Instruction: Generate impression based on findings.

Input: Thoracic spine: There is high T2 signal of the intervertebral disc T9-T10 with erosions of the inferior endplate of T9 and the superior endplate of T10, as well as slight focal kyphosis. There is epidural extension of the disc material and fluid with impingement upon the spinal cord, which displays patchy high signal in this region, and paravertebral extension of the inflammatory process with multiple small fluid collections, particularly on the right side. At the T9 and T10 levels, there is also hypertrophy of the ligamentum flavum, which contributes to severe spinal stenosis. The neural foramina is also severely narrowed bilaterally. There are multiple intravertebral disc herniation in the inferior endplates of T6 through T8 and T10 through T12 and the superior and inferior endplates of T11 and T12, with associated degenerative endplate marrow signal alterations. There is bilateral renal atrophy, with multiple cysts.Lumbar spine: There are multiple intravertebral disc herniation with associated degenerative marrow changes. At L4-L5 and L5-S1, there are disc bulges, ligamentum flavum hypertrophy, and bilateral facet degenerative changes with effusions and synovial cysts with mild spinal canal stenosis and at least moderate narrowing of the neural foramina bilaterally at both of these levels. There is straightening of the lumbar spine alignment in the sagittal plane.

Output: 1. Discitis-osteomyelitis at the level of T9-T10 with epidural extension that results in spinal cord compression and mild edema. The infectious process also extends into the paraspinal region with what appears to be multiple small abscesses. However, characterization is limited due to the lack of intravenous contrast. 2. Multiple thoracic and lumbar intravertebral disc herniations.3. Degenerative spondylosis at L4-L5 and L5-S1 with at least moderate narrowing of the neural foramina bilaterally and mild spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Suspected viral mmeningitis. A lumbar puncture was done which revealed an elevated opening pressure. Brain MRI: There is a subcentimeter nodular lesion with susceptibility effect in the left corona radiata with an adjacent small development venous anomaly. There is no evidence of cerebral abscess or abnormal leptomeningeal enhancement. There is no evidence of intracranial hemorrhage or acute infarct. There is flattening of the pituitary gland. The ventricles and basal cisterns are normal in size. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRV: There is apparent focal constriction of the bilateral transverse sinuses. There is no evidence of cerebral venous sinus thrombosis.Orbits MRI: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. Small cavernous malformation in the left corona radiata with an adjacent small development venous anomaly.2. No evidence of cerebral abscess or abnormal leptomeningeal enhancement.3. No evidence of cerebral venous sinus thrombosis.4. No evidence of orbital lesions.5. Flattening of the pituitary gland and apparent focal constriction of the bilateral transverse sinuses can be manifestations of elevated intracranial pressure.


Instruction: Generate impression based on findings.

Input: 55 years Male (DOB:9/2/1960)Reason: 55yom w IDDM, HTN, Rheumatoid arthritis on prednisone and MTX, presenting with right hemibody "clumsiness" having subacute Lt MCA stroke, pls eval age of infarct . pt has central nystagmus and complains of vertigo concern for concurrent brainstem infarct History: see abovePROVIDER/ATTENDING NAME: WILLARD W SHARP ADIL JAVED There is a focus of diffusion restriction present in the left postcentral gyrus associated with punctate focus of diffusion restriction in the left inferior parietal lobule. These foci of diffusion restriction associated with FLAIR and T2 signal abnormalities. 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.On susceptibility images are multiple foci of punctate signal loss within the distribution of the area of diffusion restriction.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are compatible with subacute infarction in the left parietal lobe.2.No evidence for brainstem infarction


Instruction: Generate impression based on findings.

Input: Parkinson's disease preoperative planning for deep brain stimulation. There is no evidence of intracranial mass lesions. There is nonspecific bilateral globi pallidi T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: Unremarkable MRI with regard to preoperative planning.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with brain metastasis, history of non-small cell lung carcinoma, planning examination for stereotactic radiosurgery. A 9 mm, round, homogeneously enhancing nodule is evident within the cortex of the left occipital lobe. This lesion produces no significant surrounding edema and there is no associated mass effect.A 3 mm focus of extra-axial enhancement is seen along the right planum sphenoidale. No other intracranial enhancing lesions are seen. No parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: 1.A 9 mm cortically based enhancing lesion is seen within the left occipital lobe causing no significant edema or mass effect. Given the history, this most likely represents a focus of metastatic disease.2.A 3 mm focus of extra-axial enhancement along the right planum sphenoidale could represent a small incidental meningioma. Attention on follow-up examinations will be required.


Instruction: Generate impression based on findings.

Input: 64-year-old male with confusion on Coumadin found down at bedside with no neurologic findings. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodense region within the subcortical and periventricular white matter consistent with small vessel disease, age indeterminate. Well defined hypodense region within the left MCA territory and left cerebellum consistent with previous strokes. No acute cortical stroke is seen, however, if there is clinical concern for acute ischemia, an MRI may be considered. Dense atherosclerotic calcifications noted throughout the large vessels.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: Male, 2 years old, with sensorineural hearing loss status post meningitis. Brain MRI:The ventricles and sulci are mildly, diffusely prominent, consistent with global volume loss, greater than expected for the patient's stated age, however unchanged in extent. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. No leptomeningeal or pachymeningeal enhancement is appreciated. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. IAC MRI:There has been interval decrease in bilateral pathologic enhancement of the cochlea, vestibules, and to a lesser degree the semicircular canals. The inner ear structures otherwise demonstrate normal morphology and T2 signal characteristics. No mass lesion or pathologic enhancement is evident in the IACs or CP angles. The eighth cranial nerves are present bilaterally. Previously described questionable pathologic enhancement of portions of the bilateral facial nerves are unchanged, and are felt to be within normal anatomic variation for the appearance of post cisternal facial nerves.

Output: 1.The ventricles and sulci are mildly, diffusely prominent, consistent with global volume loss, greater than expected for the patient's stated age, however unchanged in extent. 2.There has been interval decrease in bilateral pathologic enhancement of the cochlea, vestibules, and to a lesser degree the semicircular canals,


Instruction: Generate impression based on findings.

Input: 70 year-old female. History of bilateral renal cysts (complex). Evaluate for bilateral renal mass. ABDOMEN:LIVER, BILIARY TRACT: Hepatic dome is not included in the field of view. No suspicious hepatic lesion in the visualized liver. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Complex left upper pole cyst with with enhancing thin septations is 3.5 x 3 cm (series 10, image 27), unchanged. A second adjacent cyst with T1 hyperintensity and a fluid-fluid level and no appreciable enhancement on subtraction sequences, most likely a hemorrhagic cyst (series 10, image 21), unchanged at 2.2 x 2.1 cm.Right interpolar region simple cyst measures 3.9 x 3.3 cm (series 10, image 40), unchanged.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: Mildly complex left upper pole cystic lesion with enhancing thin septations is indeterminate, continued follow-up is recommended. No new suspicious lesions.


Instruction: Generate impression based on findings.

Input: 43 years Male (DOB:11/12/1972)Reason: history of brain mets s/p SRS please History: nonePROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left occipital craniotomy.There is redemonstration of T2 and FLAIR hyperintense lesions in the left precuneus which are stable compared to the prior exam. There are additional foci of susceptibility present in this location as well. There is no contrast enhancing lesion identified in the surgical bed.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is redemonstration of postoperative changes in the left precuneus which are stable. Most likely this represents posttreatment change


Instruction: Generate impression based on findings.

Input: History of cervical spine fusion at C5-C6. Status post car accident with new right arm pain/paresthesias. There are postsurgical changes of anterior cervical fusion at the C5-C6 level with associated artifact slightly limiting evaluation. There appears to be moderate degree of spinal canal stenosis at this level. There is questionable signal abnormality in the cord at this level without cord swelling. There are additional disc osteophyte complexes throughout the cervical spine with mild to moderate degree of spinal canal stenosis also present at the C4-C5 and C6-C7 levels.There is otherwise no high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine. The vertebral bodies are appropriate in the overall alignment and height. Mild degenerative changes in the lumbar spine are also present including a disc bulge at the L2-L3 level with dorsal annular fissure. No evidence of epidural hematoma.

Output: This is a limited exam specific for the exclusion of cord compression only. There is no evidence of acute cord compression or epidural hematoma. There are postsurgical changes of ACDF at the C5-C6 level with moderate spinal canal stenosis at this level and questionable small focus of T2 hyperintensity within the cord, which is age-indeterminate. There are also multilevel disc osteophyte complexes particularly at the C4-C5 and C6-C7 levels with associated mild to moderate degree of spinal canal stenosis. Dedicated cervical spine MRI can be considered for better assessment of these findings.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Left upper extremity weakness and neck pain. C4-C5 fusion. Multiple sequences are motion degraded and repeated. Again seen are postoperative changes of ACDF at C4-C5 with solid osseous fusion better demonstrated on CT. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Susceptibility artifact from patient's hardware and motion degradation somewhat limit evaluation. There is abnormal T2 signal involving the right ventral aspect of the cord at the C4-C5 level likely representing myelomalacia, presumably from prior compressive myelopathy. There is no spinal canal stenosis on the current study at this level.There is mild developmental narrowing of the cervical spinal canal with superimposed degenerative changes including small disc osteophyte complexes and mild multilevel facet arthropathy. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina. Mild facet arthropathy.C3-4: Small disc osteophyte complex and uncovertebral hypertrophy. There is partial effacement of the ventral and dorsal thecal sac without significant spinal canal stenosis overall. There is mild to moderate right and mild left left neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C4-5: No significant compromise to the spinal canal or neural foramina. Cord signal abnormality as described above.C5-6: There is a small disc osteophyte complex and ligamentum flavum thickening contributing to mild spinal canal stenosis. There is up to moderate, right slightly worse than left neural foraminal stenosis.C6-7: No significant compromise to the spinal canal. Minimal bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.

Output: 1. Postoperative changes of ACDF at C4-C5, with solid osseous fusion better demonstrated on CT.2. Degenerative changes in the cervical spine superimposed on mild developmental narrowing of the cervical spinal canal. There is mild spinal canal stenosis at the C5-C6 level. Otherwise no evidence of high-grade spinal canal stenosis. Neural foraminal stenosis is worst at the C5-C6 level where there may be impingement of the C6 nerve roots, right worse than left.3. Abnormal T2 signal involving the right ventral cord at the C4-C5 level likely represents myelomalacia and may be related to prior compression. There is no spinal canal stenosis on the current study at this level..


Instruction: Generate impression based on findings.

Input: 41-year-old male status post left knee dislocation and multi ligamentous injury. MENISCI: The lateral meniscus appears intact. There is increased globular signal abnormality within the posterior horn and body of the medial meniscus suggesting intrasubstance degeneration. Some of this signal extends to the tibial articular surface indicating undersurface fraying/degenerative tearing. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There are focal full-thickness articular cartilage defects centrally as well as along the medial and lateral facets of the patella, with underlying subchondral signal abnormality. There is an apparent full-thickness articular cartilage cleft along the medial facet of the femoral trochlea. The articular cartilage of the medial tibiofemoral compartment appears relatively spared, as is the cartilage along the lateral tibiofemoral compartment.LIGAMENTS: There is disruption of the ACL. There is complete rupture of the PCL. There is indistinctness and increased signal abnormality within the proximal fibers of the lateral collateral ligament proper indicating a tear. The IT band and biceps femoris appear intact. The medial collateral ligament appears intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complete rupture of the ACL and PCL. Indistinctness of the proximal fibers of the lateral collateral ligament proper, indicating a tear.2. Focal full-thickness articular cartilage defects affecting the patellofemoral joint. Other findings as described above.3. Elevated tibial tubercle to trochlear groove distance with measurements provided above which may be post traumatic in etiology.4. Nonspecific edema type signal abnormality within the tibialis anterior muscle as described above.


Instruction: Generate impression based on findings.

Input: 66-year-old male patient with history of gout, pain and swelling of the left knee. Mild osteoarthritis on films with probable meniscal tear, knee clicking. MENISCI: The lateral meniscus appears intact. There is increased, multidirectional signal intensity within the posterior horn of the medial meniscus which likely represents complex tearing. Additionally the body of the medial meniscus appears macerated.ARTICULAR CARTILAGE AND BONE: There is full-thickness loss of the articular cartilage of the posterior aspect of the weightbearing portion of the medial femoral condyle articular cartilage. There is marked thinning of the articular cartilage more anteriorly. The articular cartilage of the lateral tibiofemoral compartment appears grossly intact. There is fraying and partial-thickness tearing of the articular cartilage of the lateral patellar facet.Edema and subchondral cyst formation is noted within the intercondylar notch of the tibia.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Complex tearing of the medial meniscus as described above.2. Chondromalacia most predominately affecting the medial femoral compartment.3. Edema within the intercondylar notch of the tibia.


Instruction: Generate impression based on findings.

Input: Reason: history of vasculitis History: occasional CP CHEST:LUNGS AND PLEURA: Grossly unremarkable.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedMR ANGIOGRAPHY: Mild circumferential wall thickening involving the ascending aorta, arch, descending aorta and abdominal aorta with shallow ulcerations are unchanged. The aorta is normal in caliber throughout. The ascending aorta measures 28 mm in diameter, unchanged.There is a common origin of the innominate and left common carotid arteries.There is a high-grade focal stenosis at the ostium of the left subclavian artery with poststenotic dilatation to 7 mm, similar to the prior exam. Smooth narrowing at the origin of the right subclavian artery appear similar to the prior exam. The common carotid arteries appear normal.There is high-grade stenosis at the origin of the celiac artery measuring 7 mm in length with 6 mm poststenotic dilatation, similar to the prior exam. The SMA is patent. The renal arteries are patent.Focal thrombosed dissection inferior to the origin of SMA is unchanged. Iliac arteries are not within the field of view on this study.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. High-grade narrowing at the origins of the left subclavian and celiac arteries are unchanged since the prior exam.2.Circumferential wall thickening of the thoracic and abdominal aorta is unchanged.


Instruction: Generate impression based on findings.

Input: Please evaluate for white matter lesion or change in pituitary: Langerhans cell histiocytosis, headaches. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Pituitary: There is an unchanged punctate pars intermedia cyst. The pituitary gland and infundibulum are unchanged in size. The optic apparatus and cavernous sinuses are intact.

Output: 1. No evidence of white matter lesions.2. Unchanged appearance of the pituitary gland and infundibulum.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for etiology of right hip/low back pain in pt with AML s/p recent bone marrow biopsy History: right hip pain and low back pain, acute onset, s/p recent bone marrow bx 1 week ago, radiation of pain down back of right leg The exam is slightly limited by motion artifact.BONE MARROW: Extensive red marrow may be secondary to patient's therapy.SOFT TISSUES: Large hematoma extending from the iliac crest to the lesser trochanter. Inflammation of the surrounding the soft tissues of the thigh, infection cannot be excluded.JOINTS: No significant abnormality noted.ADDITIONAL

Output: Large hematoma extending from the iliac crests to the lesser trochanter. Inflammation of the surrounding soft tissues of the thigh, infection cannot be excluded.Findings discussed with Dr. Olatoyosi Odenike at the time of dictation.


Instruction: Generate impression based on findings.

Input: Male 77 years old Reason: severe low back pain with radicular pain in right leg Moderate degenerative disc disease affects the L2-3 level. Marked degenerative disease at L4-5 and L5-S1. Compression fracture of the L5 vertebral body, which appears to have progressed since MRI 11/17/2015. The full extent of the L5 vertebral body is not well-visualized. However, there is apparent retropulsion of the L5 vertebral body secondary to this compression, however this is not well visualized on the radiograph. Again seen is bilateral L4 pars defects and a grade 1 anterolisthesis of L4 and L5. Hypertrophy of the spinous processes.

Output: Compression fracture of L5 vertebral body appears to have progressed since most recent MRI, however the full extent of the L5 vertebral body is not well-visualized as detailed above. Cross-sectional imaging with CT or MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Female 62 years old Reason: History of chronic diarrhea and NSAID's usage, chronic anal fissures. Assess for inflammation History: diarrhea ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Biliary tree is normal in caliber.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: Calcific arterial sclerotic disease affects the aorta.BOWEL, MESENTERY: Small bowel is normal in caliber and course. No focal inflammatory changes. Terminal ileum is normal in caliber without thickening or abnormal enhancement.BONES, SOFT TISSUES: Post surgical changes in the lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Above-average colonic fecal content.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of bowel inflammation.


Instruction: Generate impression based on findings.

Input: 66-year-old male with right adrenal adenoma ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: There is a right adrenal nodule measuring 2.5-1.9 cm demonstrating loss of signal on out of phase sequence compatible with a microscopic fat containing adrenal adenoma. The nodule in the left adrenal gland measuring 2.0 x 1.3 cm also demonstrates loss of signal on out of phase sequence compatible with microscopic fat containing adrenal adenoma.KIDNEYS, URETERS: Subcentimeter cyst in the superior pole left 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.Bilateral microscopic fat-containing adrenal adenomas as described above.


Instruction: Generate impression based on findings.

Input: History of pancreatic cystic lesion. Presents for follow-up. ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. The liver is normal morphology, size and enhancement. No focal suspicious lesion. Stable segment 8 probable flash filling hemangioma. (Series 1001/237)Stable segment 8 punctate cyst. (601/32)No biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: The spleen measures 15 cm in craniocaudal length without a focal lesion.PANCREAS: Several small cystic lesions are again noted in the pancreas. The largest is in the pancreatic head and measures 1.2 x 0.9 cm (series 401/27) compared to 7 x 5 mm previously.A lesion in the tail measures 1.0 x 0.8 cm (series 401/29), compared to 7 mm previously. These lesions do not clearly communicate with the main pancreatic duct which is normal in caliber. The pancreas demonstrates normal signal intensity and morphology otherwise. No peripancreatic inflammatory changes.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate right renal too small to characterize hyperintensity, probable a small benign renal cyst.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: Mild interval increase in the size of the nonspecific cystic lesions within the pancreatic head and tail now measuring 1.2 and 1.0 cm respectively. No definite communication with the main pancreatic duct which is normal in caliber. Given their small size evaluation for mural nodularity/enhancement is limited. Given this limitation no suspicious postcontrast imaging features are evident. EUS/FNA sampling should be considered. At least continued imaging follow-up is recommended.Hepatic steatosis.Borderline nonspecific splenomegaly, unchanged.


Instruction: Generate impression based on findings.

Input: Slurred speech and weakness. MRI: There is periventricular and subcortical white matter T2 hyperintensity and there is an area of encephalomalacia in the right superior frontal gyrus. There is a nonspecific punctate focus of susceptibility effect in the left frontal lobe white matter, which may represent a chronic microhemorrhage. There are mildly prominent perivascular spaces in the right inferior basal ganglia. There is no evidence of intracranial mass or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a left lens implant.MRA: There may be minimal narrowing of the proximal left posterior cerebral artery. Otherwise, there is no evidence of significant steno-occlusive lesions or aneurysms.

Output: 1. Probable chronic small vessel ischemic cerebral white matter disease and chronic infarct in the right superior frontal gyrus, but no evidence of acute infarct.2. Perhaps minimal narrowing of the proximal left posterior cerebral artery. Otherwise, no evidence of significant steno-occlusive lesions involving the other proximal cerebral arteries.


Instruction: Generate impression based on findings.

Input: Severe headache. History of intractable epilepsy and brain cysts. 27 year old female with, cerebral palsy, encephalitis, post hemispherectomy as child, hydrocephalus with VP shunt and multiple revisions. Previous craniotomy for cyst fenestration and removal of Ommaya reservoir and intracranial catheter. There are findings related to previous right cerebral hemispherectomy. The multiloculated cystic structure at the resection margin which also involves the posterior aspect of the left cerebral hemisphere has slightly increased since the previous examination. The largest locule that along the posterior body/splenium of the corpus callosum now measures in the axial plane 3.4 cm x 2.7 cm (image #19 of series #501) compared to 2.3 cm x 2.2 cm (image #13 of series #7). These locules are now entirely fluid-filled with no air and have similar signal intensity to CSF with complete attenuation on FLAIR sequence.The moderate periventricular T2-hyperintensity in the left cerebral hemisphere and along the resection margin has not changed and may reflect gliosis. The tracts of the previous left parieto-occipital ventriculostomies and the associated susceptibility artifact remain unchanged. The left lateral ventricle remains collapsed except for its temporal horn. There is no diffusion restriction in the brain parenchyma. Apparent tethering of the upper cervical spinal cord to the posterior dura at the site of previous posterior decompression is unchanged, with mild associated kinking.The multiloculated fluid collection just deep to the partially resorbed right pterional craniotomy flap is not significantly changed in size with resolution of previously seen air. It shows diffusion restriction which most likely reflect the presence of blood products.The right internal carotid artery and its right anterior and middle cerebral arteries are small in size but show preserved flow voids. The other major intracranial arteries show also preserved flow voids, reflect gross patency.

Output: 1.Compared to the previous MRI from September 2015, the multiloculated cystic structure at the right hemispherectomy margin and involving the corpus callosum is slightly increased in size although results in no significant mass-effect.2.The air within this multiloculated cystic structure and in the extra-axial fluid collection at the craniotomy site is resolved and the cysts are now completely fluid-filled.


Instruction: Generate impression based on findings.

Input: MRI brain:The ventricles and sulci are within normal limits. There is mild global volume loss greater than expected for age but this is nonspecific. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is partial opacification of the right sphenoid sinus. MRI T-spine:The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is a small T7-8 central disc protrusion but no significant spinal canal or foraminal stenosis within the thoracic spine.

Output: No evidence of a demyelinating process in the brain or thoracic spine. Global volume loss greater than expected for patient's stated age.


Instruction: Generate impression based on findings.

Input: 53 are old female with history of right breast lumpectomy in 2014 for DCIS with clear margins, presents with new right-sided breast biopsy which is positive for DCIS adjacent to the prior lumpectomy bed. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Susceptibility artifact from biopsy clip is present within the mid central right breast, with adjacent 1.8-cm hematoma. Mild peripheral enhancement is present surrounding the biopsy cavity, and may be related to post biopsy change rather than DCIS given that it is largely thin and uniform around the hematoma. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Post biopsy changes in the mid central right breast with associated clip. Mild peripheral enhancement is noted surrounding the biopsy cavity, likely post biopsy change. Residual DCIS is considered less likely.2. No MRI evidence of malignancy in the left breast or suspicious axillary node.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: left elbow pain The elbow appears normal without findings to account for the patient's pain.

Output: Normal exam without findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Ms. Durkin submitted outside study for review. Submitted for review is:-Breast MRI: 8/7/2015 This examination was performed at Palos Community Hospital. Bilateral breast MRI was performed using the outside institutions protocol. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST: In the right upper outer breast (posterior depth), there is faint linear non-mass enhancement identified measuring approximately 2.8 cm in maximal dimension. Susceptibility artifact from biopsy marker clip is seen at the posterior aspect of this non-mass enhancement, compatible with biopsy proven malignancy. The MRI extent of enhancement measures larger than the mammographically visualized extent of calcifications (2.8 cm vs 1.4 cm) likely due to associated post-biopsy changes. In addition, in the right central breast, there is an oval enhancing mass measuring 0.7 x 0.5 x 0.6 cm. This enhancing mass is located approximately 5.5 cm anterior to the biopsy marker clip at site of known malignancy. LEFT BREAST: In the left lateral breast, there is susceptibility artifact from a biopsy marker clip, at the site of benign breast biopsy. Associated non-mass enhancement measuring approximately 2.6 cm in maximal dimension is present, likely representing associated post-biopsy changes. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Biopsy proven malignancy in the right upper outer breast with associated post-biopsy related changes. Clip is at the posterior aspect of this enhancement.(2) 0.7 cm enhancing mass in the right anterior central breast. An MR-directed US with possible biopsy is recommended for further evaluation. If no US correlate is identified, then an MR biopsy may be recommended. (3) Benign left breast biopsy with associated post-biopsy related changes. No MR evidence of malignancy in the left breast. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: 46 year old with right breast cancer on neoadjuvant chemotherapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. A few scattered cysts are present. At the 10 o'clock position of the right breast, there is faint residual enhancement during the later phases of the dynamic study, measuring as a 1.0 x 0.9 x 1.0 cm mass. This is significantly decreased in size and degree of enhancement compared to the pre-treatment MRI. Previously this measured 3.3 x 3.0 x 2.8. The lymph nodes in the right axilla are normal in morphology. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary region.A port-a-cath is present in the left upper chest wall. Trace pleural effusions are present.

Output: Significant response since the pre-treatment MRI. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Punctate hemorrhage on CT? Signs and symptoms: Dizziness and ataxia. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrate no convincing evidence of intracranial hemorrhage. Note should be made however that MRI is insensitive for detection of subtle isolated subarachnoid hemorrhage.FLAIR and T2-weighted images demonstrate scattered foci of FLAIR and T2 hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres. Minimal similar findings are also noted in bilateral basal ganglia and pons. Although nonspecific this appearance is often result of microvascular ischemic changes. Correlate with history and risk factors. Remote possibility of demyelinating disease cannot be entirely ruled out considering patient's stated age.Mild prominence of cortical sulci and lateral ventricles suggestive of underlying parenchymal volume loss.All CSF cisterns remain widely patent.The signal void of major intracranial arterial branches are identified.There is normal anatomical variation of a partially empty sella. Unremarkable calvarium and soft tissues of the scalp, unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.No evidence of intracranial hemorrhage and negative diffusion weighted series.2.Diffuse foci of FLAIR hyperintensity in the subcortical, periventricular and minimally in bilateral basal ganglia and pons suggestive of chronic small vessel ischemic strokes. Correlate with history and risk factors and consider follow-up with enhanced imaging to exclude other white matter lesions if clinically warranted.3.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Male 21 years old; Reason: Is there an injury to the UCL? History: Medial elbow pain and felt a pop after a throw as a baseball catcher LIGAMENTS: The posterior fibers of the ulnar collateral ligament are indistinct, with associated high T2 signal, compatible with tearing. The anterior fibers of the ulnar collateral ligament are intact. The remaining ligaments of the elbow are unremarkable.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. SURROUNDING STRUCTURES: No significant abnormality noted.

Output: Partial full-thickness tear of the posterior fibers of the ulnar collateral ligament.


Instruction: Generate impression based on findings.

Input: History of epilepsy status post laser ablation of the left hippocampus. There are postoperative findings related to left occipital approach laser ablation of the left hippocampus, where there are persistent punctate foci of high T2 signal and enhancement. The rest of the brain parenchyma appears unremarkable. There are also postoperative findings related to left temporal craniotomy and left frontal burr hole, with diffuse enhancement in the overlying scalp soft tissues. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a small left maxillary sinus retention cyst.

Output: Expected postoperative findings related to left hippocampal laser ablation.


Instruction: Generate impression based on findings.

Input: This is a motion degraded exam and multiple sequences were repeated. The brain, brainstem, and cerebellum appear unremarkable. In particular, the globus pallidus, subthalamic nuclei, hippocampus, putamen, thalamus, and cranial nerve nuclei appear to be grossly intact. There degree of myelination is within the realm of normal. There is no evidence of acute infarction. There is a small amount of T1 hyperintense and T2 hypointense subdural hemorrhage within the posterior fossa. There are also a few punctate foci of extra-axial, probably subarachnoid hemorrhage along the bilateral posterior cerebral convexities. There is no midline shift or herniation. The orbits and scalp soft tissues are unremarkable.

Output: 1. A small amount of subacute subdural hemorrhage and probable subarachnoid hemorrhage long the bilateral posterior cerebral convexities.2. No discernible findings to suggest hyperbilirubinemic encephalopathy, although the exam is limited by motion artifact.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 76 years old, with left facial droop and memory loss. No restricted diffusion is seen. No evidence of edema or mass effect is observed. There are no large cortical defects. A small focus of apparent encephalomalacia in the right caudate head is similar to findings seen on prior CT. Numerous scattered foci of T2 hyperintensity are demonstrated within the cerebral hemispheres and pons. No findings are seen to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. Brain volume is relatively well-preserved. Ventricular size and morphology are also within normal limits.

Output: 1.No evidence of acute ischemia or any other definite acute intracranial abnormality.2.Findings are seen compatible with chronic microvascular and lacunar ischemic disease.


Instruction: Generate impression based on findings.

Input: 63 year old man s/p CABG. Assess for ischemia, viability.MEDICATIONS: Regadenoson and aminophylline per protocol Status post CABG. First Pass PerfusionDuring hyperemia, subendocardial perfusion defects are present in the basal inferoseptal, inferior, and inferolateral wall as well as the mid inferoseptal and inferior walls of the LV.Viability/ Myocardial ScarThere is focal full thickness delayed hyperenhancement within the basal inferior and mid inferoseptal walls of the LV, consistent with previous myocardial infarct. A focal area of apparent delayed hyperenhancement with the basal/mid lateral wall may be artifactual.Left Ventricle There is moderate hypokinesis of the inferior wall of the basal and mid LV.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal.Right AtriumThe right atrium is moderately enlarged.Aortic ValveMild aortic regurgitation.Mitral ValveMild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveModerate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall scattered pulmonary micronodules. Indeterminate T2 hyperintense hepatic lesion better characterized on previous MRI of the liver. 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. During hyperemia, subendocardial perfusion defects are present in the basal inferoseptal, inferior, and inferolateral wall as well as the mid inferoseptal and inferior walls of the LV.2. There is focal full thickness delayed hyperenhancement within the basal inferior and mid inferoseptal walls of the LV, consistent with previous myocardial infarct.3. Moderate tricuspid regurgitation. Mild aortic and mitral regurgitation.LV and RV function will be added as a separate addendum once those measurements have been performed.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out cord compression. Signs and symptoms: Numbness. Nonenhanced total spine MRI:Examination demonstrates normal signal intensity and anatomic alignment the vertebral column other than mild grade 1 anterolisthesis at L5 -- S1 which is believed to be secondary to degenerative disease.Examination in the cervical region demonstrate degenerative changes with resultant mild central spinal stenosis at C6 -- C7. The signal intensity and caliber cervical cord remains within normal.Examination of thoracic spine demonstrate normal signal intensity and caliber of cord without evidence of mass effect. No appreciable degenerative changes, spinal canal or neural foraminal compromise is present.MRI images of lumbar region demonstrate a centrally located disk protrusion with partial effacement of ventral subarachnoid space and no significant central spinal stenosis. The signal intensity of conus and the cauda equina demonstrate no abnormality. No evidence of spinal canal compromise at any other level.Mild grade 1 anterolisthesis at L5 -- S1 secondary to pars defect. This finding can be further assessed with a dedicated MRI of the lumbar spine.

Output: 1.No evidence of cord compression.2.Degenerative changes at C6 -- C7 results in mild central spinal stenosis. 3.Small disk protrusion at L1 -- L2 with partial effacement of ventral subarachnoid space as detailed.4.Grade 1 anterolisthesis at L5 -- S1 secondary to pars defect. Dedicated MRI of lumbar spine is recommended for further assessment. There is no evidence of spinal stenosis with this finding.


Instruction: Generate impression based on findings.

Input: Clinical question: Possible stroke. Signs and symptoms: Left upper and/or extremity weakness. Nonenhanced head CT:Examination demonstrates a large area of vasogenic edema in the right frontal lobe there there is an isodense mass measuring 14 times 17-mm in size within the area of vasogenic edema. There is resultant effacement of adjacent cortical sulci however no midline shift is present. There is no evidence of hemorrhage associated with this finding. A questionable area of low attenuation in the inferior aspect of the left cerebellum may represent an additional focus of edema and or an artifact. Recommend follow-up with an MRI exam.

Output: 1.Right frontal lobe tumor measuring 17 times 14-mm in size with surrounding vasogenic edema.2.Either artifact or an additional small foci of edema in the inferior left cerebellum.3.Recommend follow-up with an MRI.


Instruction: Generate impression based on findings.

Input: No intra-articular gadolinium traverses the scapholunate or lunotriquetral intervals into the radiocarpal joint to suggest ligamentous disruption. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 6 seconds

Output: Fluoroscopic guided injection of dilute gadolinium into the right wrist for subsequent MRI arthrogram examination. No fluoroscopic findings to suggest ligamentous disruption. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on findings.

Input: Female, 69 years old. Left-sided low back pain with left-sided sciatica. Five lumbar type vertebral bodies are presumed to be present. The lumbar spine shows leftward thoracolumbar scoliosis more clearly demonstrated on recent radiographs. The vertebral body and disk heights are well-maintained. No focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact, terminating at approximately the L1 level. The paraspinal soft tissues are unremarkable.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is diffuse disc bulge and mild facet hypertrophy with mild right neural foraminal narrowing and no significant spinal canal stenosis.L3-L4: There is diffuse disc bulge and mild facet hypertrophy with mild right neural foraminal narrowing and no significant spinal canal stenosis.L4-5: There is grade 1 anterolisthesis of L4 over L5 with disc uncovering, diffuse disc bulge which is slightly more prominent posterolaterally toward the left neural foramen, as well as ligamentum flavum hypertrophy and facet hypertrophy, left greater than right, with severe left neural foraminal narrowing, mild right neural foraminal narrowing, as well as mild spinal canal stenosis.L5-S1: There mild facet hypertrophy with no significant compromise to spinal canal or neural foramina.

Output: Degenerative changes involving the lumbar spine, most severe at the L4-5 level with severe left neural foraminal narrowing and mild spinal canal stenosis at this level. Up to mild neural foraminal narrowing at other levels.


Instruction: Generate impression based on findings.

Input: Possible oropharyngeal cancer and lung nodules. There is a somewhat ill-defined right oropharyngeal mass that appears to arise from the superior pole of the right palatine tonsil. The mass measures up to approximately 20 mm and there is no invasion of the parapharyngeal or masticator spaces. There are mildly and asymmetrically prominent right level 1B and 2A lymph nodes, which are otherwise not significantly enlarged by size criteria. There is a cystic left thyroid nodules that measures up to 17 mm. The salivary glands are unremarkable. There is mild multilevel degenerative cervical spondylosis. The orbits and imaged intracranial structures are unremarkable.

Output: A right oropharyngeal mass that measures up to approximately 20 mm may indeed represent a tonsillar squamous cell carcinoma. Mildly and asymmetrically prominent right level 1B and 2A lymph nodes, which are otherwise not significantly enlarged by size criteria are nonspecific.


Instruction: Generate impression based on findings.

Input: 85-year-old woman with history of left lateral C1 fracture and right frontal brain mass diagnosed on outside CT. On the surface of the anterior right frontal lobe, there is a 34 x 31 x 25 mm (2001/20). It is unclear whether this mass is intra-axial or extra-axial with intraparenchymal invasion, however there is thickening of the adjacent dura. Additionally, there are curvilinear areas of calcification along the peripheral, posterior aspect of this mass, better characterized on the CT. This mass is isointense on T1 and slightly hyperintense on T2 weighted images with homogenous, avid enhancement. There is significant amount of abnormal T2/FLAIR signal in the underlying right frontal lobe white matter which extends through the genu of the corpus callosum into the medial left frontal lobe. There is local mass effect on the frontal horn of the right lateral ventricle, 9 mm of leftward midline shift, and slight asymmetric dilation of the left lateral ventricle suggesting entrapment. There is no restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage. A few additional foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter are nonspecific, but compatible with chronic small vessel ischemic changes. The major flow-voids are preserved.The patient is status post right cataract surgery, otherwise the sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits including the calvarium overlying the aforementioned mass. CERVICAL SPINE

Output: 1.Avidly enhance mass along the surface of the right anterior frontal lobe with peripheral calcification. While it is unclear whether this mass is intra or extra-axial, differentials include meningioma with invasion of the underlying parenchyma, a solitary dural based metastasis, or a primary glial neoplasm.2.Significant underlying vasogenic edema with midline shift and an asymmetric left lateral ventriculomegaly suggestive of entrapment.3.C1 fracture better characterized on recent CT.4.Edema in the interspinous cervical soft tissues which may indicate interspinous ligamentous injury, but no frank disruption of the major cervical ligaments is seen. No cord signal abnormality or epidural hematoma.5.Multilevel cervical degenerative disc disease with mild to moderate spinal canal stenosis and neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 59-year-old female with biopsy proven invasive lobular carcinoma in the left breast presents for breast MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast, there is an irregularly shaped enhancing mass with a marker clip at 2:00 position, consistent with biopsy-proven carcinoma. The lesion measures 12 x 12 x 12 mm (AP x LR x CC).There is an enhancing focus with irregular margins at retroareolar 4:00 position in the left breast, measuring 5 x 4 x 5 mm. This enhancing focus is located 46 mm anterior and inferior to the index cancer.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven carcinoma at 2:00 position in the left breast.2. Indeterminate enhancing focus at retroareolar 4:00 position in the left breast. MR directed ultrasound study is recommended. If the lesion is not detected on ultrasound study, MR guided biopsy should be considered.3. No MRI evidence for malignancy in the right breast.4. No abnormal lymph nodes in either axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, intracerebral hemorrhage. An acute hematoma is redemonstrated within the left basal ganglia which, accounting for differences in technique, has not substantially changed in size relative to the prior CT. This hematoma causes modest surrounding edema and mass effect with bulging of the insula into the Sylvian fissure. No clear evidence of any underlying enhancing or nonenhancing lesion is seen to account for this hematoma.Elsewhere in the brain, numerous periventricular and subcortical T2 hyperintense lesions are seen but without evidence of restricted diffusion. No pathologic intracranial enhancement is detected. The ventricular system remains patent allowing for minimal effacement of the left lateral ventricle. No other abnormal extra-axial fluid collections are seen.Mucosal thickening is demonstrated in the left maxillary sinus. Bone marrow signal characteristics are unremarkable.

Output: 1. Redemonstration of a left basal ganglia hematoma without significant interval change in size. No clear evidence of any underlying lesion is seen.2. Extensive scattered white matter lesions are seen which, although nonspecific, probably reflect chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Male 12 years old Reason: genetic positive for ARVD with +FHx - evaluate for ARVD History: ARVD Left VentricleThe left ventricle is normal in size. 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. Right VentricleThe right ventricle is normal in size. 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.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation. Dedicated through plane imaging of the aortic valve was not performed.Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.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 pericardial thickening or effusion.Extracardiac Findings

Output: 1. No evidence of ARVD.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: MRI Brain: There are no areas of abnormal signal or pathological enhancement to suggest demyelinating disease. There is a normal variant cavum septum pellucidum and vergae. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a small left maxillary sinus mucosal retention cyst, with other scattered mild thickening in the paranasal sinuses.MRI Orbits: Images are limited by patient motion, especially axial STIR images. There is diffuse atrophy of the optic nerves bilaterally, with again questioned mild increased T2 signal. There is no definite associated enhancement. The optic chiasm is not well delineated secondary to its significant atrophy.The globes and extraocular muscles are otherwise unremarkable.

Output: 1. Redemonstration of optic apparatus atrophy with likely chronic signal changes, without definite focal enhancement.2. Unremarkable contrast enhanced MRI of the brain.


Instruction: Generate impression based on findings.

Input: Vertigo. History of CVA 2/2010. Following for CVA No intracranial bleed, mass effect, edema, or midline shift. Moderately prominent extra-axial space and sulci. A moderate size patchy low attenuation is present in the left corona radiata, centrum semiovale, and left deep gray nuclei, new since previous CT, consistent with the acute infarction seen on 2/4/2010 MRI. It is consistent with interval maturation of an infarction with expected encephalomalacia. Within the limitation of the CT, which has less sensitive evaluation of the posterior fossa structures, it appears unremarkable. Basal cisterns are patent. Moderate vascular calcifications. No hydrocephalus. Opacification of right mastoid air cells, new since previous study. Otherwise, the rest of the visualized paranasal sinuses and mastoid air cells are clear

Output: 1. No intracranial bleed. 2. Interval maturation of the previously seen left sided white matter and deep gray matter MCA distribution acute infarction seen on 2/4/2010 MRI. 3. New right mastoid air cells congestive/inflammatory disease.


Instruction: Generate impression based on findings.

Input: Evaluate for cerebellar CVA: vertigo, uvular deviation, dysmetria. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. However, there is a heterogeneous mass along the inferior portion of the left parotid gland that measures up to approximately 5 cm. There are bilateral maxillary sinus retention cysts, right larger than left.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysm.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant steno-occlusive lesions in the head and neck arteries.3. Heterogeneous mass along the inferior portion of the left parotid gland that measures up to approximately 5 cm, which may represent a salivary gland neoplasm.


Instruction: Generate impression based on findings.

Input: 59 years Female (DOB:3/15/1957)Reason: r/o CNS mass History: neuropathyPROVIDER/ATTENDING NAME: SUSAN HONG SUSAN HONG There is a moderate degree of periventricular and subcortical patchy hyperintense white matter lesions present identified on the FLAIR and T2 images. There is no associated contrast enhancement.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some partial opacification of the left sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter patchy lesions of a moderate degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: There is a 9 x 9 mm nonenhancing lesion in the midline sella which is T1 hyperintense to brain and very T2 hyperintense, nearly matching CSF signal. The lesion abuts the infundibulum and appears to displace the pituitary gland along the floor of the sella. This lesion appears to be stable in size when compared to prior studies dating back to 2007. The lesion projects up into the suprasellar space and approaches the optic structures, but does not impinge on them. There is patchy and confluent periventricular white matter T2 hyperintensity which is consistent with previously demonstrated small vessel ischemic disease.

Output: T1/T2 hyperintense, non-enhancing lesion within the sella which displaces the pituitary gland; the appearance raises the question of a proteinaceous cyst or, perhaps less likely, a non-enhancing adenoma. The lesion has been stable in size dating back to studies from 2007.


Instruction: Generate impression based on findings.

Input: MRI CARD W/VASODILATOR STRESS WWO CNTRST, 9/6/2016 10:48 AM First Pass PerfusionDuring hyperemia, a non-transmural, moderate sized perfusion defect was noted in the basal anterolateral wall and the mid inferior and inferolateral wall. The overall ischemic burden is 9% of the LV mass. Viability/ Myocardial ScarThere is a small non-transmural myocardial infarction involving the basal anterolateral wall. This segment has an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and likely to be viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 82 ml/m2 (normal range: 74+/-15), the LVEDV is 163 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 70 ml (normal range 47+/-19), the LV mass index is 45 g/m2, and the LV mass is 90 g. There is hypokinesis of the basal anterolateral and mid inferolateral walls. Native myocardial pre-contrast T1 relaxation time is mildly elevated in the septal mid myocardiumLeft AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 147 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 66 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve has evidence of flow acceleration suggesting at least mild aortic valve stenosis. Correlation with echocardiography suggested. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLeft lung basilar discoid atelectasis, sternal wires consistent with previous bypass surgery. 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 evidence of hibernating myocardium involving the basal anterolateral and mid inferior and inferolateral walls. This territory is ischemic and mostly viable. 2. There is a small myocardial infarction involving the basal anterolateral wall. 3. Normal LV size and systolic function (LVEF 58%). The native myocardial T1-relaxation time is mildly increased in the mid interventricular level suggesting the presence of interstitial fibrosis. 4. Normal RV size and systolic function (RVEF 55%).5. There is at least mild aortic stenosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 42 year old female with hypertension and new cardiomyopathy, referred to evaluate for etiology of LV dysfunction. Left VentricleThe left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 117 ml/m2 (normal range: 65+/-11), the LVEDV is 278 ml (normal range 109+/-23), the LV end systolic volume index is 80 ml/m2 (normal range 18+/-5), the LVESV is 191 ml (normal range 31+/-10). There is global hypokinesis with regional variation. LVH is present with LV wall thickness of 12-13 mm (despite LV enlargement).There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 1080-1120ms. This is borderline abnormal. The extracellular volume fraction could not be reliably assessed.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 39%, the RV end diastolic volume index is 46 ml/m2 (normal range 69+/-14), the RVEDV is 109 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 71 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is at least moderate mitral regurgitation which is central.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.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. Severely dilated left ventricle with moderate-severely reduced systolic function (EF 31%).2. Borderline elevated native T1 myocardial relaxation times (1080-1120ms) with no evidence of late gadolinium enhancement. This may suggest mild diffuse interstitial fibrosis. 3. Normal size right ventricle with mildly reduced systolic function (EF 39%).4. At least moderate mitral 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: Thoracic spine:There is a CSF intensity collection within the thoracic spinal cord, expansile in appearance, extending from the T5/6 level inferiorly through the T9/10 level, measuring a maximal 5 x 6 mm transverse dimension at the T7/8 level.There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. There are no stenoses.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The visualized intra-abdominal and paraspinal contents are unremarkable. There are no significant degenerative changes or stenoses.The conus is normal in signal and morphology and terminates at L1/2. There are no MRI findings of fatty filum. Upon prone positioning, the conus and cauda equina translated anteriorly.

Output: 1.A syrinx is present within the thoracic spinal cord extending from the T5/6 level inferiorly through the T9/10 level, measuring a maximal 5 x 6 mm transverse dimension at the T7/8 level.2.There are no MRI findings of fatty filum or tethered cord.


Instruction: Generate impression based on findings.

Input: Left upper extremity radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: There is a disc osteophyte complex with uncovertebral hypertrophy resulting in moderate left-sided neural foraminal stenosis. No significant spinal canal or right neural foraminal narrowing.C3-4: Small disc osteophyte complex with uncovertebral hypertrophy results in no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.C4-5: Left paracentral disc osteophyte complex and uncovertebral hypertrophy, left greater than right. There is mild to moderate stenosis involving the left aspect of the spinal canal at this level including mild impression on the left ventral aspect of the cord. There is moderate to severe left and moderate right neural foraminal stenoses.C5-6: Disc osteophyte complex including bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis, particularly on the left. There is severe left and moderate to severe right neural foraminal stenosis.C6-7: Disc osteophyte complex with uncovertebral hypertrophy. There is moderate to severe left and moderate right neural foraminal stenosis. No significant spinal canal stenosis.C7-T1: No significant compromise to the spinal canal. There is bilateral uncovertebral hypertrophy. There is mild bilateral neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine. There is mild to moderate spinal canal stenosis involving the left aspect of the spinal canal at the C4-C5 level and to a lesser degree at the C5-C6 level. No cord signal abnormality.2. There is multilevel neural foraminal stenoses, relatively worse at the C4-C5, C5-C6, and C6-C7 levels. Please see details above.


Instruction: Generate impression based on findings.

Input: 73-year-old male. Elevated PSA, negative prostate biopsy x 2. Evaluate for prostate tumor. EPIC history: PSA ranging from 4.1 to 6.85 ng/mL. PELVIS:PROSTATE:Prostate Size: 3.8 x 5.1 x 5.5 cm.Peripheral Zone: No suspicious lesions.Central Gland: 1.5 x 2.4 cm T2 hypointense lesion with associated diffusion restriction and early enhancement in the apex of the prostate in the transitional zone, immediately anterior to the urethra, consistent with prostate cancer (series 704, image 104). Central gland hypertrophy.Seminal Vesicles: No evidence of invasion.Extracapsular Extension: The mass is confluent with the anterior prostatic capsule with extracapsular extension on the right (series 1001, image 8).BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large transitional zone lesion in the apex consistent with prostate cancer. There is extracapsular extension on the right anteriorly.


Instruction: Generate impression based on findings.

Input: Limited examination of the complete spine shows no evidence of spinal cord compression or abnormal cord signal intensity. There is preservation of vertebral body heights and intervertebral disk spaces with normal lordotic curvature of the cervical and lumbar spine. Focal lesions are noted within the L1 and L5 vertebral bodies on STIR imaging and are nonspecific in the absence of contrast. Possible smaller lesion is also noted in the spinous processes of L1. Additional STIR hyperintense lesions is located anterior to the T4 vertebral body and adjacent to the aorta (series 6 or one, image 13) and along the aortic arch (series 601, image 3) are incompletely evaluated.

Output: 1.Limited evaluation of the spine with no evidence of spinal cord compression or abnormal cord signal intensity.2.Focal lesions in the L1 and L5 vertebral bodies, which are nonspecific but suspected to represent neoplastic process.3.Retroperitoneal lymphadenopathy and possible thoracic prevertebral and mediastinal lymphadenopathy is incompletely evaluated in this limited survey for acute spinal cord compression. Please refer to recent PET scan for further comments.


Instruction: Generate impression based on findings.

Input: Male, 18 years old. Recurrent dislocation ROTATOR CUFF: The rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. We see no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is a Hill-Sachs deformity of the humeral head posteriorly. Evaluation of the labrum is limited due to lack of intra-articular contrast. Although we see no fluid signal intensity traversing the anterior inferior labrum, intermediate signal intensity separates the anterior inferior labrum from the underlying glenoid, likely representing sequela of a prior labral tear. Furthermore, the superior labrum appears detached from the underlying glenoid anteriorly and is associated with a paralabral cyst. The posterior labrum appears normal.BICEPS TENDON: The tendon of the long head of the biceps appears normal.

Output: Findings indicating prior anterior dislocation, including Hill-Sachs deformity and findings suggestive of prior anterior inferior labral tearing. There also appears to be a superior labral tear. These findings can be better evaluated with MR arthrography if clinically indicated.


Instruction: Generate impression based on findings.

Input: Chiari malformation with syrinx in thoracic spine: yearly follow up. There are postoperative findings related to Chiari decompression with a patent neo-foramen magnum and biphasic cerebrospinal fluid flow anteriorly. The long-segment syrinx appears to have a slightly larger caliber, measuring up to 3 mm, previously 2 mm. The vertebral column alignment is unchanged, with diffuse straightening in the sagittal plane. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. However, there is a horseshoe kidney with persistently prominent renal collecting systems and a distended bladder.

Output: 1. Postoperative findings related to Chiari decompression with a grossly patent neo-foramen magnum.2. The long-segment syrinx appears to have a slightly larger caliber, measuring up to 3 mm, previously 2 mm. 3. Horseshoe kidney with persistently prominent renal collecting systems and a distended bladder.


Instruction: Generate impression based on findings.

Input: The lacrimal glands are slightly prominent but symmetric and without focal lesions. The optic nerves are symmetric and normal in size and signal intensity. There is no suspicious intraorbital mass or abnormal enhancement. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable. There are scattered patchy foci of T2 hyperintensity within the supratentorial white matter. Mild prominence of the bilateral parotid glands also seen. Small left intraparotid lymph node. No suspicious salivary gland lesions are seen. No significant cervical lymphadenopathy.

Output: 1.Mild symmetric enlargement of the bilateral lacrimal glands and slight prominence of the bilateral parotid glands compatible with known Sjogren's. No priors are available for comparison; however, no aggressive features are seen to suggest lymphoma. 2.Scattered patchy foci of T2 hyperintensity within the supratentorial white matter are nonspecific but compatible with mild chronic small vessel ischemic changes. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: new dx MM, evaluate disease burden SKULL: Numerous myelomatous deposits throughout the skull.CERVICAL SPINE: Diffuse demineralization and multiple small lucencies of the cervical spine consistent with myelomatous deposits. Degenerative disc disease of the mid to lower cervical spine. THORACIC SPINE: Diffuse demineralization and multiple small lucencies of the thoracic spine consistent with myelomatous deposits. Small anterior osteophytes. LUMBAR SPINE: Degenerative changes of the lumbar spine. Myelomatous deposits in the L1 and S1 vertebrae are better seen on prior MRI spine. Diffuse demineralization and multiple small lucencies of the lumbar spine consistent with myelomatous deposits. RIBS: Healing fracture of the left 7th rib suspicious for myelomatous involvement. Small multiple lucencies of the bilateral scapulae and distal clavicles suspicious for myelomatous deposits. PELVIS: Numerous myelomatous deposits throughout the pelvis.UPPER EXTREMITY: Multiple small myelomatous deposits of the bilateral humerus and radius.LOWER EXTREMITY: Multiple small myelomatous deposits of the bilateral femurs, tibias, and fibulas. Mild osteoarthritis of the bilateral hips. Moderate osteoarthritis of the bilateral knees.

Output: Diffuse myelomatous deposits involving the axial and appendicular skeleton as above.


Instruction: Generate impression based on findings.

Input: Persistent headaches and dysequilibrium. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered foci of T2 hyperintensity in the cerebral white matter. The ventricles and sulci are mildly prominent diffusely due to cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There are bilateral lens implants. There is a left maxillary sinus retention cyst.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Mild scattered foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent the result of chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 41-year-old female with knee pain. Assess for meniscal injury. MENISCI: There is linear signal abnormality within the posterior horn of the medial meniscus which extends to the tibial articular surface and body of the meniscus consistent with a horizontal cleavage tear. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is mild chondromalacia affecting the articular cartilage along the lateral facet of the patella. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Medial meniscus tear as described above.


Instruction: Generate impression based on findings.

Input: 16 day old male evaluate for bleed or mass. Signs and symptoms: Seizure No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. This examination is essentially within normal limits for patient's stated age of 16 days. Follow-up with an MRI is recommended. Calvarium is unremarkable. Mastoid air cells are been pneumatized.

Output: Negative CT of brain without the infusion.


Instruction: Generate impression based on findings.

Input: 60 years Female (DOB:2/15/1956)Reason: assess for mets History: presumed metastatic breast cancerPROVIDER/ATTENDING NAME: JOHN F. MCCONVILLE JOHN F. MCCONVILLE There is a punctate focus of diffusion restriction present in the right occipital lobe subcortical white matter. Another focus of diffusion restriction is present in the right cerebellar hemisphere which is associated with T2 and FLAIR signal hyperintensity.There is diffuse thickening of the calvarium associated with the marrow replacement throughout the calvarium, skull base and visualized upper cervical spineThere is diffuse pachymeningeal thickening present.Punctate focus of susceptibility effect is present in the upper vermis. This associated with some contrast enhancement. Another punctate focus of susceptibility effect is present along the right marginal ramus of the cingulate sulcus. This is not seen on any other pulse sequences and is therefore nonspecific.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 demonstrates mucosal thickening in the right sphenoid sinus and scattered opacities in the ethmoid air cells. The visualized portions of the mastoid air cells demonstrate partial opacification. The visualized portions of the orbits are intact. The left eyelid appears distorted possibly related to tape closing the patient's eyelids. Patient is status post intubation..

Output: 1.Findings are compatible with diffuse calvarial, skull base and upper cervical spine metastases.2.There is diffuse pachymeningeal thickening present which is a nonspecific finding. One possibility is that it is a reaction to the patient's calvarial metastatic disease.3.A microhemorrhage within the vermis is a nonspecific finding. It's conceivable this represents a small cavernoma or other hemorrhagic lesion. A follow-up exam would help differentiate this from metastatic disease.4.Findings suggest microinfarcts in the right cerebellar hemisphere and of the right occipital lobe


Instruction: Generate impression based on findings.

Input: Left trigeminal nerve deficits. Face: There is a predominantly T2 intermediate, enhancing, relatively well-defined, mildly lobulated mass with low diffusivity within the left masticator space, centered around the posterior mandible, which appears to have cortical erosions medially. The mass measures up to 48 mm and surrounds the proximal left inferior alveolar nerve. The mass contains a cystic area laterally with fluid-fluid level that is suggestive of hemorrhage. The mass contributes minimally to oropharyngeal airway narrowing. There is mild posterior deviation and narrowing of the left internal jugular vein. The left internal carotid artery flow void appears to be intact. There is no convincing evidence of significant regional lymphadenopathy. There is no evidence of intracranial extension. Aside from mass effect upon the left parotid gland, the salivary glands are intact. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. The cisternal segments of the bilateral trigeminal nerves are also intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: A bulky mass within the left masticator space likely represents a neoplasm such as a sarcoma.


Instruction: Generate impression based on findings.

Input: For the purposes of numbering, there are 5 nonrib-bearing lumbar vertebral bodies and a transitional segment labeled S1 for the purposes of this report. Please note the numbering is slightly different compared to previous exam dated 3/17/2009. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body are well-maintained. There is progression of loss of disc height at L5-S1 compared to prior exam. Remaining intervertebral discs heights are maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L2 level.T12-L1: There is minimal disc bulge without significant spinal canal or neural foramina stenosis.L1-2: There is mild facet arthropathy. No significant disc bulge, spinal canal or foraminal stenosis.L2-L3: There is mild interval progression of left paracentral disc extrusion which extends mildly superiorly and inferiorly extends posterior to the L3 vertebral body to the L3-4 disc level, associated with mild spinal canal stenosis. There is mild facet arthropathy. There is mild right neural foraminal narrowing. There is no left neuroforaminal narrowing.L3-L4: There is central disc extrusion which is contiguous with above-described disc extrusion resulting in mild spinal canal stenosis. There is mild facet arthropathy. No neural foraminal narrowing.L4-L5: There is disc bulge. There is facet arthropathy and mild ligamentum flavum thickening. No significant spinal canal stenosis stenosis. There is minimal right neuroforamina narrowing. There is no left neuroforaminal narrowing. L5-S1: There is advanced facet arthropathy. There is mild disc bulge. There is mild to moderate neural foraminal stenosis bilaterally. There is no evidence of spinal canal stenosis.S1-S2: No significant disc bulge or spinal canal or neuroforaminal narrowing is evident.

Output: 1. Multilevel degenerative changes with disc extrusion extending from L2-3 to the L3-L4 level which is slightly progressed since the previous study dated 3/17/2009. There is mild associated spinal canal stenosis.2. Neuroforaminal stenosis is relatively worst at the L5-S1 level.3. Please note there is transitional anatomy as described above and the numbering scheme is slightly different from previous study dated 3/17/2009.4. Advanced facet arthropathy at L5-S1, which may be contributing to the patient's back pain.


Instruction: Generate impression based on findings.

Input: 89-year-old female with hypothyroidism, hypertension, dementia, admitted with exacerbation of right-sided sciatica. Five lumbar type vertebral bodies are presumed to be present. There is a Schmorl's node involving the superior endplate of the T11 vertebral body with approximately 35 % loss of height involving the left aspect of the vertebral body suggestive of a mild chronic compression fracture. Small Schmorl's nodes are also noted involving the inferior L2 and upper and lower L3 endplates. Vertebral body heights are otherwise maintained. Alignment is grossly maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen with disc height loss and vacuum phenomena evident at the L1-L2, L2-L3, and L3-L4 levels. Individual levels, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: There is mild disc bulge, bilateral facet arthropathy, as well as a cystic structure dorsally which may represent a ligamentum flavum cyst versus a synovial cyst associated with the facet arthropathy. There is overall mild to moderate spinal canal stenosis at this level. There is mild bilateral neural foraminal stenosis.L3-L4: There is a large right-sided disc extrusion which effaces the right lateral recess and extends caudally along the dorsal aspect of the L4 vertebral body to the level of the L4-L5 disc. The inferior aspect of the extruded disc material appears to be in contact with the remainder of the disc material superiorly, but may represent a free fragment. There is also ligamentum flavum thickening and bilateral facet arthropathy contributing to severe spinal canal stenosis at this level. There is moderate to severe right-sided neural foraminal stenosis and moderate left-sided neural foraminal stenosis.L4-L5: There is a disc bulge eccentric to the right with ligamentum flavum thickening and bilateral facet arthropathy contributing to mild to moderate spinal canal stenosis. There is also moderate right and mild left neural foraminal stenosis. L5-S1: Minimal disc bulge and bilateral facet arthropathy with distended facet joints. There is no significant spinal canal or neural foraminal stenosis.Fatty atrophic changes are noted involving the lower lumbar paraspinous musculature at the L5 level, right greater than left. Bilateral renal cysts noted. Degenerative changes are also noted at the right T12 costovertebral joint with associated surrounding bone marrow edema.

Output: Multilevel degenerative changes in the lumbar spine which are severe at the L3-L4 level. There is severe spinal canal stenosis as well as moderate to severe right-sided neural foraminal stenosis at this level. There is also a disc extrusion with inferior migration which appears to originate from the L3-L4 level and migrates inferiorly to the L4-L5 level, and is associated with complete effacement of the right lateral recess. There is suspected impingement of the exiting right L3 nerve root as well as the descending L4 nerve root.Please see findings at additional details as above.


Instruction: Generate impression based on findings.

Input: 61 year old male patient with history of eye surgery. Evaluate for metallic foreign object prior to MRI. There is soft tissue swelling of the lateral aspect of the left scalp with foci of gas density which may reflect recent intervention or an abscess. There is a spherical density in the right orbit likely representing a prosthetic globe. The density of this prosthesis appears less than that of metal and we suspect it is MRI compatible. However, close attention should be paid to the patient's symptoms during the MRI examination.

Output: We see no metallic foreign density and suspect the patient's right prosthetic globe is MRI compatible; however, close attention should be paid to the patient's symptoms during the MRI examination. Findings communicated to T Shah at 1725 hrs on 12/14/2015.


Instruction: Generate impression based on findings.

Input: Reason: eval for lesions, assess hepatic vessel patency History: s/p OLT in 12/08, history of met HCC in right lung in 2009. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of a right lobe transplant. No new or suspicious focal hepatic lesion. Hepatic vasculature is patent. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Splenomegaly, unchanged.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: Extensive esophageal and splenorenal varices, unchanged.

Output: 1.Postsurgical changes of a right hepatic lobe transplant with no evidence of HCC recurrence.2.Stable splenomegaly and esophageal/splenorenal varices.


Instruction: Generate impression based on findings.

Input: 67-year-old male with upper and lower left-sided weakness and history of metastatic bladder cancer, rule out metastatic disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There are scattered nonspecific punctate foci of high T2 signal in the periventricular and subcortical white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a 1.7 x 1.2 cm enhancing mass in the right anterior masticator space. There is a partially-imaged nodule in the left posterior upper neck subcutaneous tissues. Otherwise, the orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.A mass in the right anterior masticator space likely represents a metastasis. Another partially-imaged nodule in the left posterior upper neck subcutaneous tissues may also represent a metastasis.2.No evidence of intracranial metastases or acute infarction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:10/4/1970)Reason: s/p resection brain mat a long time ago. PLease evaluate for progression in brainstem History: WobblyPROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA There is redemonstration of enhancing lesions within the brain parenchyma. One in the left middle frontal gyrus posteriorly measures 7 mm and previously measured approximately the same. One along the left inferior frontal gyrus measures 6 mm and previously measured similar dimensions. One in the right centrum semiovale measures 5 mm and previously measured the same. One in the medial aspect of the right occipital lobe measures 7 mm and previously measured approximately the same though it enhances less on the current exam. One in the left cerebellar hemisphere measures 15 mm and is stable. One in the pons measures 10 x 13 mm and is stable. One in the left cerebellar hemisphere inferiorly measures 10 mm and previously measured the sameThe patient status post left frontal craniotomy and suboccipital craniotomy. There is a enhancement along the margins of the left frontal craniotomy site the calvarium and adjacent soft tissues. This most likely postoperative in nature. Within the suboccipital craniotomy site there are fluid collections present within the subcutaneous tissues which appear to be more organized on the current exam versus the prior.There is no abnormal enhancing lesion identified in the left frontal lobe at the surgical site. Previously within the posterior fossa at the surgical site there are 2 large lesions present. One was at the left cerebellar hemisphere inferiorly and the other one was medial aspect of the right cerebellar hemisphere. Comparing with the preoperative exam from 5/2/2016 there is a there are small foci of nodular enhancement present at the surgical margins which are more apparent on the current exam than on the prior. Small nodule is present along the left inferior cerebellum at the surgical margin which is not clearly delineated on the prior exam and was possibly obscured by associated findings. Another focus of nodular enhancement is present along the inferior aspect of the right cerebellar hemisphere at the surgical margin measuring 9 x 6 mm. There is also redemonstration of a enhancement along the surface of the cerebellum along the posterior fossa surgical sites which is likely postoperative in nature.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple lesions scattered within the brain parenchyma including supratentorial and infratentorial brain compatible with metastases. These are stable since the examination from May 4.2.The patient is status post suboccipital craniotomy for tumor removal/debulking. Postoperative changes include fluid collections at the surgical site. This could represent seroma or CSF leak. At the surgical margins within the cerebellum there are nodules in the enhancement which are suggestive of a small bits of residual or recurrent neoplasm.3.The patient is status post left frontal lobe surgery. There is no evidence for local recurrence.