Instruction: Generate impression based on findings.

Input: 70-year-old male history of elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.8 x 6.4 x 5.6 cmPeripheral Zone: No significant abnormality noted.Central Gland: In the left anterior apex, there is a T2 hypointense nodule measuring 2.1 x 1.7 cm with associated restricted diffusion.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Probable extracapsular extension anteriorly.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Highly suspicious transitional zone nodule in the left anterior apex with probable extracapsular extension.


Instruction: Generate impression based on findings.

Input: 56 year old female with brain mass, most likely meningioma. Rule out systemic involvement. Expressive aphasia. CHEST:LUNGS AND PLEURA: Atelectasis at the right lung base. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right breast mass with macrocalcification at image 30 of series 5 measures 2 cm in diameter. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Laparoscopic band at gastroesophageal junction is in the expected position. Normal appendix in the right lower quadrant. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Foley catheter in decompressed bladder. 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. Right breast mass.2. Lap band at GE junction.3. No occult malignancy was found.


Instruction: Generate impression based on findings.

Input: Back pain. Postoperative changes of a posterior laminectomy at L4 and L5.L1-2: Disk disease with posterior disk bulge. Bilateral facet hypertrophy. No significant central canal stenosis. L2-3: Posterior disk bulge, bilateral facet hypertrophy and thickening of the ligamentum flavum with mild narrowing of the spinal canal. Bilateral neuroforaminal narrowing. L3-4: Grade 1 retrolisthesis of L3 on L4. Degenerative disk disease is present. There are severe endplate changes and multiples lytic foci, very suspicious for a diskitis/osteomyelitis or metastatic disease. There is extensive soft tissue abnormality in the spinal canal and in paravertebral region, with involvement of neuroforamina. There is likely impingement of nerve roots within the spinal canal and right neuroforamen. Please correlate with a dedicated MRI of the lumbar spine.L4-5: Grade 1 retrolisthesis of L4 on L5 with degenerative disk disease including loss of disk height and posterior disk bulge / herniation. There is bilateral spinal canal and neuroforaminal narrowing, and likely nerve impingement.L5-S1: Grade 1 retrolisthesis of L5 on S1 with posterior disk bulge and bilateral neural foramen narrowing. There is extensive soft tissue abnormality in the spinal canal and neuroforamina, probably causing encasement or impingement of nerve roots.A small sclerotic lesion is seen in the left ilium. This likely represents an enostosis, but blastic bone metastasis can have similar appearance.

Output: 1.Degenerative disease of the lumbar spine as described above. Postoperative changes of posterior laminectomy extending at L4 and L5 level.2.There is extensive L3-L4 disk disease and endplate destruction with multiple lytic lesions, and extensive soft tissue abnormality within the spinal canal, neuroforamina and paravertebral region, very suspicious for discitis/osteomyelitis versus metastatic disease.3.Spinal canal and neuroforaminal narrowing at multiple levels.4.Small sclerotic lesion in the left ilium. This likely represents an enostosis, but blastic bone metastasis can have similar appearance.5.Findings were discussed with Dr. Pettit at time of final reporting of the study.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for left hip labral tear History: hip pain left side with clicks and piriformis and sciatica ACETABULAR LABRUM: No significant abnormality noted. The labrum is in tact without evidence of tearing.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. The bone marrow signal is normal.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Normal MRI of the left hip.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: any evidence of CSF leak post contrast History: headaches post-exerctional after bearing down For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-2 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: no neuroforaminal narrowing or spinal stenosis. L5-S1: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis.

Output: Normal L-spine MRI scan except minimal bulging of disc at the level of L5-S1.Comment: If clinically indicated, nuclear medicine cisternogram can be considered for further imaging evaluation of CSF leakage.


Instruction: Generate impression based on findings.

Input: Reason: mild aphasia prior CVA, please assess History: language problems, mild attentional problems The CSF spaces are appropriate for the patient's stated age with no midline shift. No diffusion restriction is appreciated.There are small foci of encephalomalacia present along the left middle and inferior frontal gyrus as well as a punctate lesion in the left hand motor area. There are associated tiny foci of SWI signal loss along the associated cortex.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is diffuse calvarial thickening. Marrow signal is diminished

Output: 1.There are small foci of encephalomalacia present in the left inferior and middle frontal gyri as well as a punctate focus in the left hand motor area. These most likely are related to a prior ischemic event.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They are most likely vascular related, however, they are nonspecific and can be seen with demyelination or vasculitis ,for example, depending on the clinical context. 3.Diffuse calvarial thickening is a nonspecific findings. Please correlate with the clinical history.4.There is no evidence for acute ischemic cerebral infarction. 5.Marrow signal is diminished which is non-specific. It could relate to chronic disease, anemia, myeloproliferative disorder, renal failure etc.


Instruction: Generate impression based on findings.

Input: Phlebitis and thrombophlebitis of unspecified site [I80.9], Reason for Study: ^Reason: dissection History: right sided neck pain; thrombophlebitis of neck Motion artifacts degraded image quality.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.In particular, there is no evidence of high signal intensity around craniocervical arterial system on fat saturated T1 weighted images indicating possible arterial dissection. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Bilateral mastoid air cells show opacification.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of arterial dissection on this scan.


Instruction: Generate impression based on findings.

Input: Male, 44 years old. Knee instability MENISCI: There is branching signal abnormality within the posterior horn and body of the medial meniscus indicating a complex, predominantly horizontal tear. There is also blunting of the free edge of the body of the medial meniscus. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is mild heterogeneity of the articular cartilage of the patella which may represent early degeneration, but this is equivocal. We see no fluid-filled defects.LIGAMENTS: Mild edema along the superficial band of the MCL is nonspecific but could represent a sprain in the correct clinical context. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Complex tear of the medial meniscus and other findings as described above.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. At the left lamina and spinous process of C3, there is sclerotic lesion with mild expansion. Subtle changes of similar appearance are also seen at level of C2. The left C2 - C3 facet joint is indistinct. Given the history of breast cancer, metastatic disease needs to be considered, although the lack of significant progression based on comparison of prior MRI is less typical. Degenerative disease is again present, with disc-osteophyte complex at C5-C6 level, causing spinal canal stenosis. There is also neural foramina narrowing bilaterally secondary to degenerative disease of uncovertebral joints.

Output: 1. Sclerotic lesions at left lamina and spinous process of C2 and C3 vertebral levels, which can represent metastatic disease, although the reported stability between the two prior MRI studies is unusual.2. Degenerative disease of the cervical spine as described above. Please also correlate with MRI cervical spine.


Instruction: Generate impression based on findings.

Input: 94 years Female (DOB:9/22/1922)Reason: episodic dizziness/unawareness; possibly TIAs; significant vascular disease? History: episodic dizziness/unawareness; possibly TIAs; significant vascular disease?PROVIDER/ATTENDING NAME: DIANE L. ALTKORN DIANE L. ALTKORN MRI of the brainThere is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of T2 and FLAIR signal hyperintensity are present in the cerebellum and brainstem. The lesion in the right middle cerebellar peduncle is associated with susceptibility effect.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells demonstrate opacities in the right mastoid more than the left. These are nonspecific. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are very small. The right vertebral artery is larger than the left vertebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Male, 10 years old. History of a left parietal DNET, S/P craniotomy tumor resection, 6 month f/u since last MRI, evaluate for residual tumor or new tumor. Again seen are postoperative findings of left parietal craniotomy for resection of a small left parietal tumor. The resection cavity lies along the posterior aspects of the supramarginal and angular gyri in the inferior parietal lobule. There is stable to slightly decreased overlying dural enhancement. A small area of curvilinear enhancement extending into the resection cavity from the dura is unchanged and likely postoperative in nature. There is no evidence of residual or recurrent tumor.The pineal gland is prominent and enhancing, unchanged from prior studies. Otherwise, the brain morphology and signal characteristics are within normal limits. There is no evidence of intracranial hemorrhage, mass effect or edema. The ventricles and basal cisterns are normal in size and configuration. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1. Continued evolution of postoperative findings related to resection of a small left inferior parietal lobule tumor, without evidence of residual or recurrent tumor.2. Enhancing pineal mass is unchanged from prior exams.


Instruction: Generate impression based on findings.

Input: Clinical question : Rule out intracranial lesion causing seizures. Signs and symptoms: Seizures Nonenhanced head CT:There is no evidence of acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white differentiation is within normal.Previously reported periventricular foci of low-attenuation on MRI examination of brain are not identified on this examination.Calvarium demonstrate postoperative changes of bilateral temporal small craniotomies.Extensive paranasal sinuses and mastoid air cells are unremarkable.

Output: Negative nonenhanced head CT.


Instruction: Generate impression based on findings.

Input: 33-year-old female with history of sickle cell disease and anti-phospholipid syndrome presenting with altered mental status, agitation, and tachycardia. Rule out acute intracranial abnormalities. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles are midline and demonstrate normal morphology and volume. Increased density in the suprasellar cistern may be due to partial volume averaging, though correlation with MRI may be helpful to further evaluate as clinically indicated.The calvaria and skull base are radiographically normal. There has been interval partial opacification of the right mastoid air cells and right frontal sinuses, with the remainder the visualized paranasal sinuses are normally pneumatized.

Output: 1. Mild inflammatory changes around the visualized right mastoid air cells.2. Increased density in the suprasellar cistern may result from artifact, though correlation with MRI to assess for sellar pathology may be helpful if clinically indicated.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out stroke. Signs and symptoms: Same. Nonenhanced brain MRI:No evidence of acute intracranial process and in particular no detectable acute ischemic stroke.Very few punctate foci of periventricular nonspecific flair hyperintensity are noted. Although nonspecific considering patient's stated age of 73 this appearance could represent mild degree of chronic nonhemorrhagic small vessel ischemic strokes. The signal intensity of brain parenchyma is otherwise within normal. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination the brain otherwise.On axial T2 series 6 there is abnormal signal intensity right internal carotid artery across the skull base and with a tiny central signal void suggestive of very high grade stenosis of right internal carotid. The supraclinoid right internal remains patent however very small in caliber. The evaluation vascular imaging is highly recommended. Emergency room staff was notified of this finding by the radiology on call resident.12 bilateral vertebral arteries, basilar artery and left internal carotid artery is unremarkable.

Output: 1.No detectable acute ischemic process.2.Minimal chronic small vessel ischemic strokes only in the subcortical/periventricular white matter. Unremarkable brain parenchyma otherwise.3.Abnormal signal intensity of the right internal carotid artery across the skull base and with a tiny central signal void highly suggestive of high grade of stenosis. Follow-up with dedicated vascular imaging is highly recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Non-Hodgkin's lymphoma with CNS involvement status post chemotherapy. Signs and symptoms: Restaging. Pre- and post enhanced complete spine MRI:Cervical spine images demonstrate normal signal intensity and alignment of vertebral column without abnormal enhancement. Normal signal intensity and caliber of cervical cord and without abnormal enhancement.No significant degenerative disease or spinal stenosis at any level is detected. There is revisualization of very faint thin smooth enhancement of few of the cervical nerve roots bilaterally in a symmetrical fashion without detectable thickening of the nerve roots is again noted. Finding is nonspecific however less likely possibility of tumor cannot be entirely excluded. There is no detectable enhancement of the leptomeningeal lining of the cervical cord.Thoracic spine images demonstrate normal alignment of vertebral column without abnormal enhancement. There is uniform marrow signal changes of the lower thoracic spine similar to prior exam and likely representing postradiation change. This finding extends from T10 inferiorly through the sacral spine and consistent with prior radiation change.There is revisualization of a stable focus of intradural extra medullary enhancement (axial series 13 image 25) in the left lateral thecal sac at T5 level measuring approximately 5 mm at the base along the dura and 5 mm in transverse axis similar to prior exam in size, density and extent. Differentials of a nerve sheath tumor or small focus of metastatic disease should be considered.There is no convincing evidence of any additional foci of abnormal leptomeningeal enhancement. This is a similar observation is prior study.No evidence of a spinal stenosis or neural foraminal compromise at any level.Lumbar spine images demonstrate uniform diffuse marrow signal changes of the vertebral column consistent with prior radiation therapy. There is subtle enhancement of the endplates abutting the L2-L3 disc representing degenerative changes. Finding was also noted on prior exam and without change.The signal intensity and morphology of the lower most visualized thoracic cord, conus and cauda equina is within normal.On post enhanced images there is uniform faint enhancement of cauda equina without detectable clumping, focal areas of thickening or tumor. This finding was not as conspicuous on prior exam which likely is techniques related. Finding could represent posttreatment changes however correlation with CSF analysis is recommended to exclude less likely possibility of leptomeningeal carcinomatosis.

Output: 1.Cervical MRI demonstrate smooth thin symmetrical faint enhancement along the nerve roots without significant change since prior exam. Unremarkable cervical MRI otherwise. The signal intensity and caliber of cervical cord is within normal and without detectable enhancement of its leptomeninges.2.Thoracic MRI demonstrates a single stable focus of intradural extra medullary enhancement ( 5 x 5 mm) in the left lateral aspect of spinal canal at T5 level. Differentials of isolated focus of the meningeal tumor or a nerve sheath tumor should be considered. No detectable additional foci of leptomeningeal enhancement.3.Lumbar MRI demonstrate smooth uniform thin enhancement of the cauda equina without focal thickening of clumping. This finding was not as conspicuous on prior exam which could be technique related. To entirely exclude leptomeningeal carcinomatosis follow up with CSF analysis is recommended.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, with altered mental status and oropharyngeal dysfunction. History of hemorrhagic medulla/pons stroke. No new lesions seen on CT. Susceptibility, T2 hyperintensity and T2 shine through artifact are seen within the medulla. The medulla is not edematous, and if anything, there appears to be a component of encephalomalacia. Patchy nonedematous T2 signal also continues into the upper cervical cord. Elsewhere in the brain, no restricted diffusion is seen. Numerous patchy foci of periventricular and subcortical T2 hyperintensity are demonstrated. No parenchymal edema or mass effect is detected. No abnormal extra-axial fluid collection is seen. Numerous scattered foci of susceptibility are evident within the brainstem and cerebellum, and to a lesser degree the cerebral hemispheres, compatible with chronic microhemorrhage. No acute intracranial hemorrhage is detected.The dura appears to be mildly and diffusely thickened. The marrow signal of the calvarium is uniformly more hypointense than what is typically seen. A mucous retention cyst is evident in the right maxillary sinus.

Output: 1.Findings in the medulla which would be compatible with the stated history of prior stroke in this area.2.Signal abnormality within the medulla and upper cervical cord is felt most likely to be chronic as there is no evidence of swelling or mass effect.3.Elsewhere in the brain, moderately extensive chronic small vessel ischemic disease is seen, but there are no suspected acute abnormalities.4.Diffuse mild thickening of the dura is of uncertain etiology. However, it may be reactive to changes in the overlying calvarium which demonstrates relatively hypointense marrow signal. This in turn is a nonspecific finding which can reflect normal variation as well as a variety of metabolic conditions such as chronic renal disease.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: 48-year-old female with newly diagnosed triple negative left breast invasive ductal carcinoma presents for bilateral staging MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A 5.0 x 4.5 x 4.4 cm heterogeneously enhancing mass is present at the 2:00 position of the left breast. A small amount of non-mass enhancement extends posteriorly from the mass. Total area of enhancement in the upper outer left breast measures 6.5 x 4.5 x 4.4 cm. Susceptibility artifact from biopsy clip is present along the superior medial margin of the mass. No additional areas of abnormal enhancement are seen in the left breast.No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Enhancing 5.0 cm mass at the 2:00 position of the left breast, compatible with the patient's known malignancy. A small amount of non-mass enhancement extends posteriorly from the mass. Total area of enhancement is 6.5 x 4.5 x 4.4 cm.2. No MRI evidence for malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Baseline scan prior to starting U. treatment to brain metastases. Signs and symptoms: Metastatic melanoma. Enhanced MRI of brain:This examination was performed after and in few CT of abdomen and no additional contrast was administered for this exam.There is no evidence of any abnormal enhancement of brain parenchymal or leptomeninges to suggest metastatic disease. There is also no evidence of any lytic or sclerotic changes of calvarium to suggest skull metastases lesion.No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Very subtle periventricular low attenuation of brain parenchyma although none is specifically is highly suspected of mild small vessel disease of indeterminate age.Paranasal sinuses and mastoid air cells are well pneumatized and unremarkable.

Output: 1.Negative enhanced CT of brain and calvarium for metastatic disease.2.Very minimal small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: 40 year-old female with low back pain. There are five lumbar vertebrae with small ribs noted at L1. Moderate degenerative disc disease affects L3-L4. The remaining intervertebral disc spaces are preserved. Mild anterior wedging of L1 is noted as seen on the prior MRI. Vertebral alignment is within normal limits.

Output: Degenerative disc disease of L3-L4 and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: eval for meniscal tear; patellar tendon tear; articular cartilage defect History: knee patellar dislocation, subluxation and tendonitis with chronic pain unresponsive to time and therapy MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified along the medial or lateral compartments. Note is made of linear decreased signal abnormality affecting the articular cartilage along the lateral facet of the patella likely representing a full-thickness articular cartilage fissure (image 15; series 7). There is a tiny amount of increased bone marrow signal abnormality within the posterior aspect of the lateral tibial plateau which may represent a resolving contusion.LIGAMENTS: There is partial thickness tearing involving the proximal fibers of the ACL (image 17; series 7). The PCL appears intact. The MCL and LCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. The medial retinaculum appears intact, although the proximal fibers are not reliably visualized without fat suppression on axial images.ADDITIONAL

Output: 1. Partial tear of the proximal fibers of the ACL which may be subacute or chronic in etiology.2. Full-thickness articular cartilage fissure along the lateral facet of the patella. Edema within the superior aspect of Hoffa's fat pad. These findings can be seen in patellofemoral instability.


Instruction: Generate impression based on findings.

Input: Again demonstrated are post surgical changes related to left parietal lobe tumor resection with areas of increased T1 signal and susceptibility effects within the treatment cavity related to blood products. No abnormal enhancement to suggest recurrence. A small extra-axial fluid collection is seen which is less prominent along the left parietal convexity. The ventricles are normal in size. No mass effect or midline shift.There is mildly increased T2 signal which extends inferiorly within the periatrial region similar to previous.Previously demonstrated T2 hyperintense, enhancing mass in the left operculum demonstrates interval mild increase in size and slightly more heterogeneous enhancement on post gadolinium images relating to necrosis, overall measuring 3.7 x 2.7 x 3.1cm and previously 3.1 x 2.3 x 2.7 cm. Enlargement is more prominent when compared to 5/7/2015 study.Ventricles are normal in size. There is no mass effect or midline shift. The basal cisterns remain patent.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Compared to 5/7/2015 and 6/9/2015, there is continued enlargement of the left frontal operculum mass likely representing a separate focus of high-grade glial neoplasm. Increased necrosis within this tumor is also demonstrated.2. Stable postsurgical changes at the left parietal lobe resection cavity without discrete lesion to suggest recurrence at this site.


Instruction: Generate impression based on findings.

Input: Low back pain and hip pain. Sciatica, right side. For the purposes of numbering, there are 4 lumbar type vertebral bodies and a fifth transitional segment labeled S1 for the purposes of this study. As such the most inferior well-defined disc space is labeled L4-S1. Vertebral body heights are within normal limits. Alignment is within normal limits. No marrow infiltrating or destructive osseous lesions. T1 hyperintense focus involving the left aspect of S1 is compatible with hemangioma. Small nonspecific sclerotic focus involving the right iliac bone also present on prior CT 5/13/2016. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge with small left extraforaminal disc protrusion. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-S1: Disc desiccation and minimal bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Small sacral perineural cysts incidentally noted. Paraspinous soft tissues are within normal limits.

Output: 1. Mild degenerative changes in the lumbar spine without significant spinal canal or neural foraminal stenosis at any level.2. Note transitional anatomy with 4 lumbar type vertebral bodies.


Instruction: Generate impression based on findings.

Input: Pituitary tumor and multiple meningiomas, 6 month evaluation for changes. Pituitary: There are postoperative findings related to transsphenoidal surgery. There is no significant interval change in the pituitary mass with suprasellar and bilateral cavernous sinus extension, as well as invasion into the clivus. Indeed, there is unchanged encasement of the left juxtasellar internal carotid artery and mass effect upon the optic apparatus, which displays regional volume loss. Brain: There are postoperative findings related to right frontal craniotomy with right frontal lobe encephalomalacia. There is no significant interval change in the multiple dural-based enhancing mass lesions, including along the tentorium with mass effect and edema in right occipital lobe, in the left anterior sylvian region, right frontal convexity and along the left anterior falx cerebri. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, paranasal sinuses, skull and scalp soft tissues appear unchanged.

Output: 1. No significant interval change in the invasive pituitary macroadenoma with massa effect upon the optic apparatus and encasement of the left internal carotid artery.2. No significant interval change in the multiple intracranial meningiomas, including the dominant left tentorial lesion with associated right occipital lobe edema.


Instruction: Generate impression based on findings.

Input: Reason: Disease progression History: schwannomatosis and bone lesions Please note that comparison to the prior examination is suboptimal due to technical differences between the protocols.Pelvis:Several small foci of signal abnormality are identified within the bones of the pelvis bilaterally. The reference lesion(s) seen on the prior study, presumably within the right ilium posteriorly, appears less confluent on the current study than on the prior study. For future reference purposes, a ring-enhancing lesion within the right ilium, lateral to the right sacroiliac joint, measures approximately 1.4 cm in its greatest transverse diameter. There is low signal intensity within the left ilium, posteriorly, which may represent a site of prior surgical biopsy with adjacent foci of metallic susceptibility artifact in the overlying soft tissues. There are small foci of abnormal signal intensity and enhancement also noted within the proximal femoral, bilaterally. Mild osteoarthritis affects both hips. Mild osteoarthritis affects the sacroiliac joints. Degenerative disc disease affects the lower lumbar spine. There is a fluid collection with thin peripheral enhancement within the lateral subcutaneous fat of the right hip, measuring approximately 4 cm in the craniocaudal dimension, perhaps representing a seroma from prior surgery. There is a small minimally enhancing mass along the S2 nerve root which may represent a small schwannoma. There is an ovoid mass measuring approximately 1 cm within the vastus lateralis muscle on the left which may also represent a peripheral nerve sheath tumor.Right femur:There is poorly defined intermediate signal intensity within the femoral diaphysis which may simply represent red marrow. There are small subcentimeter schwannomas in the right sciatic nerve within the proximal thigh and also in the distal thigh which measures approximately 1.3 cm in its greatest diameter. There is an additional schwannoma within the vastus lateralis measuring approximately 1.2 cm in its greatest diameter. There is a small amount of fluid within the knee joint.

Output: 1. Multiple small marrow-based lesions within the pelvis and proximal femora, as described above, of uncertain etiology.2. Multiple small nerve sheath tumors as described above.


Instruction: Generate impression based on findings.

Input: 31-year-old female with intermittent swelling and pain in the dorsal mid foot. Evaluate for stress fracture or ganglion cyst TENDONS: The tendons appear intact.LIGAMENTS: The lateral collateral ligament complex is intact. The distal tibiofibular syndesmotic complex appears normal. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: Bone marrow signal intensity is within normal limits without evidence of stress fracture. We see no osteochondral defects.ADDITIONAL

Output: Mild subcutaneous edema without evidence of stress fracture or ganglion.


Instruction: Generate impression based on findings.

Input: 62 years, Male, glioblastoma on TMZ/TTF. Note examination is limited to 3-D T1 sequence and is inadequate for assessment of tumor progression. Again seen is evidence of resection of right paramedian frontal tumor with soft tissue thickening along the anterior resection cavity margin and to a slightly lesser degree along the posterior and inferior resection cavity margin, which was also noted and better assessed previously with gadolinium. Ventricles are unchanged in size. No midline shift or herniation. There is extensive T1 hypointensity in the right cerebral hemisphere which is again seen and much of it likely represents vasogenic edema and posttreatment changes.

Output: Patient was claustrophobic and examination was prematurely aborted. This study is not adequate for assessment for tumor progression.


Instruction: Generate impression based on findings.

Input: 64-year-old female for evaluation of meniscal tear MENISCI: There is a large complete radial tear through the posterior horn and body of the medial meniscus. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is degeneration of the articular cartilage of the medial femoral condyle above the torn meniscus. There is mild edema within the medial tibial plateau below the torn meniscus. There is near-full-thickness to full-thickness degeneration of the articular cartilage of the undersurface of the patella along the median eminence and along the medial facet resulting in the defect that is just over 1 cm. There is underlying degenerative signal abnormality within the subchondral bone. Focal degeneration of the articular cartilage of the inferior aspect of the medial facet of the femoral trochlea with underlying subchondral cyst formation. The lateral tibiofemoral compartment is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complete radial tear of the medial meniscus as described above.2.Cartilage degeneration and joint effusion.


Instruction: Generate impression based on findings.

Input: Dizziness, unsteady gait: progressive imbalance with walking for 6 weeks. History of invasive anorectal carcinoma. There is mild cerebellar volume loss, particularly involving the vermis. There is a subcentimeter linear focus of susceptibility effect in the left pons with slight extension into the cerebral peduncle. There is also patchy T2 hyperintensity throughout the pons. In addition, there is mild scattered cerebral white matter T2 hyperintensity, particularly in a periventricular distribution and mild diffuse cerebral volume loss. There is no evidence of mass or acute infarct. There is no abnormal intracranial enhancement. There is a mega cisterna magna. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and ears are grossly unremarkable. The skull appears to be intact. There are bilateral lens implants. There is mucosal thickening in the ethmoid sinuses.

Output: 1. Nonspecific mild cerebellar volume loss, particularly involving the vermis, and mild diffuse cerebral volume loss. 2. A subcentimeter linear focus of susceptibility effect in the left pons with slight extension into the cerebral peduncle may represent a chronic hemorrhagic lacunar infarct. 3. Patchy T2 hyperintensity throughout the pons and mild scattered cerebral white matter T2 hyperintensity particularly in a periventricular distribution likely represent chronic small vessel ischemic disease4. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 58 year-old the female status post craniotomy for epilepsy, complaint of headache There is post craniotomy change at the right temporal region. Images demonstrate subcutaneous soft tissue edema, small amount of extra axial fluid collection and pneumocephalus along the surgical incision, and patchy hyperattenuation blood and low attenuation air bubbles in the right temporal lobe surgical site. Hypodense signal in the right temporal lobe is likely a mixture of surgery cavity and vasogenic edema secondary to the surgical manipulation. All are expecting post surgery change. There is no evidence of large hematoma formation or hydrocephalus. The findings are similar to the MRI study done on 9/21/11.The gray-white matter differentiation is preserved in the remainder structure. However, the cortical sulci of the right cerebral hemisphere is effaced when compared to the contralateral side. There is minimal midline shift to the left approximately 3mm and mild compression of the right lateral ventricle. The findings are suggestive of parenchyma edema on the right, which is relative new when compare to previous MR study. In addition, there is small patchy hypoattenuation in the right frontal lobe cortex (image 18,19). This can be secondary to positioning, however, small ischemic change can not be completely excluded.There is large calcification along the anterior interhemispheric falx and the right frontal dura. The superior sagittal sinus appears hypoattenuation in density, which may secondary to blood loss. Except for craniotomy, the remainder calvarium is unremarkable. Calvarium, visualized paranasal sinuses, orbits and mastoid air cells are unremarkable.

Output: 1. Effacement of the cortical sulci with preserved gray-white matter differentiation of the right cerebral hemisphere, minimal midline shift and partial compression of the right lateral ventricle. The findings are suggestive of parenchyma edema.2. Expected post surgery change as detailed above.3. There is small patchy hypoattenuation in the right frontal lobe cortex. This can be secondary to positioning, however, small ischemic change can not be completely excluded. Non-infusion CT is not sensitive to detect early parenchyma ischemia. If cortical ischemia is suspected on clinical setting, a MRI study may help further evaluate.


Instruction: Generate impression based on findings.

Input: Reason: Well-differentiated papillary mesothelioma with invasive foci. Please compare to prior outside exams. ABDOMEN:LIVER, BILIARY TRACT: Normal signal intensity of the liver with homogeneous enhancement. No focal liver lesion is identified. There is no biliary ductal dilatation. The gallbladder is normal in appearance. No gallstones are identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cysts are identified. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No soft tissue density is seen in the left lower quadrant to correlate with findings on outside CT. There is no definite evidence of metastatic or recurrent disease in the abdomen or pelvis.BOWEL, MESENTERY: The bowel is of normal caliber without obstruction. The appendix appears normal.BONES, SOFT TISSUES: Mild degenerative disc disease affects the lower lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is normal in appearance. The left ovary is atrophic. The right ovary is not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter pelvic lymph nodes are present.OTHER: Bilateral breast implants are noted.

Output: 1.No measurable disease is identified in the abdomen or pelvis.2.Subcentimeter pelvic lymph nodes, which are not enlarged by size criteria.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:9/17/1943)Reason: rule out structural lesion including MS History: gait problem, blurry vision, weaknessPROVIDER/ATTENDING NAME: GABRIELLA L BORRELLI GABRIELLA L BORRELLI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate T2 and FLAIR hyperintense foci are present in the brainstem. There are enlarged perivascular spaces in the basal ganglia.There is a punctate focus of signal loss in the right centrum semiovale on susceptibility weighted imaging. In isolation this is of microhemorrhages are known clinical significance.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery flow-void is very small.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: Periventricular and subcortical white matter lesions of a moderate degree and a few punctate lesions in the brainstem are nonspecific. At this age they are most likely vascular related. Although not particularly characteristic of demyelination based on the morphology and pattern of demyelination cannot be excluded based on this exam. These lesions are nonspecific and demyelinating disorder is in the differential diagnosis..


Instruction: Generate impression based on findings.

Input: Reason: liver lesion noted on CT scan please characterize History: liver lesion on CT scan ABDOMEN:LIVER, BILIARY TRACT: In the right lobe of the liver, there is a 8.6 x 5.9 x 9.1 cm lobulated mass (series 1202 image 477, series 701 image 20). This mass remonstrates relatively homogeneous T1 isointense, T2 mildly hyperintense signal and diffusely decreased signal on out of phase sequences. There is avid homogeneous arterial phase enhancement, some contrast retention seen on subsequent delayed imaging. There is mass effect on the vessels with adjacent perfusion abnormality in the right lobe of the liver. The remainder of the liver demonstrates questionably mild signal loss on out of phase imaging, otherwise, normal morphology and size. No intrahepatic or intrahepatic biliary ductal dilatation.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: Small nonenlarged left paraaortic lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fluid within the subcutaneous fat of the right and posterior abdominal walls likely related to recent surgery.OTHER: No significant abnormality noted.

Output: 1.Large 9 cm mass within the right lobe of the liver with signal characteristics that are most consistent with a hepatic adenoma given the patient's age, gender and absence of cirrhotic liver background, specifically the HNF-1 alpha subtype.2.Questionable mild diffuse hepatic steatosis.


Instruction: Generate impression based on findings.

Input: History of colon cancer status post resection with adrenal nodule seen on CT. ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology without a focal lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The left adrenal nodule measures approximately 1.0 x 0.4 cm. The difference in size is likely due to different imaging modalities. There appears to be loss of signal on out of phase imaging (series 802/32), compared to in phase imaging (series 801/32), suggestive of a lipid rich adrenal adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from abdominal colectomy with right lower quadrant end ileostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The left adrenal nodule measures approximately 1.0 x 0.4 cm. Subtle loss of signal on out of phase imaging is suggestive of a lipid rich adrenal adenoma. However, its small size limits characterization and a follow-up CT in 6 months is suggested.


Instruction: Generate impression based on findings.

Input: 55-year-old female with right frozen shoulder ROTATOR CUFF: Increased signal abnormality within the distal supraspinatus tendon, consistent with tendinopathy. No full-thickness tear is seen. The muscles and tendons of the rotator cuff are otherwise intact.SUPRASPINATUS OUTLET: The AC joint is unremarkable. There is a small amount of fluid within the subacromial subdeltoid bursa. The coracohumeral ligament and subcoracoid fat pad appear within normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The labrum is grossly intact..BICEPS TENDON: Normally situated within the bicipital groove.ADDITIONAL

Output: Distal supraspinous tendinopathy without evidence of rotator cuff tear. No specific evidence of adhesive capsulitis.


Instruction: Generate impression based on findings.

Input: Female, 43 years old. Reason: evaluate for nodule History: right thyroid nodule, slight thyroid enlargement RIGHT LOBE MEASUREMENTS: 2.8 x 2.4 x 5.2 cmLEFT LOBE MEASUREMENTS: 2.3 x 1.9 x 5.5 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Mildly heterogeneous echotexture. A small spongiform nodule within the superior pole of the right thyroid lobe measures 0.5 x 0.4 x 0 .3 cm, with mild internal vascularity.LEFT LOBE: Mildly heterogeneous echotexture. A complex cystic nodule within the inferior pole of the left thyroid lobe measures 0.7 x 0.5 x 0.6 cm, without internal vascularity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are noted. A left level 3 lymph node measures 1.0 x 0.3 x 1.4 cm. A left level 2 lymph node measures 0.9 x 0.4 x 1.4 cm.OTHER: No significant abnormality noted.

Output: Bilateral subcentimeter spongiform and complex cystic lesions are likely benign .


Instruction: Generate impression based on findings.

Input: Q.D. MENISCI: There is complex tearing of the posterior horn of the medial meniscus which extends to the tibial articular surface. Lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild articular cartilage loss of the medial femoral condyle anteriorly with associated degenerative marrow signal. The remaining cartilage of the medial, lateral, and patellofemoral compartments is otherwise intact.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus.2. Mild articular cartilage loss of the medial femoral condyle.3. Small joint effusion.


Instruction: Generate impression based on findings.

Input: 60-year-old female undergoing radiation therapy. Evaluate for split renal function. The posterior abdominal radionuclide angiogram demonstrates prompt, symmetrical perfusion of the kidneys.Sequential renal images show the left kidney to be of normal size and morphology. There is decreased size of the right kidney, particularly of the right lower pole, as seen on prior MRI and which may be due to postsurgical change versus scarring from prior infection or infarct.There is prompt uptake and excretion of the radiopharmaceutical by both kidneys. The estimated contribution of the right kidney to total renal function is 42% and that of the left kidney is 58%. On washout phase, there is pooling of radiotracer in the dilated right renal pelvis with delayed clearance from the proximal right collecting system. The half time of tracer clearance from the left kidney is 12.2 minutes and that from right kidney is 185 minutes. As a result, partial obstruction cannot be excluded.

Output: 1. Mildly decreased contribution of the right kidney to total renal function as detailed above.2. Delayed washout of radiotracer from the dilated right renal pelvis, and as a result, partial obstruction cannot be excluded.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for new baseline of recurrent GBM prior to initiating Tx on ALLIANCE HSPPC96 vax trial. History: recurrent GBM. The patient has undergone left-sided occipital craniotomy for debulking of a mass involving the left occipital lobe and posterior temporal lobe. There remains enhancing component of the tumor adjacent to the occipital horn of the left lateral ventricle previously measuring 39 x 19 mm axial dimensions and it currently measuring 50 x 38 mm axial dimensions. There is increased cerebral blood volume present at this location. Microvascularity can be identified in this same location on the susceptibility weighted imaging. There are blood products present at the operative site. There is a vasogenic pattern of edema which was also present on the prior exam and has not changed in extent compared small amount of extra-axial fluid is present at the site of the craniotomy flap. Associated T2 and flair signal hyperintensities surrounding this mass has mildly increased in extent and involves more of the medial aspect of the left parietal lobe than on the prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The sella is made of a developmental venous anomaly along the right frontal lobe associated with a small hemorrhagic lesion which is unchanged since the previous exam.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.Since the prior exam the patient's left occipital mass has increased in size suggesting progression. 2.There is redemonstration of a hemorrhagic lesion in the right frontal lobe along the inferior frontal gyrus most likely representing a cerebral cavernous malformation associated with a developmental venous anomaly..3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 37 years, Female, multiple sclerosis, follow-up for progression. Weakness of arms and legs. BRAIN: Compared to 4/3/2015, there is interval development of a new T2 hyperintense lesions in the brain, one of which involves the left precentral gyrus near the junction with the left middle frontal gyrus and one which involves the dorsal aspect of the lower medulla in the midline/paramedian region extending to the cervicomedullary junction. These two new lesions demonstrated enhancement.Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are again noted and consistent with known demyelinating disease. Additional infratentorial lesions including the right middle cerebellar peduncle and the left cerebellar hemisphere are again seen. Brain parenchymal volume is maintained. Few lesions with T1 hypointensity are also noted.No intracranial mass or mass effect. No midline shift, hydrocephalus, or herniation. Calvarium and extracranial soft tissue structures are grossly unremarkable.CERVICAL SPINE: There is a new T2 hyperintense lesion involving the cervicomedullary junction with enhancement as mentioned above. There are tiny T2 hyperintense lesions involving the bilateral ventrolateral aspects of the cervical cord at the C4-C5 level. These lesions are evident on the axial T2, axial mFFE, and STIR sequences and more subtle on the prior study. There is a questionable additional T2 hyperintense lesion involving the cervical cord at the C7 level. No abnormal enhancement is appreciated.Partially imaged thoracic cord demonstrates a T2 hyperintense lesion in the ventral cord at the T1-T2 level, which appears to be present on prior although better seen on current study.Vertebral body heights are normal. There is mild reversal of cervical lordosis. Alignment is otherwise maintained. There is no significant spinal canal or neural foraminal stenosis at any level. Scattered perineural cysts are incidentally noted in the neural foramina.

Output: 1. Multiple supra- and infratentorial T2 hyperintense lesions consistent with known demyelinating disease. Compared to MRI brain dated 4/3/2015, there is interval development of two new lesions involving the left frontal lobe and cervicomedullary junction. These lesions demonstrate enhancement. Findings are consistent with progression of disease with areas of active demyelination.2. There are small T2 hyperintense lesions in the cervical cord at the C4-C5 level and partially imaged upper thoracic cord, which were present previously. Aside from the cervicomedullary junction lesion mentioned above, no new lesions or lesions with enhancement in the cervical cord are appreciated.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with headache and tremors, known small cell lung cancer, evaluate for metastases. Motion artifact degrades image quality on several sequences. No evidence of mass effect or pathologic parenchymal or extra-axial enhancement is seen. No restricted diffusion is evident. Encephalomalacia of the right inferior frontal lobe is likely related to prior infarction. Scattered periventricular T2 hyperintensities are also noted, most likely representing chronic microvascular ischemic disease. On postcontrast images, the pituitary gland appears to be inhomogeneously enhancing with an area of relative hypoenhancement posteriorly.No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are within normal limits for size and morphology.

Output: 1.No evidence of intracranial metastatic disease within the limitations of a motion degraded examination.2.No definite acute intracranial abnormalities. Sequelae of chronic right inferior frontal infarction are noted along with findings likely related to chronic microvascular ischemic disease.3.Incidental note is made of asymmetric hypoenhancement of the posterior aspect of the pituitary. This is probably an incidental finding and unrelated to the patient's presenting symptoms. If clinical concern warrants, dedicated pituitary imaging can be considered.


Instruction: Generate impression based on findings.

Input: There is no evidence for intracranial hemorrhage or diffusion-weighted abnormalities. Redemonstration of the right ACA and MCA territory encephalomalacia compatible with prior infarct. Scattered susceptibility artifact in the areas of MCA territory infarct compatible with hemosiderin deposition. There is also hyperintensity of the subcortical and periventricular white matter compatible with chronic small vessel ischemic disease. There is ex vacuo dilatation of the right lateral ventricle. Generalized cerebral volume loss. The white matter of the corpus callosal body is symmetrically thin, possibly developmental.There are no masses or midline shift. Redemonstration of focal prominence of CSF signal intensity in the midline along the posterior aspect of the posterior fossa which may represent a retrocerebellar cyst versus less likely mega cisterna magna, with mild mass effect upon the cerebellar hemispheres. There are no pathologic extraaxial fluid collections. Flow voids are present within the major proximal anterior vessels indicating patency. There is slight paucity of flow voids in the distal right MCA vessels on the right, compatible with known areas of chronic infarct. The basilar and vertebral flow voids are present but diminutive in size, likely developmental. Mucous retention cyst in the right maxillary sinus. Scattered bilateral ethmoid air cell opacity.

Output: 1.No evidence of acute ischemia or hemorrhage.2.Redemonstration of prior ischemia with extensive encephalomalacia of right ACA and MCA.3.Incidental retrocerebellar cyst versus less likely mega cisterna magna.


Instruction: Generate impression based on findings.

Input: PA/meniscal tear. Question of IAD left knee. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a 5-mm full-thickness chondral defect of the anterior lateral femoral condyle with underlying abnormal curvilinear T1 signal. This likely represent an osteochondral injury. No intervening fluid sensitive signal is identified to suggest an unstable lesion.The articular cartilage of the medial and patellofemoral compartments is intact.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Osteochondral injury of the anterior lateral femoral condyle without evidence of an unstable lesion.


Instruction: Generate impression based on findings.

Input: Sensorineural hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is patchy fluid signal within the bilateral mastoid air cells. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears 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 skull, orbits, and scalp soft tissues are unremarkable. There is diffuse paranasal sinus mucosal thickening.

Output: 1. No evidence of inner ear anomalies, cochlear nerve deficiency, or intracranial lesions.2. Patchy fluid signal within the bilateral mastoid air cells may represent effusions.3. Diffuse paranasal sinus mucosal thickening may represent sinusitis.


Instruction: Generate impression based on findings.

Input: Fluctuating Wiernicki and persistent right face and arm weakness. There is an area of high T2 signal and restricted diffuse in the medial left thalamus that measures up to 20 mm. There may be punctate foci of susceptibility effect within this lesion. The rest of 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.

Output: Small left medial thalamus acute infarct with possible petechial hemorrhages, although assessment is limited by patient motion artifact.


Instruction: Generate impression based on findings.

Input: 56 old female with LBP. Evaluate for spondylolisthesis L5-S1. There is a broad-based disc bulge at L5-S1 predominantly towards the left as well as mild moderate bilateral facet hypertrophy. There is associated effacement of the left lateral recess. There is mild deformity of the spinal canal at this level. There is mild neural foraminal narrowing bilaterally at this level. There is mild grade 1 anterolisthesis of L5 on S1. A disc bulge is also present at L3-L4 and L4-5 with no significant spinal canal or neural foraminal narrowing. The spinal cord displays normal signal and morphology. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: Mild multilevel degenerative changes of the lumbar spine predominantly affecting the L5-S1 level, where there is also mild anterolisthesis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 6 years old, with neuroblastoma, off therapy evaluation. Assess for progression of disease. Lobular enhancing masses are again seen within the anterior paraspinal tissues bilaterally.On the left, tumor becomes apparent first at the T4 level continuing down to the T10 level. There has been no change in craniocaudal extent. Likewise, the maximal transaxial dimension is not significant changed at 26 x 18 mm.On the right, tumor is redemonstrated within the right T4-5 neural foramen and extending between the fourth and fifth ribs. Tumor is also evident extending between the fifth and sixth ribs. This latter lesion measures 23 x 10 mm which, again, is not significantly changed from prior.No evidence of any new lesion is detected. A mild scoliotic deformity is evident. Spinal alignment, vertebral body morphology and marrow signal characteristics are otherwise unremarkable. Mildly prominent mediastinal and right hilar lymph nodes are unchanged and nonspecific.

Output: Stable bilateral anterior paraspinal masses are seen with no evidence to suggest any new or progressive lesions.


Instruction: Generate impression based on findings.

Input: 55 year old woman with history of adriamycin as part of chemotherapy for breast cancer, referred for cardiac MRI to evaluate cardiac function. Left VentricleThe left ventricle is severely dilated (previously moderately dilated) with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 115 ml/m2 (normal range: 65+/-11), the LVEDV is 200 ml (normal range 109+/-23), the LV end systolic volume index is 50 ml/m2 (normal range 18+/-5), the LVESV is 87 ml (normal range 31+/-10), the LV mass index is 34 g/m2 (normal range 67+/-11), and the LV mass is 60 g (normal range 114+/-24). 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. Normal myocardial T1 relaxation time. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is mild-moderately dilated.Right VentricleThe right ventricle is severely dilated. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 140 ml/m2 (normal range 69+/-14), the RVEDV is 244 ml (normal range 110+/-24), the RV end systolic volume index is 71 ml/m2 (normal range 22+/-8), and the RVESV is 123 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 and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral breast implants are present. There is low signal intensity in the liver associated with a significantly reduced T2* decay time of 12.7ms. Taken together, this may suggest iron overload of the liver or recent iron infusion. 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. Severely dilated LV with normal systolic function (EF 56%). There is no late gadolinium enhancement to suggest previous underlying infiltrative, inflammatory or fibrotic myocardial processes.2. Severely dilated RV with normal systolic function (EF 50%). 3. Biatrial enlargement. 4. Low signal intensity in the liver associated with significantly reduced T2* decay time of 12.7ms, suggestive of iron overload in the liver or recent iron infusion. When compared to the previous cardiac MRI of 7/2014, the ventricular volumes have increased by one degree in size with no significant change in function. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 62-year-old male with a history of multiple myeloma with 3 weeks of cough, hemoptysis. Bronchoscopy showed adenocarcinoma of the lungs. Rule-out brain metastases. There are areas of white matter hypodensity in the right frontal lobe. Given the history of a neoplastic primary, metastatic involvement cannot be ruled out. An MRI with contrast is recommended for further evaluation. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is partial opacification of the dependent portions of the left maxillary sinus, improved compared to the prior examination. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Patchy areas of hypodensity in the right frontal white matter. Given the history of neoplasm, an MRI is recommended for further evaluation to rule out metastatic foci as clinically indicated.


Instruction: Generate impression based on findings.

Input: History of right mastectomy for IDC and DCIS in 2011. Status post right reconstruction and left breast reduction. There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.Status post right mastectomy with autologous reconstruction.No suspicious enhancement is seen in either the left breast or right reconstruction. Stable foci in the left breast are noted.No abnormal lymph nodes are identified in either axillary region.A few high T2 hepatic lesions are probably benign lesions such as cysts or hemangiomas. High T2 thoracic vertebral body lesion is also stable, probably a hemangioma.

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


Instruction: Generate impression based on findings.

Input: 71 year old female with stage IIIB cervical cancer. Please evaluate disease extent for radiation planning purposes. Presents with vaginal bleeding. PELVIS:UTERUS, ADNEXA: There is irregular asymmetric enlargement of the cervix, area measures approximately 4.2 x 2.9 cm, with associated enhancement and increased signal abnormality, consistent with patient's history of cervical carcinoma. There is apparent extension of this signal abnormality and enhancement superiorly to involve the myometrium/uterine body. There is a fluid filled endocervical canal. Note is made of multiple low signal intensity masses within the fundus and body of the uterus, which enhance on postcontrast sequences, appearing most consistent with intramural and pedunculated/subserosal leiomyomas. There is a simple appearing left adnexal cyst measuring 1.6 cm in diameter. BLADDER: No significant abnormality noted.LYMPH NODES: There is left iliac lymphadenopathy measuring 1.9 x 1.0 cm (33; series 801). Right iliac lymph node, corresponding to the hypermetabolic focus on recent PET/CT examination, measures 0.7 x 0.5 cm (59; series 801).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Note is made of diffuse heterogeneous bone marrow signal abnormality which is nonspecific but may be seen in setting of anemia.

Output: 1.Findings consistent with the patient's history of cervical carcinoma with reference measurements provided above.2.Persistent bilateral pelvic lymphadenopathy, suspicious for metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: 78-year-old female with history of CVA. Now with slurred speech. Signs and symptoms: Slurred speech Nonenhanced head CT:Examination demonstrate mild to moderate findings of small vessel ischemic disease of indeterminate age in the subcortical and periventricular white matter of bilateral cerebral hemispheres. Exclude possibly to overlapping new stroke recommend an MRI exam.There is no evidence of hemorrhage, edema, mass effect or midline shift or hydrocephalus.

Output: Small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: 6-year-old male with history of T-cell lymphoma. Evaluate for relapse. There is no evidence of intracranial mass lesions. There is no evidence of acute intracranial hemorrhage or acute infarction. The left lateral ventricle is smaller than the right, likely a congenital normal variant. There is no abnormal parenchymal or meningeal enhancement. The major flow-voids are preserved. The sella and orbits are grossly within normal limits. The paranasal sinuses and mastoid cells are unremarkable. The skull and extracranial soft tissues are within normal limits.

Output: No evidence of intracranial mass lesions.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 18 years old Reason: eval for ATFL tear and OCD talus; healing fifth MT fracture. History: ankle pain for months s/p inversion TENDONS: No significant abnormality noted.LIGAMENTS: The anterior and posterior talofibular ligaments are intact and demonstrate normal signal intensity and caliber.ARTICULAR SURFACES AND BONE: Linear high T2 signal traverses the known fracture of the fifth metatarsal base (series 6/6), with the fracture fragments in unchanged, near-anatomic alignment.ADDITIONAL

Output: 1.Linear high T2 marrow signal traversing the known fracture of the fifth metatarsal base, suggestive of nonunion.2.No evidence of anterior or posterior talofibular ligament injury.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer, EGFR mutated. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered and confluent nonspecific cerebral white matter T2 hyperintensity. 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. There are bilateral lens implants and mild staphylomatous deformity of the globes. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is periodontal enhancement associated with tooth number 3.

Output: 1. No evidence of intracranial metastases. 2. Nonspecific cerebral white matter T2 hyperintensity may represent treatment effects or chronic small vessel ischemic disease. 3. Apparent periodontal inflammation associated with tooth number 3.


Instruction: Generate impression based on findings.

Input: 37-year-old female with wrist pain, cyst LIGAMENTS: Contrast is seen within the radiocarpal joint with no communication with the mid carpal or distal radioulnar joint. The scapholunate and lunotriquetral ligaments are intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is intact.TENDONS: No significant abnormality noted. BONES: Cysts are noted in the capitate and may be degenerative or idiopathic in etiology.ADDITIONAL

Output: 1.No evidence of TFCC tear. 2.Cystic lesion in the soft tissues along the ulnar side of the wrist may represent a ganglion although other lesions cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: Nonunion fracture, concern for osteomyelitis Again seen is a transverse fracture of the distal radial metaphysis with volar and lateral displacement of the distal fracture fragment. The margins of the fracture appear relatively well defined and although there is slight low T1 signal intensity of the proximal fracture margin, there is no convincing evidence of osteomyelitis. There is marrow edema within the distal radius, distal radial fracture fragment, and distal ulna related to the previously described fractures. Following contrast administration, there is enhancement of the distal radius but no evidence of surrounding fluid collection. The remaining surrounding soft tissues are normal in signal intensity.

Output: Displaced transverse fracture of the distal radial metaphysis without definite evidence of osteomyelitis or abscess. Abnormal marrow signal intensity and enhancement of the distal radius is thought to represent reactive osteitis or inflammation.


Instruction: Generate impression based on findings.

Input: Clinical question: Right buttock pain, bilateral leg pain, sport injury. Signs and symptoms: As above. Nonenhanced lumbar MRI: There is normal anatomical alignment of vertebral column.There is normal signal intensity of vertebral column. There is no detectable posttraumatic findings.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 is unremarkable.L3 -- L4 is unremarkable.L4 -- L5 demonstrate mild ligamentum flavum hypertrophy and unremarkable otherwise.L5 -- S1 demonstrate mild to moderate disk disease and loss of disk height, mild bilateral ligamentum flavum hypertrophy. There is a broad based central disk protrusion with resultant slight flattening and posterior displacement of thecal sac however without spinal stenosis or neural foraminal compromise. This finding is best appreciated on axial T2 series 701 image 6 and axial T2 series 901 image two.Perispinal soft tissues are unremarkable.

Output: 1.L5 -- S1 demonstrates mild-to-moderate disk disease, loss of disk height and a broad-based central disk protrusion without spinal stenosis or neural foraminal compromise as detailed.2.Unremarkable nonenhanced lumbar MRI otherwise.


Instruction: Generate impression based on findings.

Input: Reason: knee osteoarthritis History: severe knee pain MENISCI: Increased signal intensity in the posterior horn of the lateral meniscus is compatible with intrasubstance degeneration, which extends to the tibial articular surface in linear fashion on one and possibly two sagittal sequences, suspicious for an undersurface tear. The posterior horn of the lateral meniscus also appears small, which may represent additional attritional tearing. The aforementioned degenerative signal/tearing extends into the body of the lateral meniscus. The anterior horn of lateral meniscus is within normal limits.There is a small focus of branching signal within the peripheral fibers of the posterior horn of the medial meniscus, extending to the femoral articular surface, which could conceivably represent a small partial thickness tear, but we see no fluid signal intensity entering the meniscus, and the current clinical significance of this finding is uncertain. There is mild intrasubstance degeneration of the body of the medial meniscus. The anterior horn of the medial meniscus is within normal limits.ARTICULAR CARTILAGE AND BONE: There is diffuse, near-full to full-thickness loss of cartilage along the lateral facet of the patella, with relatively mild degeneration of the articular cartilage of the medial facet. There is also near-full to full-thickness loss of articular cartilage along the lateral facet of the femoral trochanter along the inferior aspect. There are small underlying subchondral cysts within the patella.There is full thickness degeneration of the articular cartilage along the medial femoral condyle, above and anterior to the posterior horn of the medial meniscus, measuring approximately 2 cm in length in AP dimension, and over 1 cm in length in medial-lateral dimension.There is also full thickness cartilage loss along the posterior aspect of the lateral femoral condyle, with adjacent foci of intermediate signal, that we suspect represent displaced cartilaginous fragments. Thinning of the articular cartilage of the lateral tibial plateau, beneath the posterior horn of the lateral meniscus, is also noted.Tricompartmental osteophytosis is compatible with osteoarthritis.LIGAMENTS: There is mild edema along the medial collateral ligament, but the ligament itself is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Tricompartmental osteoarthritis as described above, most severely affecting the patellofemoral joint. Suspected meniscal tears may be degenerative in etiology.2.Large joint effusion with intra-articular loose bodies.3.Other findings as above.


Instruction: Generate impression based on findings.

Input: 72 year old female with history of hypertension, now presents with blurred vision and headache. A large area of hyperattenuation is noted in the right occipital and parietal lobes, extending into the right lateral ventricle, basal cisterns and subdural space along the right tentorium. This finding is consistent with an acute intraparenchymal and subdural hemorrhage. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Acute right occipital/parietal intraparenchymal, intraventricular, and subdural hemorrhage. This finding was discussed with Dr. Nasrallah at 45657.


Instruction: Generate impression based on findings.

Input: 48-year-old male patient with cholestasis. ABDOMEN:LIVER, BILIARY TRACT: No intrahepatic or extra hepatic biliary ductal dilatation. No suspicious hepatic lesions. No filling defects within the gallbladder. SPLEEN: Splenomegaly, measuring up to 15 cm in craniocaudal dimension. Innumerable diffuse subcentimeter T2 hypointense lesions within the splenic parenchyma.PANCREAS: No pancreatic ductal dilatation. No focal pancreatic lesions.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bronchial wall thickening in the lung bases.

Output: 1.No biliary ductal dilatation to suggest obstructive biliary pathology.2.Heterogeneous splenic parenchyma likely secondary to sarcoidosis.


Instruction: Generate impression based on findings.

Input: Male 35 years old Reason: Evaluate plexiform neurofibroma History: NF1, known plexiform tumors in chest Redemonstration of innumerable masses with increased signal intensity on fluid sensitive sequences, again compatible with nerve sheath tumors and history of neurofibromatosis type I. Lesions are again noted in the soft tissues adjacent to the right lung apex, with additional small concentration of lesions adjacent to the left lung apex. Lesions along the thoracic nerve roots and intercostal nerves at all levels. No new lesions are identified.Reference lesion in the right anterior chest wall measures 2.7 x 1.2 x 3.1 cm (image 23 series 401; image 10 series 601) previously 2.4 x 1.4 x 3.5 cm.Reference right-sided paraspinal region at the level of the thoracic inlet measures 2.9 x 2.0 x 3.5 cm (image 8 series 41; image 22 series 601) previously 2.9 x 2.1 x 3.4 cm.Reference right-sided paraspinal lesion at the level thoracic inlet measures 3.0 x 0.9 x 2.5 cm (image 10 series 401; image 25 series 601) previously 3.1 x 1.1 x 2.5 cm.No specific evidence of malignant degeneration on this noncontrast MR examination.

Output: Findings are again compatible with neurofibromatosis, with significant interval change of index lesions or evidence of new lesions.


Instruction: Generate impression based on findings.

Input: Altered mental status. Altered mental status. New left sided facial droop There is a punctate focus of diffusion restriction present in the right fusiform gyrus and another punctate focus of diffusion restriction in the right cerebellar hemisphere in the right posterior inferior cerebellar artery territory.There is a slitlike focus of the hyperintensity with a little bit of signal loss located in the right basal ganglia neostriatum. It is associated with some susceptibility artifact. There is associated volume loss.On susceptibility imaging are punctate foci of signal loss present in the brainstem, right thalamus and in the left periventricular white matterThere is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There appears to be fetal origin of the left posterior cerebral artery.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.The exam is mildly degraded on some of the sequences due to patient motion.

Output: 1.There are a couple tiny foci of cerebral infarction present one in the right cerebellar hemisphere and another in the right fusiform gyrus.2.There is an old hemorrhagic lesion in the right basal ganglia.3.There is a mild degree of microhemorrhages in the brainstem and right thalamus. Most likely these are related to hypertension. Please correlate with clinical history.4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.The exam is mildly degraded on some of the sequences due to patient motion.


Instruction: Generate impression based on findings.

Input: 45-year-old woman with history of multiple sclerosis and paresthesias. There are multiple T2 hyperintense lesions within the cerebral and cerebellar white matter, overall similar in size and number when accounting for differences in imaging technique. Multiple, small lesions are more prominent on today's study, however this is likely due to technique, currently measures to 3 Tesla with thinner sections. There is no intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. The major flow-voids are preserved. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are bilateral maxillary mucosal retention cysts.

Output: Probable stable size and number of demyelinating white matter lesions given differences in technique.


Instruction: Generate impression based on findings.

Input: Partially imaged cervical spine demonstrates postsurgical changes of prior anterior cervical fusion extending from C3 to C6. There is a disc bulge at the C6-C7 level with moderate spinal canal stenosis, more completely assessed on prior outside cervical spine study. There is suggestion of T2 hyperintensity involving the right aspect of the cord at the C6 level on the outside study which may be related to prior injury.Thoracic spine:The thoracic spine is in normal alignment. The vertebral body heights are maintained. There are ventral flowing osteophytes at multiple levels suggestive of diffuse idiopathic skeletal hyperostosis. There is T1 hyperintensity involving the disc spaces, particularly at T6-T7 and T10-T11 which be related to mineralization/calcification and can be confirmed on CT. There is T1 hyperintensity involving the vertebral body bone marrow at T8, T9, and superior aspect of T10 with associated enhancement. There is edema involving the disc space at the T7-T8 disc space with T2 hyperintensity and enhancement.There is prominence of the epidural fat extending from T5-T6 to T9-T10 levels. There is associated severe spinal canal stenosis with flattening of the thoracic cord from T6-T7 to T9-T10. Small T8-T9 disc bulge contributes slightly to the stenosis. There is suggestion of subtle T2 hyperintensity in the cord.Abnormal epidural enhancement is noted from T7-T8 to to the T9-T10 levels. There is also prominent paraspinous enhancement from T7-T8 to T9-T10 surrounding the bulky ventral and lateral osteophytes at this level.There is mild to moderate neural foraminal stenosis at T8-T9 bilaterally. Otherwise no significant neural foraminal stenosis in the thoracic spine.Lumbar Spine:Vertebral bodies in the lumbar spine are normal. Alignment is normal. Bone marrow signal is diffusely heterogeneous which is nonspecific but without discrete suspicious lesions evident. There is epidural lipomatosis narrowing the lumbar spinal canal, worst at the L4-L5 level. Individual levels as below:L1-L2: Minimal disc bulge. No significant foraminal stenosis. Minimal spinal canal narrowing related to epidural fat.L2-L3: Mild disc bulge and facet arthropathy. There is mild to moderate spinal canal stenosis related to epidural lipomatosis. No significant neural foraminal stenosis. L3-L4: Mild disc bulge and facet arthropathy. There is moderate spinal canal stenosis related to epidural lipomatosis. No significant neural foraminal stenosis. L4-L5: Diffuse disc bulge, bilateral facet arthropathy with distention of the left facet. There is moderate to severe spinal canal stenosis primarily related to epidural lipomatosis. Mild bilateral neural foraminal stenosis.L5-S1: Minimal disc bulge. Advanced bilateral facet arthropathy. There is moderate to severe spinal canal stenosis related to epidural lipomatosis. There is no significant neural foraminal stenosis.There is edema and enhancement surrounding the L4-L5 and to a lesser degree L5-S1 facet joints, likely on a degenerative basis.

Output: 1. Severe spinal canal stenosis with mild flattening of the cord from T6-T7 to the T9-T10 levels related to epidural lipomatosis. There is suggestion of associated subtle T2 cord signal abnormality. Epidural lipomatosis is also evident in the lumbar spine with moderate to severe spinal canal stenosis at the L4-L5 and L5-S1 levels.2. Multiple ventral flowing osteophytes suggestive of diffuse idiopathic skeletal hyperostosis (DISH). There is abnormal enhancement involving the T8-T10 vertebral bodies, T7-T8 disc and to a lesser degree adjacent intervertebral discs, abnormal epidural enhancement from T7-T8 to T9-T10, as well as abnormal paraspinous enhancement from T7-T8 to T9-10 levels surrounding the large thoracic osteophytes. These findings are favored to be on a degenerative basis and/or related to arthropathy such as DISH or CPPD. Much less likely enhancement is related to infection or neoplastic process. Facet arthropathy at L4-L5 and to a lesser degree L5-S1 is also evident with adjacent soft tissue enhancement; these findings are also likely on a degenerative basis.3. Partially imaged cervical spine demonstrates prior anterior cervical fusion from C3 to C6. There is a disc bulge at the C6-C7 level with moderate spinal canal stenosis, more completely assessed on prior outside cervical spine study. There is suggestion of T2 hyperintensity involving the right aspect of the cord at the C6 level on the outside study which may be related to prior injury.4. Mild to moderate neural foraminal stenosis at bilaterally T8-T9. Mild bilateral L4-L5 neural foraminal stenosis. Otherwise neural foramina in the thoracic and lumbar spine are patent.


Instruction: Generate impression based on findings.

Input: Reason: Patient reports tearing sensation in right forearm. Rule out tendon tear. History: Patient reports tearing sensation in right forearm. We see no tendon tear. On the fat saturated fluid sensitive sequences, the muscle bellies of the extensor carpi radialis brevis and extensor digitorum are slightly hyperintense. We are uncertain if this represents artifact or the sequela of subacute denervation. We see no muscle atrophy. The muscles otherwise appear normal. We see no masses along the courses of the major nerves. There is fluid and/or synovitis affecting the distal radial ulnar joint. The wrist is not included in its entirety on this study, but the changes of rheumatoid arthritis are again noted as seen on prior radiographs.

Output: 1. No evidence of tendon tear.2. Minimal increased signal intensity within the extensor carpi radialis brevis and extensor digitorum is of uncertain clinical significance and may simply be artifactual, although this could represent subacute denervation.3. Distal radioulnar joint synovitis and findings of rheumatoid arthritis affecting the wrist.


Instruction: Generate impression based on findings.

Input: 47 years Male (DOB:12/31/1968)Reason: 3T scanner, please evaluate for AVM History: HHT, at risk for cerebral AVMsPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a developmental venous anomaly present in the right cerebellar hemisphereThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is no arterial supply identified to the patient's right cerebellar developmental venous anomaly.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the left PCA. The LVA is larger than the RVA.

Output: 1.No evidence for cerebrovascular occlusive disease.2.DVA right cerebellar hemisphere. 3.No convincing evidence for intracranial aneurysm or AVM based on this exam.


Instruction: Generate impression based on findings.

Input: Reason: lateral meniscus tear History: left knee pain. MENISCI: Complex multidirectional tear of the lateral meniscus including oblique and horizontal components through the body and complete displacement of the posterior horn posteriorly. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. Bone marrow signal is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Complex multidirectional tear of the lateral meniscus as described above.


Instruction: Generate impression based on findings.

Input: 21 years Female (DOB:10/10/1995)Reason: pituitary cystic lesion, enlarge in Sep 2015 w possible hemorrhage associated with headache, also has infratentorial lesion. History: normal vision and endocrine functionPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI brain:There is a 32 x 36 mm sagittal dimension and 52 x 36 mm axial dimension cystic mass in the posterior fossa compatible with arachnoid cyst associated with bone remodeling which appears largely unchanged when compared to the previous exam it follows spinal fluid on all pulse sequences.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 right sigmoid sinus appears to be absent. The left sigmoid sinus is large. The straight sinus is relatively small. The right transverse sinus is smaller than the left transverse sinus. The right transverse sinus appears to drain into vein of Labbe.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:There is redemonstration of a T1 hyperintense focus in the inferior aspect of the pituitary at the midline is unchanged compared to prior exam. It measures approximately 2 mm in size.The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. The cavernous sinuses are intact bilaterally.

Output: 1.Stable pituitary lesion which could represent a Rathke's cyst.2.There is a compatible with an arachnoid cyst in the posterior fossa which is stable compared to the prior exam.3.Findings suggest congenital absence or hypoplasia of the right sigmoid sinus.