoid and subdural hemorrhage along the right frontotemporal convexity grossly similar to prior CT allowing for slight differences in technique. No intracranial mass or abnormal enhancing lesions.2.Ventricular enlargement which appears slightly disproportional to the degree of volume loss and raises possibility of communicating hydrocephalus/NPH in the appropriate clinical setting.3.Moderate chronic small vessel ischemic disease.4.No cord signal abnormality or significant spinal canal stenosis in the cervical spine at any level.5.Multilevel degenerative changes in the cervical spine with small disc osteophyte complexes at multiple levels which contact the ventral cord. There is however no significant spinal canal stenosis overall at any level or cord signal abnormality. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Medial joint pain MENISCI: There is attenuation of the posterior horn of the medial meniscus which may reflect changes of prior partial meniscectomy versus chronic attritional tearing. There is branching intermediate signal of the posterior horn of the medial meniscus which extends to both the tibial and femoral articular surfaces compatible with tear although this could also represent residual intrasubstance degenerative signal following meniscectomy. We suspect there is at least undersurface tearing of the posterior horn, however. There is mild medial extrusion of the body of the medial meniscus which also appears attenuated. The anterior horn of the medial meniscus is intact.There is attenuation of the posterior horn of the lateral meniscus which again may reflect changes of prior partial meniscectomy or chronic attritional tearing. There is obliquely and vertically oriented intermediate signal within the posterior horn which extends to the tibial articular surface which we suspect represents undersurface tearing although could represent residual intrasubstance degenerative signal following partial meniscectomy.ARTICULAR CARTILAGE AND BONE: There is moderate to severe degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle posteriorly with areas of full-thickness cartilage loss. A small focus of degenerative subchondral signal intensity is seen within the medial tibial plateau with mild degeneration of the overlying articular cartilage. There is moderate degeneration of the articular cartilage of the lateral compartment with full-thickness cartilage loss along the lateral femoral condyle and lateral tibial plateau adjacent to the posterior horn of the lateral meniscus. There is moderate degeneration of the articular cartilage of the patellofemoral joint. There are tricompartmental osteophytes.LIGAMENTS: The patient has undergone ACL reconstruction. Graft fibers can be traced from the femoral interference screw to the tibial interference screw and the graft itself is slightly ill-defined with intermediate signal intensity representing degeneration. Additional adjacent intermediate-low signal intensity is thought to represent scarring. Degenerative signal intensity is also seen within the lateral collateral ligament proximally with the remaining major ligaments intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Medial and lateral meniscus abnormalities as described above likely represent a combination of postmeniscectomy changes and degenerative tearing.2. Surgical changes of ACL reconstruction with intact graft showing features of degeneration and adjacent scarring.3. Osteoarthritis further detailed above; loose body noted within a Baker's cyst.


Instruction: Generate impression based on findings.

Input: 67-year-old male with a history of orthotopic liver transplant 11/05 with prior hepatic abscess, and biliary anastomotic stricture. Follow up evaluation of biliary stricture and hepatic abscess. ABDOMEN:LIVER, BILIARY TRACT: Note is made of diffuse low T2 signal abnormality affecting the liver and spleen with associated loss of signal intensity on in phase sequences, consistent with secondary hemosiderosis. There is moderate dilation of the right posterior segmental branch of the intrahepatic biliary system. The remainder of the intra-and extrahepatic biliary system is normal in appearance. Percutaneous biliary drain in place.No focal mass lesions are identified, however, lack of intravenous contrast limits evaluation of solid organs.SPLEEN: Note is made of diffuse low T2 signal abnormality affecting the liver and spleen with associated loss of signal intensity on in phase sequences, consistent with secondary hemosiderosis. 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: 1.Focal biliary ductal dilation of the right posterior segmental branch of the intrahepatic biliary system.2.Findings consistent with hemosiderosis of the liver and spleen.


Instruction: Generate impression based on findings.

Input: Right lower quadrant pain in a pregnant patient. 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: Gravid uterus with 3 fetuses noted. Please note that this study was not performed for the detailed evaluation of the fetuses. Oval soft tissue structure in the region of the right adnexa with several follicles likely represents a normal ovary measuring approximately 3.8 cm. There is minimal fluid in the right lower quadrant. On the coronal series #3 there appears to be a blind-ending tubular structure originating from the cecum which likely corresponds to the appendix which is normal in caliber without adjacent inflammatory changes.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 right lower quadrant pain. Please note that this study was not performed for the detailed evaluation of the fetuses.


Instruction: Generate impression based on findings.

Input: Female 29 years old; Reason: Pt Pregnant. R/O appendicitis History: abd pain, N/V ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. No biliary ductal dilatation. Gallbladder is not distended.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. No perinephric fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. The appendix is not identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Cystic area within the uterus likely represents the gestational sac. Exophytic fibroid noted in the right uterine body.Right ovary is enlarged measuring 6.4 x 5.9 cm with a large cyst measuring 3.5 cm and multiple peripherally located follicles. Vascular pedicle is thickened.There is fluid adjacent to the right ovary. The left ovary is normal in size with multiple small scattered follicles.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: 1.Findings suspicious for right ovarian torsion. Correlate with pelvic sonography.


Instruction: Generate impression based on findings.

Input: Confusion, evaluate for progression or recurrence of cerebellar cavernoma. There are post-surgical changes of a prior suboccipital craniotomy with underlying resection of a left anteromedial cerebellar cavernous malformation. There is a mild amount of residual hemosiderin staining at the resection cavity. Redemonstrated is a prominent adjacent developmental venous anomaly. The remainder of the brain demonstrates no new cavernous malformations, or other mass or mass effect. There is mild hypoplasia involving the inferior cerebellar vermis. Brain parenchyma is otherwise unremarkable for age. There is no restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Sella and orbits are within normal limits. The paranasal sinuses and mastoid air cells are clear.

Output: Post-surgical findings of suboccipital craniotomy for resection of a left anteromedial cerebellar cavernous malformation are again seen. Small resection cavity demonstrates slight evolution but is otherwise unchanged including mild amount of adjacent parenchymal hemosiderin staining. No new cavernous malformations.


Instruction: Generate impression based on findings.

Input: Male, 29 years old, history of neurofibromatosis type I with intermittent severe pain in the right arm. Extensive plexiform neurofibroma formation is seen along all of the cervical nerve roots including throughout the brachial plexi. The right brachial plexus is more extensively involved than the left. Bilateral heterogeneous masses are present within the apical thoraces with resultant inferior displacement of the lung apices. The mass on the left measures up to 60 mm, and the mass on the right measures up to 42 mm. A scoliotic deformity of the cervicothoracic junction is evident at the level of the apical masses.Numerous additional small tumors are evident within the mediastinum, deep spaces of the neck, and even perhaps the left laryngeal folds. The trachea is deviated to the left and mildly narrowed secondary to paratracheal tumor at the level of the thoracic inlet. Numerous cutaneous and subcutaneous nodules are evident.

Output: Extensive plexiform neurofibroma formation throughout the brachial plexi affecting the right side more than the left.Large bilateral apical thorax masses are seen. Given their heterogeneous appearance and disproportionate size relative to the other visualized neurofibromas, the possibility of malignant degeneration should be considered. Correlation with prior imaging if available would be helpful.Numerous additional small neurofibromas are evident within the cutaneous and subcutaneous tissues as well as the deep spaces of the neck.


Instruction: Generate impression based on findings.

Input: 43-year-old male with chronic pancreatitis and new onset right lower quadrant pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Numerous calcifications are scattered throughout the pancreas, compatible with chronic pancreatitis.A 14 x 9 cm cystic lesion is seen at the junction of the body/tail of the pancreas (series 3, image 41) with possible associated calcifications, unchanged from recent MRI.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is not definitively visualized. No right lower quadrant inflammatory changes are visualized.A tubular, blind ending structure (series 3, image 114) arises off the distal ileum, compatible with a Meckel's diverticulum. No adjacent inflammatory changes are visualized.Mild diffuse haziness of the mesentery is seen, not significantly changed.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace free fluid in the pelvis, unchanged.

Output: Meckel's diverticulum without adjacent inflammatory changes. Nonvisualized appendix without inflammatory changes in the ileocecal region to suggest appendicitis.Cystic lesion in the pancreas, unchanged from MRI from 7/15/09. In retrospect, this is compatible with a side branch IMPN. Follow-up MRI may beneficial.


Instruction: Generate impression based on findings.

Input: Knee pain. Heard popping this morning Severe degenerative changes are observed largely the medial compartment however changes are tricompartmental. On bone narrowing, sclerosis and osteophytes with subchondral cyst are noted. A large suprapatellar calcification and moderate effusion are also observed suggesting free loose body within the joint, this ovoid finding measures over 3 cm in length. No immediate superimposed acute abnormality, however MRI may be needed if internal derangement is now suspected.

Output: Severe osteoarthritic changes with suspected loose body and effusion, however no superimposed acute osseous abnormality observed


Instruction: Generate impression based on findings.

Input: For numbering purposes, there are total of 5 lumbar type vertebral bodies. There is minimal anterolisthesis of L4 on L5. Otherwise the alignment is anatomic. Foci of T1 and T2 hyperintensity in the L3 and L4 vertebral bodies are suggestive of hemangiomas. Vertebral body heights are preserved.The conus is normal in signal and morphology and terminates at L1-L2 level. The visualized intra-abdominal and paraspinal contents are unremarkable.There is mild desiccation of L2-L3, L3-L4, and L4-L5 intervertebral discs with no significant loss of height.T12/L1: No significant spinal canal or neural foraminal stenosis.L1/2: No significant spinal canal or neural foraminal stenosis.L2/3: There is a small right paracentral disc protrusion with no significant spinal canal or neural foramina stenoses.L3/4: There is a moderately sized left foraminal disc protrusion, resulting in severe left neural foraminal stenosis and probable impingement of the exiting nerve root. Additionally, there is mild facet joint hypertrophy bilaterally resulting in mild right neural foraminal stenosis. No significant spinal canal stenosis present.L4/5: There is a central disc protrusion and bilateral facet joint arthropathy and edema resulting in moderate spinal canal stenosis and severe left neural foraminal stenosis with possible nerve impingement and moderate-to-severe right neural foraminal stenosis.L5/S1: Mild facet joint hypertrophy, left greater than the right, resulting in mild left neural foraminal narrowing with no significant spinal canal stenosis.SI Joints: No significant abnormalities.

Output: 1.Left foraminal disc protrusion at the L3-L4 level, resulting in severe left neural foraminal stenosis and possible nerve impingement at this level.2.Central disc protrusion at L4-L5 which, with posterior element degeneration, contributes to a moderate generalized spinal canal stenosis. Facet arthropathy contributes to significant left foraminal narrowing at this level with possible nerve root impingement.


Instruction: Generate impression based on findings.

Input: Recurrent breast cancer with headache/blurring of vision. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. 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 scalp soft tissues are grossly unremarkable. There is left maxillary sinus mucosal thickening.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 60-year-old female with heel pain and overlying violaceous skin discoloration and rash. Question of fat necrosis following cortisone injection. Evaluate calcaneal fat pad and plantar fascia. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament are normal in appearance.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. ADDITIONAL

Output: Increased signal abnormality and thickening within the medial plantar aponeurosis suggesting a plantar fasciitis, although superimposed infection cannot been excluded by this examination. Nonspecific soft tissue edema along the plantar aspect of the calcaneus.


Instruction: Generate impression based on findings.

Input: History of elevated liver function tests. Evaluation limited by patient motion, body habitus, and lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly. There are a myriad rounded as well as geographic sites of increased T2 signal throughout the liver with interposed reticular or linear relatively decreased T2 signal, uncertain . The largest of the lesions do not appear to show restricted diffusion (no low ADC signal corresponding to the increased DWI signal observed) but difficult to exclude smaller sites of restricted diffusion. The gallbladder is collapsed. No gross biliary ductal dilatation, though MRCP images are heavily degraded by motion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: There is a nonspecific left adrenal nodule measuring 2.0 x 2.1 cm which is incompletely characterized due to lack of T1 in/out of phase and postcontrast imaging.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse signal abnormality of the visualized osseous structures compatible with metastases. There is apparent associated narrowing of the spinal canal in the lumbar spine. Scattered body wall edema.OTHER: Scattered mild abdominal pelvic ascites.

Output: 1.Limited and truncated examination.2.Hepatomegaly with diffuse hepatic signal abnormality as described above, appearance may be due in part to prior receipt of treatment (correlation with patient's clinical history recommended), difficult to include active metastatic disease. PET and/or contrast-enhanced CT using liver protocol may be considered for additional evaluation.3.Widespread osseous metastatic disease. Associated narrowing of the spinal canal in the lumbar spine which could be further evaluated with dedicated imaging if clinically warranted.4.Incompletely characterized left adrenal nodule.5.Small abdominopelvic ascites.


Instruction: Generate impression based on findings.

Input: Fall. History of stroke. The study is limited by patient motion.Cervical spinal alignment is notable for partial straightening which may relate to patient positioning. The vertebral bodies are preserved in height. There is mild multilevel degenerative marrow signal abnormality subjacent to the endplates, most pronounced at C3-C4, but no suspicious marrow abnormality. This is associated with multilevel loss of disc height and T2 signal, most pronounced at C5-C6 and C7-T1, where it is moderate. Multilevel shallow ventral indentations of the thecal sac are also present as described below, but there is no significant spinal canal stenosis. The cervical spinal cord shows normal morphology and signal, accounting for motion. There are secretions along the posterior nasopharyngeal/oropharyngeal wall but no abnormal soft tissue signal in the prevertebral soft tissues. There is also a small catheter extending from the esophagus below reaching superiorly to the lower most nasopharynx along posterior pharyngeal wall to the right of midline. It is not visible above this level but this may relate to the lack of fluid within the catheter lumen.C2-C3: No significant degenerative disc disease or spinal canal stenosis. Minimal left neural foraminal stenosis by uncovertebral arthropathy.C3-C4, C4-C5, C5-C6: Flattening of the anterior thecal sac by disc-osteophyte complex but no significant spinal canal stenosis. Mild bilateral neural foraminal stenosis by uncovertebral and facet arthropathy.C6-C7: No significant additional disc disease or spinal canal stenosis. No significant neural foraminal stenosis.C7-T1: Flattening of the anterior thecal sac by disc-osteophyte complex. Left more than right uncovertebral and facet arthropathy and moderate left neural foraminal stenosis.

Output: 1.Multilevel degenerative cervical spondylosis is relatively mild and results in no significant spinal canal stenosis. 2.There is moderate left C7-T1 foraminal stenosis. There is no or mild foraminal stenosis at the other levels as described above.3.The catheter in the esophagus is not visible by MRI above the soft palate which may be related to the lack of fluid within the catheter lumen. The possibility of malposition or retained tube across the oropharynx to upper esophagus would be better assessed clinically. Dr. Monther Qandeel discussed the above findings and recommendations with the NeuroICU residents (including Dr. Robin A Buerki) over the phone on 1/7/2016 at 1400 hours.


Instruction: Generate impression based on findings.

Input: Follow-up regarding neck abscesses. Please evaluate soft tissues of the neck for fistulous tracks. There postoperative findings related to prior incision and drainage in the left neck soft tissues. There is no evidence of residual fluid collections in the neck. There is asymmetric effacement of the left piriform sinus. There is now normal alignment of the cervical spine. There is no significant lymphadenopathy. The major salivary glands are unremarkable. The imaged intracranial structures are unremarkable. The imaged portions of the mediastinum and lungs are unremarkable.

Output: Postoperative findings related to left neck incision and drainage of an abscess, without evidence of residual fluid collections. However, a collapsed fistula related to an underlying branchial cleft anomaly cannot be entirely excluded. Therefore, an image-guided fistulogram may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Recurrent CNS lymphoma with headache and lethargy. There are postoperative findings in the left cerebellar hemisphere. The limited sequences suggest the presence of mass lesions with relatively restricted diffusion within the anterior right temporal lobe, right posterior corpus callosum, and perhaps the right corona radiata, with extensive surrounding vasogenic edema. There appears to be mild right uncal herniation, but no significant midline shift.

Output: The limited exam shows evidence of central nervous system lymphoma involving the anterior right temporal lobe, right posterior corpus callosum, and perhaps the right corona radiata, with extensive surrounding vasogenic edema.


Instruction: Generate impression based on findings.

Input: 66 year old man referred to evaluate aorta, aortic valve, and to rule out ischemia as a cause of his shortness of breath and chest pain. First Pass PerfusionDuring hyperemia, there is a nearly circumferential perfusion defect involving the basal, mid-ventricular, and apical slices. During resting conditions, no perfusion defect is noted. These findings are consistent with either multivessel coronary artery disease or microvascular dysfunction. 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 59%, the LV end diastolic volume index is 66 ml/m2 (normal range: 74+/-15), the LVEDV is 150 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 62 ml (normal range 47+/-19), the LV mass index is 56 g/m2, and the LV mass is 131 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 173 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 87 ml (normal range 54+/-17).Right AtriumThe right atrium is moderate dilated.Aortic ValveThe aortic valve is anatomically trileaflet; however, the right and non-coronary cusps are partially fused together and heavily calcified. There is evidence of poor leaflet excursion and flow acceleration through the aortic valve consistent, with aortic valve stenosis. Correlation with echocardiography is suggested to better quantify the severity. There is mild aortic regurgitation (RF 5%).Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trivial pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. No thoracic aortic aneurysm, dissection, or coarctation is noted. Sinus of Valsalva: 36x37x38mmST Junction: 32x34mmAscending Aorta: 33x34mmPulmonary 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 FindingsBilateral renal cysts are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a global circumferential perfusion defect present during stress consistent with either multivessel coronary disease or extensive microvascular disease.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 59%).4. Normal RV size and systolic function (RVEF 50%).5. The aortic valve is anatomically trileaflet; however, the right and non-coronary cusps are partially fused together and heavily calcified. There is evidence of poor leaflet excursion and flow acceleration through the aortic valve consistent, with aortic valve stenosis. Correlation with echocardiography is suggested to better quantify the severity. 6. No evidence of aortic dilation, dissection, or coarctation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of L3-L4, L4-L5 fusion. L1-L2 cyst. Evaluate for change in cyst size or abnormality. Right-sided low back pain. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. Alignment is grossly within normal limits, aside from perhaps minimal L4 on L5 anterolisthesis. Bone marrow signal is benign. The conus medullaris is normal in position. Postoperative changes of prior surgical fusion from L3 to L5 are again seen. Bilateral paraspinous rods, pedicle screws, and interbody grafts were better assessed on recent CT, which showed bony bridging.Susceptibility artifact from hardware slightly limits exam. Mild multilevel degenerative changes are seen including disc desiccation. Individual levels as below: L1-L2: There is approximately 5 x 6 x 7 mm lesion with T2 hyperintensity and peripheral enhancement involving the dorsal epidural soft tissues to the right of the midline abutting the ligamentum flavum. The lesion projects anteriorly with mild mild effacement of the dorsal thecal sac. Mild facet arthropathy with surrounding enhancement. There is also mild edema involving the right pedicle/transverse process junction.Disc desiccation and mild disc bulge also seen. Overall no significant central canal stenosis. Neural foramina are patent.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. Moderate bilateral facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Advanced bilateral facet arthropathy. Artifact related to hardware limits assessment; however previously seen synovial cysts on the left are not clearly appreciated and presumably have decreased in size.Mild degenerative changes at the sacroiliac joints also noted.

Output: 1. Subcentimeter benign-appearing cystic structure involving the right dorsal epidural space at the L1-L2 level which is not seen on preoperative imaging from 2/14/2015. Finding is favored to represent a synovial cyst. There is mild facet arthropathy at this level with enhancement which is likely on a degenerative basis. Ligamentum flavum cyst or perhaps residual chronic blood products related to prior intervention are other less likely differentials. There is mild indentation of the right dorsal aspect of the thecal sac without significant central canal stenosis overall at this level.2. No significant spinal canal or neural foraminal stenosis. Multilevel facet arthropathy, advanced at the bilateral L5-S1 level.


Instruction: Generate impression based on findings.

Input: 37 years Male (DOB:7/22/1978)Reason: evaluate for progression of NMO History: tingling of the feet bilaterally PROVIDER/ATTENDING NAME: DAVID A HARTER RIMAS V LUKAS MRI thoracic spine:An enhancing T2 hyperintense lesion is present within the thoracic spinal cord. The T2 hyperintensity extends from the T1-T2 level to the T6 vertebral level. The enhancing component extends from the T2-3 disc space level to the T4-5 disc space level. It is located centrally within the spinal cord.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is disc desiccation at T7-8 and T8-9.Sagittal images of the cervical spine demonstrate a broad-based central disc protrusion at C3-4.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is enhancing lesion present within the central portion of the upper thoracic spinal cord with adjacent edema. There are no other lesions appreciated within the spinal cord. Differential considerations include neoplasm and inflammatory lesion. Given the clinical history of NMO demyelinating plaque is certainly in the differential diagnosis.


Instruction: Generate impression based on findings.

Input: Assess for abscess versus hematoma of tongue: Left-sided tongue pain and swelling; ESBL E coli of buccal mucosa treated with 3 wks IV ertapenem (9/2015). There is now diffuse T2 hyperintensity and swelling with areas of relatively lower T2 signal within the left oral tongue and tongue base with extension into the submandibular space, floor of the mouth and buccal mucosa region. The mandible bone marrow signal appears to be unremarkable. There does not appear to be significant lymphadenopathy in the upper neck and the imaged portions of the major cervical flow voids appear to be intact. There is left retinal hemorrhage with a hematocrit level. There is a right lens implant. There is scattered mild paranasal sinus mucosal thickening. The imaged intracranial structures are grossly unremarkable.

Output: 1. Findings suggestive of left oral cavity and tongue base inflammation, such as a form of Ludwig angina, without definite abscess formation, although the assessment is limited due to the lack of intravenous contrast, versus hemorrhage with associated edema.2. Left intraocular hemorrhage.


Instruction: Generate impression based on findings.

Input: Ms. Iannitelli is a 44-year-old female with a personal history of left breast lumpectomy in 2008 for IDC with nodal involvement treated with radiation and chemotherapy. Personal history of benign right breast biopsy in 2011. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Susceptibility artifact from biopsy marker clip is identified in the right lower breast, at site of prior benign breast biopsy. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: MVC with back pain. Assess for acute process. Per the on call radiology resident memo, the patient also has a history of breast cancer with diffuse osseous lesions. Thoracic spine: There are multiple poorly defined lucent lesions involving the thoracic spine and ribs compatible with the stated history of metastatic breast cancer. There are multiple vertebral body compression fractures which I presume to be pathologic in nature, most notably affecting T4, T7, and T9-T12. While I suspect that most if not all of these are chronic, I cannot ascertain whether or not any individual compression fracture might be due to the patient's recent MVC. In addition to numerous rib lesions, multiple sites of rib deformity represent healing or healed fractures. Although the cervical spine is not optimally evaluated on these thoracic spine radiographs, on the swimmer's view there is suggestion of loss of height of the C4 and C5 vertebral bodies, which I suspect is pathologic in nature; please refer to the subsequent cervical spine MRI report for additional information. Poorly defined left lung basilar opacity is nonspecific and would be better evaluated with dedicated chest radiographs if clinically warranted. There is a right-sided central venous access device with its tip in the right atrium.Lumbar spine: Diffuse metastatic disease affects the lumbar spine. There is severe compression deformity of L3 and moderate compression deformities of L1 and L2, which I suspect are chronic. Facet joint osteoarthritis affects the lower lumbar spine.Pelvis: There is diffuse metastatic disease involving the bones of the pelvis with additional lucent lesions involving the proximal femora. Deformity of the right ischiopubic junction likely represents an old healed fracture; however, I see no acute fracture on this study.

Output: Widespread metastatic disease to bone with multiple cervical, thoracic, and lumbar spine compression fractures as described above.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of unspecified site [C79.9], Reason for Study: ^Reason: h/o metastatic melanoma with brain metastases and increased seizures/psychosis; eval for interval change of metastases/edema/hemorrhage History: see above Redemonstration of multiple peripheral enhancing intra axial lesions on bilateral hemispheres and bilateral cerebellar hemispheres indicating metastatic lesions, however, each enhancing lesions show overall decrease in maximum diameter as well as the extent of surrounding edema since prior scan.On gradient echo images, several of those lesions show increased extent of susceptibility artifacts indicating increased intra-lesional blood products such as interval intra-lesional hemorrhages.There is no new abnormal enhancing lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is 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. Interval decrease of multifocal intra axial metastatic lesions and the extent of surrounding edema since prior scan.2. Interval increase of intra lesional blood products since prior scan.3. No new abnormal enhancing lesion is seen.4. No evidence of acute ischemic lesion.


Instruction: Generate impression based on findings.

Input: Left upper extremity paresthesias, and prior neck injury. There is multilevel degenerative spondylosis. At C3-4, there is a posterior disc-osteophyte complex that abuts the spinal cord and there is moderate to severe bilateral neural foraminal narrowing. At C4-5, there is a posterior disc-osteophyte complex that also abuts the spinal cord and there is moderate left and mild right neural foraminal narrowing. At C5-6, there is a posterior disc-osteophyte complex that mildly narrows the spinal canal and there is at least moderate bilateral neural foraminal narrowing. At C5-6, there is a posterior disc-osteophyte complex that effaces the anterior thecal sac in the spinal canal and there is at least mild bilateral neural foraminal narrowing. There is no significant degenerative disease at C2-3 and C7-T1. There is lack of the usual cervical kyphosis, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative cervical spondylosis with variable degrees of spinal canal and neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Altered mental status, evaluate for brain metastases. There is no restricted diffusion to suggest acute infarction. There are scattered foci of increased T2/FLAIR signal within the bilateral cerebral white matter which do not appear significantly changed compared to the 8/20/2016 examination allowing for differences in technique. Previously seen signal abnormality on 8/8/2016 exam predominantly involving the bilateral posterior cerebral hemispheres likely related to PRES no longer seen. There is no evidence of acute intracranial hemorrhage or mass. There is an unchanged punctate focus of susceptibility in the left frontal lobe, which is nonspecific, but likely related to trace mineralization or chronic hemosiderin. No pathologic enhancement is identified. The ventricles and sulci are unchanged including a normal variant cavum septum pellucidum. There is no midline shift or herniation. The major cerebral flow voids are intact. There is diffusely decreased T1 signal within the bone marrow with a few scattered areas of preserved increased T1 signal which is nonspecific and may be related to chronic anemia.

Output: 1.No evidence of acute infarct or other acute intracranial abnormality.2.Few scattered areas of signal abnormality within the cerebral white matter which are nonspecific and not significantly changed compared to 8/20/2016. These may represent chronic small vessel ischemic changes or sequela of other injury.3.No evidence of intracranial metastases as questioned.


Instruction: Generate impression based on findings.

Input: Right knee pain after dancing Saturday. Check for ligamentous tear MENISCI: No significant abnormality noted. Specifically menisci appear intact.ARTICULAR CARTILAGE AND BONE: Minimal signal or malunion the subpatellar cartilage more pronounced underlying the medial facet. No distinct definite tear, however mild irregularity along the surface is suggested. Mild-to-moderate chondromalacia patellae. Medial and lateral compartment cartilage is otherwise unremarkableMild contusion is observed in the lateral tibial plateauLIGAMENTS: Minimal fluid in signal and amount is observed in the MCL towards the proximal origin. The remaining ligaments are otherwise intact and well visualizedEXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Combination of findings correlating with an moderate MCL sprain with an associated contusion of the tibial plateau, chondromalacia patellae and suprapatellar soft tissue edema. Specifically no underlying acute meniscal or retinaculum injury.


Instruction: Generate impression based on findings.

Input: Male, 36 years old, history of grade 2 astrocytoma status post biopsy and third ventriculostomy. Surveillance scan. A T2 hyperintense, well-circumscribed mass is demonstrated involving the tegmentum of the midbrain, slightly asymmetric to the right. This lesion is predominantly nonenhancing with the exception of one or two very small vessels which seem to penetrate it. There has been no significant change in size or morphology with the lesion continuing to measure approximately 19 x 18 mm in the axial plane. Mass effect upon the cerebral aqueduct is unchanged.Again seen is a tract running through the right frontal lobe to the level of the right lateral ventricle likely related to prior instrumentation. No new intracranial lesions are seen. Ventricle size and morphology are unchanged and normal.

Output: Stable midbrain mass.


Instruction: Generate impression based on findings.

Input: 3-year-old male with seizure disorder and history of grade 4 IVH. Evaluate for acute changes Low attenuation of left cerebellar hemisphere consistent with encephalomalacia. Regions of encephalomalacia are also seen in the periventricular areas consistent with findings on prior MRIThere is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial abnormality. 2. Left cerebellar and periventricular encephalomalacia as described in prior MRI.


Instruction: Generate impression based on findings.

Input: 28 year old woman with history of atrial septal defect who presents for further evaluation by cardiac MRI Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 71 ml/m2 (normal range: 65+/-11), the LVEDV is 130 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 71 g/m2 (normal range 67+/-11), and the LV mass is 130 g (normal range 114+/-24). There is diastolic flattening of the interventricular septum suggesting RV volume overload. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size.Atrial SeptumA sinus venosus type atrial septal defect is noted (i.e. a communication between right superior pulmonary vein, right superior vena cava, right atrium, and left atrium). The Qp:Qs is 2.6:1. The septum bows from right to left.Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 231 ml/m2 (normal range 69+/-14), the RVEDV is 423 ml (normal range 110+/-24), the RV end systolic volume index is 104 ml/m2 (normal range 22+/-8), and the RVESV is 190 ml (normal range 35+/-13). Right AtriumThe right atrium is severely 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 moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsThe right inferior, left superior, and left inferior pulmonary veins drain normally into the left atrium. The right superior pulmonary vein is involved with the above mentioned sinus venosus type atrial septal defect.Pulmonary ArteryThe main pulmonary artery is moderately dilated in size measuring 35 mm.Venous AnatomyThe IVC drains normally into the right atrium. The right-superior vena cava is involved with the above mentioned sinus venosus type atrial septal defect. There is a persistent left-superior vena cava which drains into the coronary sinus. The coronary sinus is dilated.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with systolic function (LVEF 55%)2. The right ventricle is severely dilated with normal systolic function (RVEF 57%)3. The is a sinus venosus-type atrial septal defect (i.e. a communication between right superior pulmonary vein, right superior vena cava, right atrium, and left atrium). The QP:QS is 2.6:1.4. Anomalous right superior pulmonary venous drainage.5. Persistent left sided SVC draining into the coronary sinus.6. Severe right atrial dilation7. Main PA with moderate dilation8. Moderate tricuspid regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Follow up from 2011. Had partial patellar tendon rupture. Pt without follow up, now increased pain. Evaluate for further rupture. MENISCI: There is increased internal signal within the posterior horn of the medial meniscus; this does not appear to reach the surface and there is no definite evidence of a tear. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is a full thickness defect measuring up to 4-5 mm in width of the lateral facet of the patellar cartilage with underlying increased T2 bone marrow signal compatible with edema. LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The patellar tendon is intact. ADDITIONAL

Output: 1. Focal chondral defect of the patellar articular cartilage with underlying bone edema.2. Intact patellar tendons and cruciate ligaments.3. Abnormal internal signal within the posterior horn of the medial meniscus without definite tear.


Instruction: Generate impression based on findings.

Input: Female 56 years old Reason: 56 yo F hx of cystic pancreatic lesion s/p distal pancreatectomy in 8/2013,EUS 5/2015 showed residual pancreas with chronic pancreatitis changes and a cystic lesion in uncinate process. 1 year f/u MRI to assess for growth, also eval for chronic pancreatic History: cystic lesion of pancreas, chronic pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent.Status post cholecystectomy. Intrahepatic bile ducts and common bile duct are normal in caliber.SPLEEN: Status post colectomy. Probable residual splenic tissue adjacent to the left kidneyPANCREAS: Status post resection of the pancreatic tail. There is a subcentimeter cystic focus in the head of the pancreas measuring 9 mm that appears to communicate with the pancreatic duct and represents a small branch type IPMN.There is mild fatty atrophy of the pancreas.There is mild ductal irregularity of the pancreatic duct in the head of the pancreas in the region of calcifications previously noted.Upon administration of secretin, response is mildly blunted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: In the left kidney, there is a 9 mm partially exophytic lesion as seen on image 25/series 7. The lesion has questionable subtle enhancement. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post pancreatic tail resection and splenectomy. Small cystic lesion (9mm) in the pancreatic head with imaging features suggestive of a IPMN. Allowing for differences in modality the lesion is not significantly changed.2.Slightly blunted response to secretin in the setting of mild pancreatic atrophy.3.Cystic lesion in the left kidney has slightly suspicious features. The lesion is too small to fully characterize and a follow-up imaging study in 12 months can be performed.


Instruction: Generate impression based on findings.

Input: Other specified types of non-hodgkin lymphoma, extranodal and solid organ sites [C85.89], Reason for Study: ^Reason: evaluate for etiology of double vision History: concern for recurrence of orbital lymphoma Orbit MRINo evidence of recurrence mass within the orbit. There is no evidence of abnormal enhancement.The globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement.  Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Focal encephalomalacia on the left frontal lobe is again seen, unchanged.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 mastoid air cells are clear.Mucosal thickening are seen within the frontal sinus and ethmoid sinus. Empty sella is noted.Lumbar spine MRIFor the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is evidence of left side laminectomy at the level of L34, L4-5 and L5-S1.Soft tissue fluid collections are seen from L23 to L45 which likely represent postoperative changes.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal.The conus medullaris terminates at the L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L1-L2: Broad-based disc protrusion central to left which abuts thecal sac. However, no significant neuroforaminal narrowing or spinal stenosis. L2-L3: Disc desiccation with diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis. L3-L4: Left sided total laminectomy status. Diffuse bulging of disc with bilateral ligamentum flavum thickening results mild to moderate spinal canal stenosis. L4-L5: Left sided total laminectomy status. Diffuse bulging of disc with bilateral ligamentum flavum thickening results moderate to severe spinal canal stenosis. L5-S1: Left sided total laminectomy status. Diffuse bulging of disc with left side lateral recess stenosis.

Output: 1. No evidence of recurrence orbital tumor or abnormal enhancement within the orbit.2. No evidence of acute ischemic or hemorrhagic lesion or abnormal enhancement of the brain.3. Unchanged left frontal encephalomalacia since prior scan.4. Postoperative status, left side laminectomy from L3-4 to L5-S1.5. Degenerative changes of lumbar spine including various degree spinal canal stenosis at the level of L3-4, L4-5 and left lateral recess stenosis at L5-S1.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of metastatic renal cancer, status post retroperitoneal resection, evaluate for recurrence ABDOMEN: Examination limited by lack of intravenous contrast.LIVER, BILIARY TRACT: Stable bilobar T2 hyperintense hepatic lesions may represent cavernous hemangiomas. No intra or extrahepatic biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post left adrenalectomy. The right adrenal gland is normal.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrence within the left nephrectomy bed. Status post partial right nephrectomy. There is a complex septated lesion in the inferior pole of the right kidney measuring up to 1.5 x 1.0 cm (series 4, image 28), previously 1.4 x 0.9 cm. Additionally, there is a complex cystic lesion in the midpole of the right kidney, unchanged for 2 years, measuring 1.4 x 1.0 cm (series 4, image 42).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes affect the lumbar spine.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.

Output: 1.No evidence of recurrent or metastatic disease on this limited exam. 2.Complex cystic mass in the right midpole, unchanged for 2 years. RCC can not be excluded.3.Stable reference complex cystic right inferior pole lesion, likely represents postsurgical changes.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with right-sided weakness. Corresponding to the area of abnormality noted on prior CT, there is restricted diffusion involving the left operculum and insula, as well as the left frontoparietal junction, with smaller scattered foci of diffusion restriction in the left anterior frontal lobe, the temporal lobe and the occipital lobe. Mild T2 hyperintensity is seen corresponding to these areas of restricted diffusion. No significant generalized mass effect is detected. There may be minimal petechial blood product in the infarct region but no frank hemorrhagic conversion is seen.Elsewhere, scattered foci of T2 hyperintensity are seen within the cerebral hemispheres appearing similar to those noted on prior MRI. No abnormal fluid collections are detected. The ventricular system is normal in size and morphology.Abrupt occlusion of the inferior division of the left MCA is seen within the sylvian fissure. No other significant intracranial stenosis is suspected. No aneurysms are detected within the limitations of technique. The region of the ACOM artery is unremarkable. Prominent bilateral PCOM arteries are seen.In the neck, there is moderate narrowing of the right carotid bifurcation but no significant stenosis by NASCET criteria. The carotid system is otherwise unremarkable. The vertebral vessels of the neck are likewise free of significant vascular stenosis.

Output: 1.Findings compatible with acute left MCA stroke. No significant generalized mass effect or frank hemorrhagic conversion is seen.2.Abrupt occlusion of the inferior division of the left MCA is seen. Elsewhere, no significant intracranial vascular stenosis is detected.3.No significant vascular stenosis is seen in the neck.


Instruction: Generate impression based on findings.

Input: 51-year-old female with right knee pain, evaluate for medial meniscal tear MENISCI: Blunting of the free edge of the body of the medial meniscus is slightly more pronounced on the current study than the prior study, suggestive of free edge tearing. A small focus of low signal intensity just lateral to the free edge may represent a small meniscal fragment, but this is equivocal. Intrasubstance degeneration is seen within the body and posterior horn of the medial meniscus. A small linear focus of intermediate signal intensity involving the inner one third of the body of the lateral meniscus was not present on the prior study and may represent a small undersurface tear.ARTICULAR CARTILAGE AND BONE: There is subjective thinning of the articular cartilage within the medial femoral compartment which appears similar to the prior exam. There is near full thickness degeneration of the articular cartilage along the lateral femoral condyle immediately adjacent to the posterior horn of the lateral meniscus with a cartilage flap which is new from the prior exam. There is a focal full-thickness defect of the articular cartilage along the lateral tibial plateau at the base of the intercondylar eminence which appears to have progressed slightly since the prior exam. There is also degeneration of the articular cartilage along the posterior and anterior aspects of the lateral femoral condyle which is similar to the prior exam. There are osteophytes along the medial aspect of the femoral trochlea with thinning of the overlying cartilage, similar to the prior exam. Degeneration of the articular cartilage of the patella is unchanged. Tricompartmental osteophytes are present. A lesion in the distal femoral metaphysis measuring 1.6 cm likely represents a benign enchondroma, similar to the prior exam.LIGAMENTS: The ACL and PCL are intact. The MCL and lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The quadriceps tendon is intact. The patellar tendon is intact, although there is an additional band of low signal intensity extending from the inferior patella to proximal tibia which presumably represents scar tissue.ADDITIONAL

Output: 1.Blunting of the free edge of the body of the medial meniscus is slightly more pronounced than on the prior exam and is suggestive of free edge tearing. A small focus of low signal intensity just lateral to the free edge may represent a small meniscal fragment, but this is equivocal.2.Findings suggestive of a small tear involving the inner third of the body of the lateral meniscus, which is of questionable clinical significance.3.Osteoarthritis as described above with progression of cartilage defects involving the lateral compartment.4.Postoperative findings from prior arthroscopy and other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 48 years old. Reason: right knee medial meniscus tear History: knee pain MENISCI: There is a bucket-handle tear of the medial meniscus with displacement of the bucket-handle fragment along the medial tibial spine. Additional branching signal abnormality within the posterior horn of the medial meniscus is seen extending to the femoral and tibial articular surfaces representing complex tearing. Overall, the appearance is similar to that seen on the prior study. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Subjectively the articular cartilage of the medial compartment appears thinned, particularly along the tibial plateau beneath the posterior horn of the meniscus and along the weightbearing surface of the medial femoral condyle. There is also a small full-thickness defect anteriorly along the medial femoral condyle. The articular cartilage of the lateral compartment appears relatively normal. There is a partial-thickness cleft of the articular cartilage of the medial articular surface of the patella and mild blistering of the articular cartilage of the lateral articular surface of the patella. Overall, these findings appear similar to those seen on the prior study. Bone marrow signal intensity is within normal limits.LIGAMENTS: The ligaments of the knee appear normal. EXTENSOR MECHANISM: The extensor mechanism is intact. There is scarring along the anterior capsular structures of the knee which presumably reflects prior surgery.ADDITIONAL

Output: Bucket-handle tear of the medial meniscus and other findings as described above.


Instruction: Generate impression based on findings.

Input: Left renal mass status post cryotherapy ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted in the liver. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The left upper pole renal lesion is unchanged in size at 2.1 x 2.1 cm (series 3, image 23) and without change in signal characteristics. Post-ablation changes are again identified. Lack of intravenous contrast limits assessment for enhancing/suspicious components. No definite restricted diffusion is seen. Multiple additional simple appearing cysts are noted bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No retroperitoneal or abdominal lymphadenopathy.BOWEL, MESENTERY: Partially imaged large hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites. Small right and trace left pleural effusions.

Output: 1.Stable appearance of the ablated left upper pole renal lesion. Lack of intravenous contrast limits assessment for solid neoplasm, and continued follow-up is recommended given the patient's history of papillary renal cell carcinoma.2.No abdominal or retroperitoneal lymphadenopathy.3.Small amount of non-specific ascites, small right greater than left pleural effusions.


Instruction: Generate impression based on findings.

Input: Clinical question: No acute intracranial abnormality. Bleed, metastases. Signs and symptoms: history of metastatic prostate cancer. New onset of headaches for one week associated with eye pain and balance problems Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. A very subtle area of low-attenuation with apparent involvement of cortex and subcortical white matter of left frontal lobe is present. The exact etiology of this finding is not clear however the finding could represent small ischemic stroke. The age of this is stroke cannot be determined due to small size. On this non-infused exam there is no evidence of metastatic disease. Recommend an MRI for further evaluation. Calvarium is intact. Mastoid air cells and paranasal sinuses are unremarkable.

Output: 1.Small focus of low-attenuation in the left frontal lobe likely result of ischemic stroke. Recommend further follow-up with MRI since the small size of this lesion makes precise determination of its age difficult.2.No evidence of metastatic disease on this non-infused study.3.Calvarium is intact.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified disorder of the pituitary gland and its hypothalamic controlClinical question: s/p pituitary adenoma resection on 7/16/15Signs and Symptoms: Post-op surveillance, visual symptoms MRI brain:The patient is status post right frontal craniotomy. There is an extra-axial collection redemonstrated at the craniotomy site which measures up to 5 mm in thickness and previously measured approximately the same.There are punctate foci of diffusion restriction present in the right occipital lobe gray matter and along the left medial thalamus.The right vertebral artery flow-void appears to be diminished. There is a prior MRA exam from 7/11/2015 which indicates potential occlusion of the extracranial distal right vertebral arteryThere is a small focus of encephalomalacia involving the medial aspect of the right orbital gyrus and the gyrus rectus with associated T2 signal hyperintensity and FLAIR signal hyperintensity but without any significant contrast enhancement.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are multiple punctate T2 and FLAIR hyperintense foci within the brain stemThere is susceptibility effect along the surface of the cerebellum and the brainstemThere is redemonstration of subdural effusion bilaterally and in the posterior fossa.The patient is status post pituitary fossa and suprasellar mass resection.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 demonstrated mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRI pituitary:The patient status post pituitary fossa surgery. There is a residual lesion present within the pituitary fossa which measures approximately 17 x 25 mm in coronal dimensions. It has heterogeneous signal on both T1 and T2. It displays a thin rim of enhancement along its periphery as well as some mild heterogeneous enhancement centrally. Coronal dimensions on the prior exam were approximately 27 x 25 mm. The mass bulges into the inferior aspects of the cavernous sinus bilaterally

Output: 1.Since the prior exam postoperative changes located within the pituitary fossa have mildly regressed. The possibility that there may be some residual tumor within the pituitary fossa is suspected. A follow-up exam may help further assess this.2.There are couple punctate foci suspicious for acute or subacute microinfarcts located in the right occipital lobe and the left thalamus.3.Findings suggesting steno-occlusive disease the right distal vertebral artery.4.A focus of encephalomalacia in the right frontal lobe is stable.5.There are subdural effusions present which are stable compared to the prior exam6.There is superficial siderosis present probably related to prior subarachnoid blood7.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Compression of brain [G93.5] / Low back pain [M54.5], Reason for Study: ^Reason: chiari malformation, lower back pain, evaluate for tethered cord or syrinx. Please do with tethered cord protocol History: Chiari , lower back pain evaluate for tethered cor There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. There is no evidence of syrinx.The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the T12-L1 level. The filum terminale is normal in size and signal intensity. There is no evidence of syrinx, tethered cord or spinal dysraphism. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Diffuse bulging of disc which results bilateral lateral recess minimal stenosis. No neuroforaminal narrowing or spinal stenosis. L5-S1: Diffuse bulging of disc which results bilateral lateral recess minimal stenosis. No neuroforaminal narrowing or spinal stenosis.

Output: 1. No evidence of syrinx. No evidence of tethered cord.2. Diffuse bulging of discs with minimal bilateral lateral recess stenosis at the level of L45 and L5S1.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: Head ct showing interval scattered areas of hypoattenuation involving right frontal and parietal lobes History: altered mental status Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.There are chronic ischemic infarction with tissue loss on the right MCA territory, in particular right inferior parietal lobule and right frontal lobe. Underlying brain shows multifocal patch high signal intensity on FLAIR/T2 images indicating nonspecific small vessel ischemic disease.There are focal susceptibility areas on the course of right MCA, in particular, both are located along the sylvian fissure. These findings may indicate possibility of MCA branch wall calcification or remained intravascular thrombus without complete occlusion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses are clear.Bilateral mastoid air cells show opacification.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 6 mm x 4.2 mm relatively wide neck basilar tip aneurysm. There is also focal luminal stenosis on the left ACA distal A2 segment before the pericallosal-callosomarginal bifurcation. Bilateral P-comm arteries are patent and Acom artery is patent.No other intracranial arterial aneurysm is seen.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate non-visualization of the left subclavian artery and right subclavian artery beyond thyrocervical trunk but otherwise patent brachiocephalic trunk, bilateral CCAs, bilateral VAs and bilateral extracranial ICAs without evidence of significant (more than 50%) luminal stenosis.

Output: 1. No acute ischemic or hemorrhagic lesion.2. 4mm x 6mm sized basilar aneurysm.3. Focal luminal stenosis on the left ACA distal A2. 4. Non visualization of right mid to distal subclavian artery and the proximal left subclavian artery indicating atherosclerotic occlusion.


Instruction: Generate impression based on findings.

Input: 60 year-old female, with peripheral vascular disease status post left above-the-knee amputation with open wound and left leg edema. Evaluate for fluid collection, tracking air.IMAGE ACQUISITIONS: Non-IV contrast enhanced CT of the pelvis and both thighs. Lack of IV contrast decreases the ability to detect small abscesses.Patient is status post left above-the-knee amputation. Irregularity of the soft tissues of the distal end of the remaining left thigh is compatible with the stated history of open wound, and there several small pockets of gas density seen within the soft tissues surrounding and adjacent to the amputated distal left femur. There are no specific features of osteomyelitis on this study, although MRI would provide a more sensitive assessment for osteomyelitis. No abscess is identified within the left thigh. Air does not extend into the proximal thigh.There is moderate bilateral stranding of the subcutaneous fat of the thighs compatible with edema, which extends into the subcutaneous fat of the pelvis and lower abdomen. An intramedullary rod is present in the right femur and results in metallic artifact that slightly limits the exam of the surrounding anatomic structures. There are atherosclerotic calcifications seen within the pelvis and both thighs as well as a femoral artery stent on the right.

Output: Status post left above-the-knee amputation with stump wound and small foci of air immediately adjacent to the distal left femur. No abscess evident.


Instruction: Generate impression based on findings.

Input: Status epilepticus with intracranial hemorrhage. Suspicion of nonaccidental trauma. Rule out spinal spine fracture or other injuries. The posterior infratentorial subdural hematoma does extend along the posterior aspect of the foramen magnum though without significant narrowing of the foramen. There is also minimal, predominantly right-sided subdural hemorrhage posterior to the vertebral bodies in the upper cervical spine, reaching to mid/lower C3 level, which has a maximum thickness of less than 2 mm and causes no significant spinal canal narrowing. Otherwise, there is no significant hemorrhage in the cervical or included upper thoracic spinal canal. The vertebral bodies show no gross morphologic abnormality or marrow edema. The intervertebral disks are preserved in height and T2 signal. The cervical spinal cord shows no significant abnormality.Opacification in the posterior, dependent lungs is probably atelectasis. There is no significant prevertebral effusion or soft tissue swelling. There is no convincing STIR T2 signal in the paraspinal soft tissues.

Output: 1.Minimal subdural hemorrhage along the upper cervical spine but without significant spinal canal stenosis, which given the prominent amount of subdural blood products in the posterior fossa and along the foramen magnum likely represents blood products tracking caudally.2.There is also no definite sign of fracture or significant soft tissue injury in the cervical spine or the included upper thoracic spine.3.The intracranial subdural hemorrhages are described in detail on the report of the brain MRI from the same day.


Instruction: Generate impression based on findings.

Input: 61-year-old male with prostate cancer. Evaluate for extraprostatic disease spread. Pathology dated 8/4/2016 showed right-sided adenocarcinoma (Gleason 3+3) and left-sided adenocarcinoma (Gleason 3+4). PELVIS:PROSTATE:Prostate Size: The prostate measures 5.9 cm in transverse, 3.6 cm in AP, and 5.3 cm in craniocaudal diameter.Peripheral Zone: Linear T2 hypointense foci throughout the peripheral zone are suggestive of chronic prostatitis versus scarring. In the left mid gland, there is a focal T2 and ADC hypointense region measuring 1.2 x 0.8 cm (axial series 501 image 20) (axial series 608 image 324) concerning for a dominant nodule.Central Gland: Heterogenous appearance compatible with BPH. There is an asymmetric enlarged hyperplastic nodule distorting the adjacent right peripheral zone (axial series 501 image 18), which partially limits evaluation of the exam.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: Nonspecific intramuscular enhancement adjacent to the bilateral femoral necks (left greater than right) is of uncertain clinical significance (axial series 2001 image 89).OTHER: No significant abnormality noted.

Output: 1.Dominant nodule in the left mid gland as described above. Right gland particularly peripheral zone suboptimally assessed as above.2.Linear T2 hypointense foci of the background peripheral zone bilaterally suggestive of chronic prostatitis versus scarring.


Instruction: Generate impression based on findings.

Input: Ms. Chernawsky is a 33 year old female with known left breast cancer. She presents today for MRI to evaluate extent of disease. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.In the left upper inner breast, 11:00 location, there is an irregular enhancing mass measuring 2.5 x 2.2 x 2.8 cm. Susceptibility artifact from biopsy marker clip is seen within the central aspect of this lesion, compatible with biopsy-proven malignancy. The MRI measurement of this mass approximates the mammographically visualized abnormality (spiculated asymmetry + pleomorphic calcifications of approximately 2.6 cm).There is no additional abnormal enhancement seen in the left breast. There is no abnormal enhancement in the right breast. No abnormal lymph nodes are identified in either axillary region.

Output: Unifocal malignancy in the left upper outer breast. Normal axillary lymph nodes. If patient desires breast conservation therapy, a single wire localization needle targeting the biopsy clip vs bracketed wire localization for the entire span of calcifications (approximately 2.5 cm) can be performed based on clinical preference. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for ischemia. Signs and symptoms: Right facial droop of right leg weakness. Nonenhanced brain MRI:Examination demonstrates small focus of restricted diffusion in the right lateral aspect of medulla measuring at 11.7 times 7-mm. No evidence of hemorrhagic changes or any appreciable mass effect.Examination in addition demonstrate extensive chronic strokes in the vertebral vascular system and including total PCA territory chronic stroke as well as multiple small bilateral cerebellar ischemic strokes and several chronic nonhemorrhagic pontine lacunar infarct.Images through supratentorial space in addition demonstrate findings of mild to moderate small vessel ischemic strokes in the subcortical and periventricular white matter of cerebral hemispheres.Midline is maintained and the cortical sulci appear normal for patient stated age.Signal void the major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells as well as calvarium and soft tissues of the scalp.

Output: 1.Focus of restricted diffusion in the right lateral medulla measuring at 7 times 11.7-mm.2.several chronic bilateral cerebellar ischemic stroke as well as large chronic nonhemorrhagic ischemic stroke involving the entire left PCA territory.3.Findings consistent with mild to moderate chronic nonhemorrhagic small vessel ischemic strokes.


Instruction: Generate impression based on findings.

Input: 49 years Female (DOB:7/23/1967)Reason: stenosis? History: L4-L5 spondylolisthesis proximal to L5-S1 PSFPROVIDER/ATTENDING NAME: JAMES M MOK JAMES M MOK Five lumbar type vertebral bodies are presumed to be present. The patient is status post posterior lumbar fusion with pedicle screws and interconnecting rods at L5-S1 1. This creates a significant amount of artifact which obscures visualization of the lumbar spine from L3 down to S1. Within the left half of the L1 vertebral body there is a 21 x 16 mm sagittal dimension well-circumscribed lesion which is high signal on T1 and T2 which most likely represents a vertebral body hemangioma.There are cystic lesions present within the kidneys bilaterallyAt L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: Examination is compromised due to metal artifact. The patient status post lower lumbar spine fusion. There is no spinal stenosis or compromise to the exiting nerve roots at the L2-3 or L1-2 levels.


Instruction: Generate impression based on findings.

Input: 80-year-old male disoriented for one day. Evaluate for stroke. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity in a periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Coarse hyperdensities within the tentorium represent calcifications of no current clinical significance. Focal areas of well delineated CSF attenuation within the region of the anterior left temporal lobe consistent with arachnoid cyst.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: Suspected small vessel disease, otherwise unremarkable. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Patient AMS and unable to provide history. Possible internal hardware on CXRReason: Stroke? Subacute changes seen on CTA. History: AMS, not triggering vent effectively, unwitnessed fall3/29/195263 yearsFemale MRI of the brainNo diffusion weighted abnormalities are appreciated. The exam is somewhat compromised due to patient motion which may obscure more subtle abnormalities.A small focus of encephalomalacia is present along the lateral posterior aspect of the right orbital gyrus, the right insular cortex and right frontal lobe and a small region measuring approximately 2 cm in size.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate air-fluid levels in the maxillary sinuses, sphenoid sinuses and ethmoid air cells and mucosal thickening in the frontal sinuses. The visualized portions of the mastoid air cells are partially opacified. The patient status post intubation. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 6 mm x 4 mm aneurysm present at the right M1 segment which has a small neck. A branch of the superior division of the right middle cerebral artery originates from the base of this aneurysm. This particular branch also supplies the small focus of encephalomalacia.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. There is fenestration of the anterior communicating artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The vertebral arteries are not well imaged proximally in part related patient motion. It is suspected that there is occlusion of the right vertebral artery at its origin. The right vertebral artery appears to be reconstituted distally most likely from collaterals

Output: 1.There is a 6 mm x 4 mm aneurysm present at the right M1 segment which has a small neck. A branch of the superior division of the right middle cerebral artery originates from the base of this aneurysm. This particular branch also supplies the small focus of encephalomalacia. CT angiography be helpful in further assessing this.2.Findings suggest occlusion of the right vertebral artery at its origin with distal reconstitution via collaterals. Please note that the vertebral arteries are not adequately imaged proximally due to patient motion. CT angiography be helpful in further assessing this.3.There is no evidence for acute ischemic cerebral infarction. 4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.A small focus of encephalomalacia is centered in the right frontal lobe which involves small portions of the right orbital gyrus, insular cortex and inferior frontal gyrus.6.The exam is somewhat compromised due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 65-year-old female patient with history of thalamic hemorrhage and microvascular disease presents with head fullness. There is mild continued evolution of chronic blood products related to left thalamic hemorrhage with residual susceptibility artifact. Again seen is susceptibility artifact compatible with hemosiderin scar in the right external capsule, appearing similar compared to prior exam. Bilateral punctate foci of susceptibility artifact in the bilateral frontal and occipital lobes as well as the basal ganglia appear similar compared to prior examination and are consistent with prior microhemorrhages. There is extensive pons and periventricular and subcortical white matter T2/FLAIR increased signal intensity without associated restricted diffusion that is not significantly changed compared to prior exam and consistent with moderate chronic small vessel ischemic disease. There is no abnormal enhancement on postcontrast images.There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The paranasal sinuses, mastoid air cells and orbits are unremarkable. The skull and extracranial soft tissues are unremarkable.

Output: 1.No acute infarct, hemorrhage, mass or mass effect.2.Mild continued evolution of chronic left thalamic hemorrhage. Stable hemosiderin scar within the right external capsule from remote hemorrhage. No significant change in multiple additional parenchymal microhemorrhages on background of advanced chronic small vessel ischemic disease. These findings are suggestive of chronic hypertensive encephalopathy and/or amyloid angiopathy.


Instruction: Generate impression based on findings.

Input: 79-year-old woman with history of HCV cirrhosis, evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour and the fissures are widened. An approximately 1 x 1 cm lesion in the dome of the liver (series 3, image 5) is hyperintense on T2 and diffusion-weighted sequences, but there is no contrast washout on delayed phase images. The gallbladder appears normal.SPLEEN: The spleen is enlarged at 13 cm. Splenic varices are noted.PANCREAS: The pancreatic parenchyma is severely atrophied and the remaining pancreatic duct is irregularly dilated measuring up to 15 mm in the pancreatic head. No obstructing lesion is identified.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Small enhancing lesion in the hepatic dome which can be followed if clinically appropriate.2.Stable dilation of the pancreatic duct which may represent chronic pancreatitis or main duct type IPMN.


Instruction: Generate impression based on findings.

Input: 79-year-old female patient with autoimmune hepatitis presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Again seen is a T2 hyperintense subcentimeter focus that demonstrates arterial enhancement in the hepatic dome that does not demonstrate washout. It is unchanged in size compared to prior examination, compatible with a hemangioma. No suspicious arterial enhancing lesions with washout are identified.Focal outpouching of the gallbladder fundus is unchanged compared to prior examination and may represent focal adenomyomatosis (series 9 image 37).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Multilevel thoracic neuroforamina perineural cysts noted. Adjacent to the left T11-T12 (when counting from below) neuroforamina, there is a T2 hyperintense enhancing lesion that measures 1.5 x 1.0 cm (series 6 image 12). This lesion can be identified retrospectively and appears to be slow growing. For reference, on 09/26/2011 this lesion measured 0.9 x 0.8 cm and measured 1.0 x 1.2 cm on 09/04/2013.OTHER: No significant abnormality noted.

Output: 1.No suspicious hepatic lesions.2.Stable subcentimeter hemangioma at the hepatic dome.3.Slow growing lesion adjacent to the left T11/T12 neuroforamina is nonspecific and may be of neural origin, such as a schwannoma. Dedicated imaging with thoracic spine MRI can be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: Proximal femur lesion. Centered within the anterior cortex of the proximal femoral diaphysis is a lucent lesion with internal septations. The lesion measures 8 mm x 12 mm in maximal axial dimensions, and approximately 2.2 cm in maximal craniocaudal dimensions. The lesion does not appear to contain internal fat, or chondroid matrix. A small portion of the lesion appears to extend beyond the cortex of the femur, and into the quadriceps musculature as demonstrated on outside MRI. This is seen for example on series 5, image 48. There are no enhancing components of this lesion. The lesion does not extend into the medullary cavity. Surrounding soft tissues are otherwise normal.The right hip joint is grossly normal.There is normal intravascular enhancement.Muscles and soft tissues are otherwise normal. No fractures.

Output: Lucent lesion with sclerotic borders and internal septation centered within the anterior cortex of the proximal right femoral diaphysis as above, with a component apparently extending beyond the cortex. Nonossifying fibroma is suspected, but this is nonspecific. Although this lesion has some imaging characteristics of a chondromyxoid fibroma, osteofibrous dysplasia or an adamantinoma, the location of this lesion within the femoral diaphysis makes these differential possibilities less likely. Additionally, chronic infection is disfavored.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with altered mental status. Innumerable scattered foci of restricted diffusion are seen involving the watershed regions of the cerebral hemispheres, the basal ganglia, left thalamus, and the posterior fossa. The most conspicuous areas of restricted diffusion are in the bilateral parietal and occipital lobes and the cerebellum. A relatively large area of mild restricted diffusion without correlating T2 signal abnormality is seen involving the right parietotemporal junction.Most of the above-mentioned areas are associated with non-masslike gyriform enhancement. The right parietal and bilateral occipital lesions show evidence of gyriform T1 hyperintensity suggesting laminar necrosis. No evidence of basal cistern or cranial nerve enhancement is seen.Apart from those lesions which are diffusion restricting, there are numerous additional areas of periventricular and subcortical T2 hyperintensity which do not diffusion restrict. No evidence of significant generalized mass effect is seen. No brain herniation is demonstrated. The ventricles and sulci are proportionately prominent compatible with volume loss. No abnormal fluid collections are detected.

Output: Innumerable areas of restricted diffusion are seen indicating cytotoxic edema or a mixture of cytotoxic and vasogenic edema both supratentorially and infratentorially. There is a marked predominance of lesions in the cerebral watershed zones, the parietal and occipital lobes, and in the cerebellum. One rather large and ill-defined area at the right parietotemporal junction demonstrates a curious pattern of mild restricted diffusion with no correlating T2 signal abnormality. Most of the lesions demonstrate non-masslike gyriform enhancement indicating blood brain barrier breakdown.The distribution of the lesions noted above, with a preference for the watershed zones and posterior circulation, is very suggestive of a PRES-like phenomenon. Lesions related to PRES do not typically diffusion restrict to this degree, but it has been reported in severe cases. The rather curious pattern of mild restricted diffusion without T2 signal abnormality at the right parietotemporal junction is also supportive of an atypical vascular process such as PRES.Other differential considerations, including embolic ischemic disease and metastatic/neoplastic disease, are considered much less likely based on the imaging characteristics.


Instruction: Generate impression based on findings.

Input: Shoulder instability ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is deformity and multiple defects of the posterolateral humeral head reflecting a Hill-Sachs deformity however there is no underlying edema to suggest this is acute in nature. There is tearing and detachment of the labrum from the anterior to inferior. Additionally, there are ares where the cartilage is absent from the inferior glenoid with areas of calcification and granulation along the inferior margin. The superior labrum is intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Tearing and detachment of the anterior to inferior labrum.2. Chronic deformities of the humeral head and inferior glenoid reflecting Hill-Sachs and bony Bankart lesions. There is callus formation and granulation noted along the inferior margin of the glenoid with the areas of articular cartilage absent.3. Mild synovitis.


Instruction: Generate impression based on findings.

Input: MRI Brain: Cerebellar tonsils are ectopic with inferior displacement of the tonsils by approximately 6 mm below the foramen magnum. There is minimal if any crowding of the CSF spaces at the foramen magnum. There is preserved bidirectional pulsatile CSF flow ventral and dorsal to the cord.FLAIR images are motion degraded but demonstrate no significant signal abnormality in the brain. Stable 8 mm pineal cyst is again seen. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is minimal mucosal thickening involving the maxillary sinuses with small mucous retention cysts. MRI Cervical spine: The cervical cord is normal in caliber and signal. There is no evidence of syrinx. Vertebral bodies are well aligned. There is no neural foraminal or spinal canal narrowing. Alignment of the vertebral bodies is unremarkable. There is mild straightening of the cervical spine which may positional in nature. The paravertebral tissues are unremarkable.

Output: 1.Stable mild cerebellar tonsillar ectopia/Chiari 1 malformation. CSF spaces and bidirectional CSF flow at the foramen magnum are preserved. No evidence of syrinx in the cervical cord.2.Stable small cystic lesion in the pineal gland.


Instruction: Generate impression based on findings.

Input: 57-year-old female patient with concern for pancreatic ductal dilatation. ABDOMEN:LIVER, BILIARY TRACT: There are multiple simple cysts in the liver. There is no significant biliary ductal dilatation, mild ductal intrahepatic and extrahepatic ductal prominence noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct measures upper limits of normal diffusely without evidence of an obstructing lesion.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: Pancreatic duct diameter upper limits of normal diffusely and mild biliary ductal prominence seen without evidence of an obstructing masslesion; findings may reflect an element of sphincter of Oddi dysfunction. Unremarkable study otherwise.