Instruction: Generate impression based on findings.

Input: Female, 54 years old, with unstable gait and brisk deep tendon reflexes, history of cervical laminectomy. Cervical:Evidence of anterior instrumented spinal fusion are seen from C5 through C7, similar to the prior examination. At least some degree of osseous fusion is evident across the disc space at C5-6 with only questionable fusion across C6-7.Spinal alignment is within normal limits. Apart from operative changes, the morphology and signal characteristics of the vertebral bodies are within normal limits. No pathologic marrow enhancement is seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No pathologic spinal cord or leptomeningeal enhancement is seen.Incidental note is made of at least two nodules within the left thyroid gland.C2-3: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. No interval changes.C3-4: Mild left facet hypertrophy. No significant spinal canal or foraminal stenosis. No interval changes.C4-5: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. No interval changes.C5-6: Mild facet hypertrophy. Fusion across the disc space. No significant spinal canal or foraminal stenosis. No interval changes.C6-7: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. No interval changes.C7-T1: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. No interval changes.Thoracic:Alignment is grossly anatomic. Vertebral body morphology is within normal limits. Signal characteristics suggesting a benign hemangioma are evident within the T7 vertebral body. No concerning marrow space signal abnormality or enhancement is seen.The visualized spinal cord demonstrates normal signal and morphology throughout. No pathologic cord or leptomeningeal enhancement is seen.A small left paracentral disc protrusion is evident at T8-9 which may have slightly increased in size from the prior examination. No other significant disc bulges or disc herniations are seen. The spinal canal and neural foramina are not significantly compromised at any level.

Output: 1.Redemonstration of findings related to anterior instrumented fusion from C5 through C7.2.Relatively mild degenerative findings are seen as described by level above.3.No areas of significant spinal canal or foraminal stenosis are detected in either the cervical or thoracic spine.4.No enhancing spinal lesions are demonstrated.


Instruction: Generate impression based on findings.

Input: Renal cell cancer, new onset terrible back pain. History of surgery in 2011. There is transitional anatomy at the lumbosacral junction with partial sacralization of the L5 vertebra which is better seen on prior CT. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5 as before. There are postsurgical changes of interbody as well as posterior spinal fusion at the L3-L4 and L4-5 levels with interbody implants and posterior pedicle screws and paraspinous rods extending from the L3-L5 levels. No bone marrow infiltrating or destructive osseous lesion is appreciated to suggest metastatic disease. No obvious epidural tumor within the limits of noncontrast study. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is a disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening which contribute to moderate to severe spinal canal stenosis and significantly progressed since prior MRI from 1/10/2012. There is also mild to moderate bilateral neural foraminal stenosis which has also progressed. There is distention of the facet joints.L3-L4: Prior left-sided laminectomy. Again seen is effacement of the left lateral recess and medial aspect of the neural foramen related to posterior displacement of the interbody implant and overlying disc protrusion. This finding is grossly similar to prior and is associated with deformity of the left ventral aspect of the thecal sac. Otherwise no significant central spinal canal stenosis. Mild bilateral neural foraminal narrowing. L4-L5: Spinal canal is surgically decompressed. This level is not well evaluated due to artifact from the hardware but the findings are grossly similar to prior. There is mild effacement of the left lateral recess and moderate to severe left foraminal stenosis related to left foraminal disc protrusion and osteophyte. There may be impingement of the left L4 nerve root. No significant central canal stenosis. Possible mild right neural foraminal stenosis but also grossly similar to prior.L5-S1: No significant spinal canal or neural foraminal stenosis. There appears to be contact of the left L5 nerve root with an osteophyte extra foraminally without clear impingement. There is facet arthropathy throughout the lumbar spine which was better seen on prior CT. Paraspinous soft tissues demonstrate no suspicious lesions. Atrophic right kidney. Left kidney surgically absent. Right iliac fossa transplant kidney partially imaged.

Output: 1. Postoperative changes of spinal fusion from L3 to L5 with development of moderate to severe spinal canal stenosis at the L2-L3 level. This finding is significantly progressed since prior MRI from 1/10/2012.2. No evidence of metastatic disease in the lumbar spine within the mild limitations of a noncontrast study. Patient refused IV contrast and was claustrophobic.3. Additional degenerative findings as detailed above including left L4-L5 neural foraminal stenosis. Effacement of the left lateral recess at the L3-L4 level related to posteriorly displaced interbody implant and overlying disc protrusion also again seen.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: History of MS, brain and spinal cord lesions, worsening symptoms History: Lower extremity weakness and spasticity Brain MRIMultiple various sized scattered T2/FLAIR high signal intensity lesions without mass effects are seen involving bilateral hemispheric white matter, midbrain and bilateral cerebellar hemispheres. The size, number and distribution patterns do not show any significant interval change since prior scan. These findings are consistent with demyelinating disease such as multiple sclerosis.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical MRIMotion artifacts degraded image quality.Subtle ill defined T2 high signal intensity lesions are redemonstrated from C2 to C6 level. Comparing to prior scan, these subtle high signal intensity lesions do not show any significant interval change.There is no evidence of focal spinal cord swelling.The cervical spine is straightened but the alignment appears to be normal.Vertebral body heights are maintained and there is no evidence of spinal canal stenosis.From C12 to C7T1, there is no evidence of neuroforaminal stenosis.

Output: 1. Multiple scattered bihemispheric white matter lesions which are consistent with demyelinating disease such as multiple sclerosis. No significant interval change of white matter lesions' number, size and pattern of distribution since prior scan.2. Ill defined patchy T2 high signal lesions from C2 to C6 level, unchanged since prior scan. However, due to motion artifacts, precise evaluation was not possible.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are:1. Diagnostic mammogram and ultrasound dated 2/24/2016 2. Right breast stereotactic biopsy and ultrasound-guided biopsy mammogram dated 9/8/20163. Breast MRI dated 9/24/2016 For comparison,1/21/2015, 7/14/2014, 7/3/2014 are available. Imaging performed at Northwestern Memorial Hospital. 1. Diagnostic mammogram and ultrasound dated 2/24/2016:Patient has a history of 2 stereotactic biopsies in 2014 with pathology reported as FEA.2 standard views of the right breast with spot magnification were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. X shaped and a hourglass trimark clip in the central inner right breast are unchanged from prior examination, consistent with prior benign biopsies.Grouped pleomorphic, linear branching calcifications spanning almost 40 mm are noted in the right lower inner quadrant medial to the 2 clips on CC view and between the 2 clips on the LM view.Ultrasound performed showed a few simple cyst in the right breast 3 and 4:00 position. An irregular hypoechoic area with few calcifications and blood flow is identified in the right breast 3:00 position 3 cm from the nipple.A diagnostic mammogram with ultrasound was performed on 8/17/2016, mammogram images have not been provided. Ultrasound dated 8/17/2016 shows a 6 mm irregular mass in the right breast 3:00 position for which ultrasound-guided biopsy was recommended. 2. Right breast stereotactic biopsy and ultrasound-guided biopsy mammogram dated 9/8/2016:An irregular hypoechoic lesion is identified in the right breast 3:00 position 3 cm from the nipple which was subsequently biopsied under ultrasound guidance. Targeting appears adequate and a coil clip was placed. Pathology is benign as per the report and appears concordant.As per the report is a coil clip did not correspond to the medications, subsequent surgical biopsy was performed and a venous clip was placed. Specimen radiograph has not been provided.Pathology revealed DCIS on samples with and without calcifications. Postprocedure mammogram demonstrates 2 additional clips, a venous clip from the stereotactic biopsy and a coil clip from the ultrasound biopsy in the right lower inner quadrant.3. Breast MRI dated 9/24/2016: Outside hospital protocol MRI uploaded on DYNACAD for post processing. Heterogeneously dense breast parenchyma noted bilaterally. Multiple cysts noted bilaterally. Multiple enhancing foci noted bilaterally none of them are uniquely enhancing.Extensive non mass enhancement in the right lower inner quadrant extending from 4 to 5:00 position measures 66 x 35 x 46 mm (AP X ML X CC) extending anteriorly to the nipple. 2 clip artifacts identified in the medial right breast from the venous and the coil clip. Nonmass enhancement is seen adjacent to the venous clip. The medialmost coil clip is close to the skin and nonmass enhancement is seen lateral to the clip.Outside hospital mentions an enhancing focus in the right upper-outer quadrant which appears to be in the spectrum of multiple enhancing foci or a benign intramammary lymph node. No abnormal axillary lymph nodes in the partially visualized axillary regions.

Output: Stereotactic biopsy of increasing calcifications in the right lower inner quadrant, pathology revealed DCIS in samples with and without calcifications. MRI shows extensive nonmass enhancement, more than the calcifications seen on MRI, approximately 66 mm extending anteriorly to the nipple. MR guided biopsy of the anterior nonmass enhancement can be performed for tissue confirmation if needed.Multiple enhancing foci bilaterally none of them are uniquely enhancing.No abnormality in the left breast or visualized axillary regions. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: lumbar radiculopathySigns and Symptoms: back pain radiating to leg Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.There are large cystic type lesions present along the expected location of the right ovaries one measuring approximately 23 mm and the other one measuring approximately 43 x 31 mm in sagittal dimensions. They are adjacent to each other small amount of fluid is present in the uterus.At L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge which has progressed since the prior exam. There is now greater encroachment of the nerve roots at the lateral recess bilaterally on the current exam versus the prior exam. There is more encroachment of the nerve roots at the right lateral recess versus the left lateral recess at this level. There is mild facet and ligamentum flavum hypertrophy at this level.At L4-5 there is redemonstration of loss of disc space height and disc desiccation and a diffuse disc bulge associated with encroachment of the nerve roots at the left lateral recess. The encroachment of the nerve roots at the left lateral recess at this level appears slightly less prominent than on the prior exam. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are large ovarian cysts present on the right side. Please correlate with the patient's ultrasound results from 10/9/2015 for further comments. These cysts are incompletely visualized on the current exam2.Since the prior exam degenerative disc disease at L5-S1 has progressed. There is now greater encroachment of the nerve roots of the right lateral recess and to a lesser degree left lateral recess.3.Since the prior exam there is been some mild regression of disc disease at L4-5 with some encroachment of the nerve roots at the left lateral recess which is slightly less on the current versus the prior exam.


Instruction: Generate impression based on findings.

Input: Bone marrow appears benign. There is a minimal spondylolisthesis of L4 on L5. The vertebral bodies height appears normal. The conus medullaris ends at the level of L1. There are no paraspinal abnormalities.At the level of T12-L1 there is no evidence of spinal or nerve root compromise. At the level of L1-L2 there is no evidence of spinal or nerve root compromise.At the level of L2-L3 there is no evidence of spinal or nerve root compromise. There is mild hypertrophy of the ligamentum flavum and mild facet hypertrophy bilaterally.At the level of L3-L4 there is mild disc bulge with no evidence of spinal or nerve root compromise. There is a thickening of the ligamentum flavum. There is mild right facet hypertrophy and moderate left facet hypertrophy.At the level of L4-L5 there is mild disc bulge with no evidence of spinal compromise. There is mild bilateral neural foraminal narrowing. There is bilateral severe facet hypertrophy with small right facet effusion. There is hypertrophy of the ligamentum flavum.At the level of L5-S1 there is mild disc bulge with no evidence of spinal or nerve root compromise. There is moderate right facet hypertrophy and mild left facet hypertrophy.

Output: Minimal spondylolisthesis of L4 on L5. At this level there is mild bilateral neural foraminal narrowing with bilateral severe facet hypertrophy containing a small right facet effusion.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis [759.5] / Benign neoplasm of kidney, except pelvis [223.0], Reason for Study: ^Reason: evaluate changes in renal angiomyolipomas s/p embolization History: tuberous sclerosis Multiple bihemispheric cortical high signal intensity lesions involving left superior frontal gyrus, left parietal lobe superior and inferior parietal lobule, left lateral orbital gyrus, left temporo-occipital gyri, right superior frontal gyrus, right inferior parietal lobule, right insular, right temporo-occipital gyri and right lateral orbital gyrus indicate cortical tubers, and they do not show any significant interval change in terms of size and MR characteristics since prior scan.High signal intensity lesions on the subcortical white matter on the right posterior temporal lobe, left trigone area, left lateral orbital gyrus subcortical white matter, no change since prior scan.Enhancing lesions on the left lateral ventricle occipital horn, left side foramen of Monroe and right lateral ventricle occipital horn area indicating subependymal giant cell astrocytomas do not show any significant interval change since prior scan in terms of size and MR characteristics.There are also various sized subependymal nodular lesions on bilateral lateral ventricles indicating subependymal hamartomas appear to be stable in terms of size, number and MR characteristics since prior exam.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No interval change of above described cortical tubers, white matter abnormal signal intensities, subependymal hamartomas, and subependymal giant cell astrocytomas since prior scan.


Instruction: Generate impression based on findings.

Input: 69-year-old female with AIH cirrhosis. HCC screening. ABDOMEN:LUNG BASES: Moderate right and small left pleural effusions, partially visualized. Small hiatal hernia.LIVER, BILIARY TRACT: Cirrhotic liver morphology with nodular surface contour and hypertrophy of the caudate and left lobes. No focal hepatic lesions. No biliary ductal dilation. Hepatic and portal veins are patent. Hepatic artery is patent. Small portosystemic shunts including esophageal varices noted. SPLEEN: Moderate splenomegaly with the spleen measuring up to 15.8 cm.PANCREAS: T2 hyperintense cystic focus in the anterior pancreatic body without mural nodularity or enhancement, measuring up to 18 mm craniocaudally (series 2/39). An additional smaller lesion is seen in the posterior pancreatic body, measuring up to 4 mm (series 7/23). These are most suspicious for small side branch IPMNs. Normal caliber of the main pancreatic duct measuring up to 1-2 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild body wall anasarca.OTHER: Moderate abdominal ascites.

Output: 1. Cirrhotic liver morphology without focal liver lesion.2. Findings suggestive of portal hypertension with splenomegaly, ascites, and small portosystemic shunts.3. Two cystic foci in the pancreatic body suspicious for small sidebranch IPMNs and for which follow-up imaging is recommended.4. Contrast extravasation occurred as detailed above.


Instruction: Generate impression based on findings.

Input: Complains of headaches. On Coumadin. Rule out chronic subdural? Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The pituitary gland appears a slightly enlarged and with apparent extension into the basal cistern. This is concerning for a pituitary adenoma and follow-up with an MRI exam is recommended. This finding measures approximately 15.2 mm in cranial cephalad access on sagittal reformatted images.The cortical sulci, ventricular system, cisterns cisterns and gray -- white matter differentiation is within normal limits.Calvarium is intact.Paranasal sinuses and mastoid air cells are well pneumatized and unremarkable.

Output: 1.Pituitary adenoma as described above. Follow-up with an MRI is recommended.2.Unremarkable non-infused CT of brain and calvarium.3.Visualized paranasal sinuses and mastoid air cells are unremarkable.


Instruction: Generate impression based on findings.

Input: Reason: MS, f/u progression History: paresthesias Brain:Redemonstration of numerous T2 hyperintense lesions within the periventricular and to a lesser extent subcortical white matter, including within the corpus callosum. There is a single new lesion in the right posterior frontal lobe subcortical white matter (series 501 image 64 and series 801 image 47). This demonstrates mild enhancement compatible with an active lesion.There is no evidence of intracranial hemorrhage, or mass.The ventricles and basal cisterns are normal in size and configuration.The expected intracranial vascular flow voids are present.Right maxillary sinus mucous retention cyst. The visualized mastoid air cells are clear. The orbits are unremarkable.Cervical spine:Again noted are multiple poorly defined long segment foci of increased T2 signal within the cervical spine. There is no associated cord expansion. The vertebral column alignment is within normal limits. The vertebral body and disc heights are preserved. The vertebral bone marrow signal is unremarkable. No significant spinal canal or neural foraminal stenoses.

Output: 1. Numerous intracranial white matter lesions compatible with the history of multiple sclerosis. There is a single new right frontal lobe subcortical lesion which also demonstrates enhancement indicating an active lesion.2. Numerous long segment poorly defined intramedullary lesions in the cervical spine compatible with the history of MS. No significant interval change.


Instruction: Generate impression based on findings.

Input: Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and trifurcates into the left anterior descending, ramus intermedius, and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD. The distal LAD is diminutive, the LV apex is supplied by RV acute marginal branches.Ramus intermedius: No significant stenoses.LCx: The left circumflex coronary artery is non-dominant and small. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery, giving rise to a large RV marginal branches (which supply the usual territory of the distal LAD, a second RV marginal branch that supplies the usual territory of the posterior descending artery), a diminutive PDA, and a posterolateral branch. There are no significant stenoses in the right coronary artery.Left VentricleThe left ventricle is normal in size. There are at least two anatomic (but not functional) ventricular septal defects. The first is located immediately proximal to the aortic valve in the usual location of the distal RVOT. The second is a muscular VSD located in the apical septum. Both VSDs have been isolated from the right ventricle by a VSD patch. There appears to be no contrast communicating between the isolated anatomical VSDs and the functional right ventricle. This explains why no turbulent jet was seen through the "VSD" on the prior cardiac MRI.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated. Not well visualized on the recent cardiac MRI, it is apparent on this study that the RV was surgically foreshortened with a patch to exclude apical muscular septal defect.Right AtriumThe right atrium is mildly dilated dilated. The right atrial appendage is located in between the left atrium and the pulmonary and aortic roots. Aortic ValveThe aortic valve is superior, anterior and to the left of the pulmonary valve.Mitral ValveThe mitral valve has no calcification.Pulmonic ValveThe pulmonic valve is normal in caliber but located to the right and posterior to the aortic root; it arises from the basal anterior wall of the right ventricle, likely via a conduit. Tricuspid ValveThe tricuspid valve has no calcification.Great VesselsMain pulmonary artery trunk (and pulmonic valve) is located along the right inferior border of the aortic root. The pulmonary artery and pulmonic valve are attached via, what is presumed to be, a short conduit to the basal free wall of the right ventricle. The distal main pulmonary artery is mildly narrowed. There are mild stenoses of the proximal right and left pulmonary arteries. Distally, the right and left pulmonary arteries are each mildly dilated. The aortic root is rotated counter-clockwise, posteriorly, and superiorly. It is likely connected to the left ventricle via an intra-ventricular baffle. The aortic arch is right-sided. The left innominate artery originates most proximally, followed by the right carotid and then right subclavian arteries. Systemic Venous ReturnRight SVC and IVC normally drain into the right atrium. A persistent left SVC courses in between the left atrial appendage and left sided pulmonary veins ultimately draining into the right atrium via a dilated coronary sinus.Pulmonary Venous ReturnAll four pulmonary veins drain into the left atrium.PericardiumThere is no obvious pericardial disease.

Output: 1.Double outlet right ventricle s/p repair. See above for details. 2.There is normal origin of the coronary arteries. There are no significant coronary artery stenoses present. The distal LAD is diminutive; however, the LV apex is supplied by large acute RV marginal branches.3. There are at least two anatomic (but not functional) ventricular septal defects. The first is located immediately proximal to the aortic valve in the usual location of the distal RVOT. The second is a muscular "VSD" located in the apical septum. Both "VSDs" have been isolated from the right ventricle by a VSD patch. There appears to be no contrast communicating between the isolated anatomical VSDs and the functional right ventricle. This explains why no turbulent jet was seen through the "VSD" on the prior cardiac MRI.4. Normal LV size.5. Moderate RV dilation.6. Persistent left sided SVC draining to coronary sinus.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of concussion now with abnormal olfactory sensation, bifrontal headaches, and vision abnormalities. No lesions are identified in the anterior skull base or anterior frontal lobes to suggest an etiology for the patient's symptoms. No suspicious intracranial mass or evidence of mass effect. No suspicious lesions on the postcontrast images. Incidentally noted is a left temporal-occipital developmental venous anomaly. There is a 13 mm pineal gland cyst without solid or enhancing components. No significant associated mass effect. There is no evidence of intracranial hemorrhage or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.Minimal mucosal thickening is present in the right anterior ethmoid air cells. There is a small left maxillary mucus retention cyst. Paranasal sinuses are otherwise clear. Calvarium and extracranial soft tissues are within normal limits.

Output: There is a 13 mm pineal cyst with a benign appearance and likely an incidental finding. MRI of the brain is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Female 38 years old Reason: please evaluate vaginal cuff History: VAIN III on biopsy PELVIS:UTERUS, ADNEXA: Postsurgical changes related to transvaginal hysterectomy. No abnormal enhancement to suggest residual or recurrent tumor.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific enlarged right external iliac node measures 1.7 x 1.0 cm (series 101, image 65).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific signs of residual or recurrent tumor in the vaginal cuff. 2.Nonspecific mildly enlarged right pelvic lymph node.


Instruction: Generate impression based on findings.

Input: Clinical question : brain lesion. Signs and symptoms : Same Nonenhanced head CT :Examination demonstrate large area of vasogenic edema in the left cerebellum measuring 28.5 x 36.2-mm in size. There is subtle mass effect on the fourth ventricle.Additional large focus of vasogenic edema in the right inferior frontal lobe measuring 32.6 x 33-mm with evidence of focal mass effect. The findings are highly suspected for peritumoral edema of metastatic lesions and recommend further follow-up with a dedicated pre-and post infused brain MRI.This examination is otherwise unremarkable.Calvarium is intact. Mastoid air cells and middle ear cavities are pneumatized and unremarkable.

Output: 1.Two foci of vasogenic edema one in the left cerebellum and a second one in the right inferior frontal lobe concerning for metastatic disease. Recommend further follow-up with pre-and post enhanced brain MRI for better characterization.2.Negative examination otherwise.


Instruction: Generate impression based on findings.

Input: Diagnosis: Transient alteration of awareness. Aphasia Transient alteration of awareness AphasiaClinical question: Evaluate for ischemia, or etiology of seizuresSigns and Symptoms: AMS, possible stroke, seizure No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally there are patchy and punctate T2 and FLAIR signal hyperintense lesions present in the brainstem, thalami and internal capsules as well as the right cerebellar hemisphere.A punctate focus of susceptibility effect is present along the left thalamus. Another similar lesion is present in the lower pons and upper midbrain, another is located in the right cerebellar hemisphere and one more is located in the left hippocampus.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. The eyeball lenses are thin.

Output: There is no evidence for intracranial mass lesion.1.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 2.Punctate lesions in the brainstem, thalami, internal capsules and right cerebellar hemisphere are also likely vascular related.3.There is no evidence for acute ischemic cerebral infarction.4.Multiple microhemorrhages are identified in the brainstem, cerebellum, left thalamus and hippocampus. This pattern suggests hypertension.


Instruction: Generate impression based on findings.

Input: 24 year-old male. Pelvic pain. Needs to be evaluated for pelvic fistulas. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval resolution of the left ischioanal abscess with mild residual inflammatory enhancement and edema. Placement of setons into the transsphincteric fistula tract on the left originating at the 3 o'clock position of the anus and bifurcating into two tracts that extend down into the left gluteal cleft. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free pelvic fluid.

Output: Interval resolution of left ischioanal abscess. Seton placement into a 3 o'clock position perianal transsphincteric fistula tract, see above.


Instruction: Generate impression based on findings.

Input: 60 year old male patient with back pain. Evaluate for nerve compression. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. The conus medullaris is normal in position. There is mild prominence of the dorsal epidural fat.There is spondylolysis of L5 with grade 1-2 spondylolisthesis of L5 on S1. There is trace retrolisthesis of L1 on L2 and L2 on L3. There are anterior osteophytes throughout the lumbar spine with disc dessication at all levels, which is most severe at L5/S1. There is mild endplate irregularity of lower lumbar spine with a small focus of enhancement within the superior endplate of L3 which is likely degenerative in etiology. Furthermore, there is enhancement within the epidural space at L5/S1 as well as the facet joints, likely on a degenerative basis. Additional multilevel degenerative changes are as described below:L1-L2: Mild posterior disc bulge without significant spinal canal or neural foraminal stenosis. L2-L3: Minimal posterior disc bulge without significant spinal canal stenosis. Ligamentum flavum thickening and facet hypertrophy contribute to minimal right neural foraminal stenosis.L3-L4: Minimal posterior disc bulge eccentric to the right, ligamentum flavum thickening, and facet hypertrophy without significant spinal canal and minimal right neural foraminal stenosis.L4-L5: Mild posterior disc bulge, ligamentum flavum thickening, and moderate facet hypertrophy contribute to mild spinal canal stenosis, particularly involving the lateral aspect of the thecal sac, moderate to severe left neural foraminal stenosis, and mild to moderate right neural foraminal stenosis. L5-S1: Grade 1-2 spondylolisthesis of L5 on S1 with disc uncovering, ligamentum flavum thickening, and moderate facet arthropathy cause severe left and mild to moderate right neural foraminal stenosis. No significant spinal canal stenosis.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes of the lumbar spine, worst at the L4-L5 and L5-S1 levels. There is grade 1-2 spondylolisthesis of L5 on S1 with bilateral pars defects of L5. There is significant neural foraminal stenosis at L4-L5 and L5-S1, worse on the left than the right. Please see additional details above.


Instruction: Generate impression based on findings.

Input: Evaluation for metastatic disease for squamous cell carcinoma of the lung. There is mild nonspecific scattered cerebral white matter T2 hyperintensity. There is diffuse mineralization in the bilateral basal ganglia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild right maxillary sinus mucosal thickening.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Nasal mucosal melanoma compare to outside MRI post 4 cycles of pembrolizumab . There is an apparent intermediate T2, enhancing mass in the inferior right nasal cavity, which appears to involve the right inferior turbinate. The abnormality is ill-defined and measures approximately 45 mm AP x 15 mm RL x 15 mm SI. There may be extension of abnormality into the right medial maxillary sinus and/or focal adjacent mucosal thickening. The rest of the paranasal sinuses are unremarkable. There is associated narrowing of the inferior portion of the right nasolacrimal duct, while the upper right nasolacrimal duct and sac are distended. There appears to be layering debris with in the lacrimal sac. The orbital contents are otherwise unremarkable bilaterally. There is nasopharynx and left nasal cavity are intact. The imaged intracranial structures are unremarkable.

Output: An apparent mass in the inferior right nasal cavity may represent recurrent nasal mucosal melanoma, with associated obstruction of the right nasolacrimal duct.


Instruction: Generate impression based on findings.

Input: Diagnosis: Abnormal findings on diagnostic imaging of skull and head, not elsewhere classifiedClinical question: Eval for change in L CVA and eval for change in R meningioma.Signs and Symptoms: meningioma. The CSF spaces are appropriate for the patient's stated age with no midline shift.There is sulcal and gyral signal hypointensity on SWI present along the medial high convexities of the frontal lobes , right parietal lobe and adjacent right occipital lobe. A focus of susceptibility effect is present in the left frontal lobe subcortical white matter and gray matter at the level of the superior frontal sulcus associated with loss of volume indicative of encephalomalaciaThere is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Since the prior exam is no significant interval change. 2.There is redemonstration of a focus of encephalomalacia in the left frontal lobe . This is most likely related to prior infarction3.There is siderosis along the medial aspects of the frontal lobes and along the right parietal and occipital lobes.4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.There is no evidence for acute ischemic cerebral infarction.6.There is no evidence for intracranial mass lesion. There is no evidence for meningioma.


Instruction: Generate impression based on findings.

Input: Brain: There are postoperative findings related to the Chiari decompression with interval resolution of the pseudomeningocele. Protrusion of the right cerebellar tonsil through the neo-foramen magnum to the lower margin of the anterior arch of C1 appears unchanged. There also appears to be mild patchy T2 hyperintensity in the inferior right cerebellar hemisphere and fine linear bands that extend from the posterior surface of the inferior right cerebellar hemisphere to the overlying dural patch. CSF flow is present across the anterior and posterior aspects of the neo-foramen magnum, although the anterior flow column remains slightly constricted due to the retroflexed dens. The third and lateral ventricles are mildly prominent. The basal cisterns remain patent. There is no midline shift or mass effect. There is no evidence of acute infarct or hemorrhage. Cervical Spine: The cervicothoracic syrinx has decreased in size and cranial extent, but is incompletely imaged inferiorly. The syrinx now extends from the inferior aspect of the C6 vertebral body and has a maximal width of 4 mm at the level of T4, previously 8 mm. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1.Postoperative findings related to Chiari I decompression with interval resolution of suboccipital pseudomeningocele, but fine linear bands that extend from the posterior surface of the inferior right cerebellar hemisphere to the overlying dural patch may represent adhesion formation.2.Decrease in size and cranial extent of syrinx.3. The third and lateral ventricles are dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: New onset seizures: starring spells. There is no evidence of intracranial hemorrhage, mass, heterotopia, or infarct. The brain parenchyma, including the hippocampi, 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 orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.

Output: No gross evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: No worrisome focal marrow signal abnormality is appreciated in the cervical spine to suggest metastatic disease within the limitations of a noncontrast exam. There is minimal retrolisthesis of C3 on C4, and minimal anterolisthesis of C6 on C7 and C7 on T1. The vertebral body and disk heights are well-maintained. The spinal cord is of normal caliber and signal. Lesions of the right clivus/basiocciput, and left occipital condyle are partially imaged and better evaluated on recent contrast enhanced brain MRI. There is STIR hyperintense lesions involving the T2 vertebral body as well as the partially imaged T3 vertebral body extending into the left pedicle which have progressed since 4/15/2016.At C2-C3, there is moderate right facet arthropathy. There is no significant spinal canal or neuroforaminal stenosis.At C3-C4, there is moderate posterior disc osteophyte complex, uncovertebral hypertrophy, right greater than left, and facet arthropathy. There is mild central canal stenosis. There is moderate right and mild left neuroforaminal stenosis.At C4-C5, there is mild posterior disc osteophyte complex and uncovertebral hypertrophy as well as mild facet arthropathy. There is no significant spinal canal or neuroforaminal stenosis.At C5-C6, there is right greater than left uncovertebral hypertrophy and posterior disc osteophyte complex and mild facet arthropathy. There is effacement of the right lateral recess but no overall significant spinal canal stenosis. There is moderate to severe right and no significant left neuroforaminal stenosis.At C6-C7, there is mild posterior disc osteophyte complex and mild facet arthropathy, left greater than right. There is no significant spinal canal or neuroforaminal stenosis.At C7-T1, there is mild left uncovertebral hypertrophy and moderate bilateral facet arthropathy. There is no significant spinal canal or neuroforaminal stenosis.

Output: 1.Skull base metastases are partially imaged and better evaluated on recent contrast-enhanced brain MRI.2.No definite evidence of metastatic disease in the cervical spine within the limitations of a noncontrast exam. There are however new lesions at the T2 and T3 levels compared to 4/15/2016 which are partially imaged. T3 lesion extends into the left pedicle. These lesions are present on recent CT chest abdomen pelvis from 7/24/2016.3.Multilevel cervical degenerative changes, as above, with facet arthropathy relatively worse at the right C2-3 and bilateral C7-T1 levels and multilevel neuroforaminal stenoses, most prominent at the right C3-C4 and right C5-6 levels.


Instruction: Generate impression based on findings.

Input: Male, 50 years old, status post lung transplant with distal arm sensory loss, altered sensorium with drowsiness, intermittent confusion and memory loss, word finding difficulty, dropping items. Brain:No evidence of restricted diffusion is seen. No edema or mass effect is detected. Numerous scattered foci of FLAIR hyperintensity are seen within the cerebral hemispheres, largely in a subcortical distribution. The pons is also affected by ill-defined FLAIR hyperintensity.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. The right cerebellar tonsil descends below the level of the foramen magnum by 5 6-mm. However, the foramen magnum does not appear to be particularly crowded.Cervical spine:Alignment is anatomic. Vertebral body heights are preserved. Degenerative endplate signal changes are seen, but there are no areas of concerning marrow replacement.Spinal cord morphology is altered by disc osteophytes at multiple levels as discussed below. However, no clear focal signal abnormality is detected within the cord. No epidural abnormalities are seen.C2-3: Facet arthropathy. Mild posterior disc-osteophyte complex formation which may just contact the ventral cord. No significant spinal canal or foraminal stenosis. C3-4: Facet arthropathy. Mild posterior disc-osteophyte complex formation which may just contact the ventral cord. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Facet arthropathy. Posterior disc-osteophyte complex formation which indents and deforms the ventral cord. Moderate generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation which indents and deforms the ventral cord. Moderate to severe spinal canal stenosis. Moderate right and mild left foraminal narrowing. C6-7: Facet arthropathy. Posterior disc-osteophyte complex formation which indents and deforms the ventral cord. Moderate spinal canal stenosis. Moderate bilateral foraminal narrowing. C7-T1: Facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1.No acute intracranial abnormality is seen. 2.There are numerous scattered foci of nonspecific FLAIR hyperintensity within the cerebral hemispheres and the pons. This could reflect chronic small vessel ischemic disease, vasculitis, sequelae of prior demyelination, or sequelae of some other inflammatory process. 3.Incidentally noted is a low-lying right cerebellar tonsil which does meet imaging criteria for a Chiari I malformation. However, the foramen magnum does not appear to be crowded.4.Multilevel disc osteophyte formation and posterior element degeneration is seen in the cervical spine. Significant spinal canal stenosis is evident at C4-5, C5-6 and C6-7 with some degree of cord impingement. No evidence of spinal cord edema is seen.


Instruction: Generate impression based on findings.

Input: Female, 16 years old. Ankle pain, injury TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Increased T2 signal in the talar neck and along the anterior aspect of the tibial metaphysis and diaphysis. No discrete associated T1 signal abnormality, suggesting that these findings are related to bone marrow edema without fracture.ADDITIONAL

Output: Bone marrow edema involving the talar neck and anterior distal tibia, compatible with bone contusion, without fracture identified.


Instruction: Generate impression based on findings.

Input: 50 years Female (DOB:1/14/1966)Reason: Stroke workup History: R arm and leg weakness, L face weakness, R hemisensory lossPROVIDER/ATTENDING NAME: DAVID G BEISER FERNANDO D. GOLDENBERG The CSF spaces are appropriate for the patient's stated age with no midline shift. 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. Opacity in the left sigmoid sinus transverse sinus junction most likely represents an arachnoid granulation.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Female, 36 years old, with headache and left eye pain. A punctate focus of restricted diffusion is seen within the left superior parietal lobule. No other definite restricted diffusion is seen. However, there are numerous scattered punctate foci of white matter T2 hyperintensity, none of which is associated with significant edema or mass effect.Brain parenchymal morphology is otherwise unremarkable. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. No pathologic parenchymal or extra-axial enhancement is observed. The ventricles are normal in size and morphology. The pituitary region is unremarkable. Asymmetric prominence of the left basal vein of Rosenthal and deep middle cerebral vein is noted.Assessment of the orbits is somewhat compromised by motion artifact and poor fat saturation. Within this limitation, no definite evidence of any optic nerve or extraocular muscle abnormality is seen. The globes are round and symmetric. The superior ophthalmic veins are not dilated.The left petrous apex is fluid-filled and shows mild streaky enhancement as well. There may be slight thickening of the adjacent middle cranial fossa dura, but this is equivocal. No definite abnormalities of the cavernous sinus are noted. The mastoid air cells and middle ear cavities as visualized on this examination are unremarkable.

Output: 1.A punctate focus of restricted diffusion is seen within the left superior parietal lobule. In addition, there are numerous scattered punctate foci of T2 hyperintensity throughout the cerebral hemisphere. These findings could represent lesions related to migraine headache or some other vasculitic process with the lesion in the left parietal lobe being relatively more acute.2.Asymmetric prominence of the left basal vein of Rosenthal and deep middle cerebral vein are of uncertain significance and may simply represent normal anatomic variation. No other findings to suggest a vascular shunting lesion are seen.3.Given reduced image quality as above, no definite intraorbital abnormalities are appreciated. However, the left petrous apex is fluid-filled and demonstrates mild streaky enhancement. This could represent mild or resolving petrous apicitis, a diagnosis which could account for the patient's left eye pain.


Instruction: Generate impression based on findings.

Input: Female 42 years old with known left breast DCIS with right-sided retroareolar abnormality on MRI and palpable right axillary lymph node. A targeted right ultrasound was performed in the right areolar region for the MRI area of concern and the right axilla for the palpable area of concern. There is no solid or cystic mass identified in the right areolar region.There is a mildly prominent lymph node in the right axilla measuring 1.3 cm. No additional solid or cystic masses identified.

Output: No sonographic evidence for malignancy. The MRI finding likely represents the nipple.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: Dysphagia and brisk jaw reflex. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are minimal scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are non-specific. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. No abnormal parenchymal or meningeal enhancement. The skull and extracranial soft tissues are unremarkable.

Output: 1. MRI examination is within normal limits for age. No evidence of acute infarct, hemorrhage, intracranial mass or mass effect.2. Minimal scattered punctate foci of white matter T2/FLAIR hyperintensity, which are non-specific, but compatible with mild age-related white matter changes. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 77-year-old female with sciatica not improving. There is slight straightening of the normal lumbar lordosis. The vertebral body heights are preserved. There is mild narrowing of the disks involving the lower lumbar levels. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology and terminates at the L1-L2 level. Degenerative changes are seen in the lumbar spine as described below:T12-L1: There is a shallow central disc protrusion but no significant compromise to spinal canal or neural foramina.L1-L2: There is a minimal disc bulge, mild facet hypertrophy and ligamentum flavum thickening but no significant compromise to spinal canal or neural foramina.L2-L3: There is a right paracentral to foraminal disc protrusion and a left foraminal disc protrusion which along with mild facet hypertrophy and ligamentum flavum thickening causes mild bilateral neural foraminal stenosis. No significant compromise to spinal canal is visualized.L3-L4: There is a trace disc bulge with left greater than right foraminal prominence as well as mild to moderate facet hypertrophy and ligamentum flavum thickening which causes minimal to mild right and moderate to severe left neuroforaminal stenosis. No significant compromise to spinal canal is visualized.L4-L5: There is a mild to moderate disc bulge with right foraminal prominence as well as moderate facet hypertrophy and ligamentum flavum thickening which causes moderate to severe right and moderate left neural foraminal stenosis. The right foraminal disc may abut the right L4 exiting nerve root. No significant compromise to spinal canal is visualized.L5-S1: There is a mild disc bulge and a large right far lateral disc osteophyte as well as mild facet hypertrophy and ligamentum flavum thickening which causes mild right neural foraminal stenosis but no left foraminal or central canal stenosis. The paravertebral soft tissues are unremarkable. Bilateral small T2 hyperintense lesions within the kidneys are nonspecific, but statistically most likely represent benign renal cysts.

Output: Overall mild to moderate spondylotic changes involving the lower lumbar spine without significant central canal stenosis but with up to moderate to severe neuroforaminal stenosis at the left L3-4 and right L4-5 levels.


Instruction: Generate impression based on findings.

Input: 63 years, Female, metastatic ovarian cancer status post resection and radiation therapy. Compared to 6/24/2015, there is evidence of treatment response with decrease in size of multiple enhancing lesions. For example left frontal lesion previously 10 x 10 mm now measures 6 x 6 mm. Right parietal 11 x 7 mm lesion measures 7 x 5 mm. 4 mm right cerebellar lesion now measures less than 2 mm. There is interval decrease in FLAIR hyperintensity associated with the left frontal and right parietal lesions. Additional areas of FLAIR hyperintensity in the periventricular and subcortical white matter are not significantly changed. Unchanged appearance of the right frontal resection cavity with surrounding FLAIR hyperintensity which may represent gliosis. Unchanged restricted diffusion involving the posterior aspect of the right frontal resection cavity likely related to chronic blood products. No new enhancing lesion or new mass effect is appreciated. Unchanged ventricular size and periventricular FLAIR abnormality. No midline shift or herniation. Major flow-voids are preserved. Paranasal sinuses and mastoid air cells are clear. No suspicious osseous lesions.

Output: Compared to 6/24/2015 there is evidence of treatment response with decrease in size of multiple previously seen enhancing lesions. No new lesions.


Instruction: Generate impression based on findings.

Input: Nontoxic single thyroid nodule RIGHT LOBE MEASUREMENTS: 5.1 x 2.6 x 3.0 cmLEFT LOBE MEASUREMENTS: 5.4 x 2.4 x 2.6 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: Innumerable nodules the largest is located near the isthmus and measures 2.4 x 2.2 x 1.7 cm it appears complex but mostly cystic with small microcalcifications.LEFT LOBE: Innumerable nodules with the largest measuring 2.4 x 2.0 x 1.4 cm. Similar to the nodules in the right lobe, these are mostly cystic with areas of complexity and small microcalcifications. ISTHMUS: 11 mm nodule with similar characteristics as the ones noted above PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Innumerable bilateral complex appearing thyroid nodules as described above; most have a appearance consistent with colloid cysts.


Instruction: Generate impression based on findings.

Input: Male, 23 years old, with unprovoked first time generalized tonic-clonic seizure. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The medial temporal lobe structures are symmetric and free of pathologic signal abnormality.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable evaluation with no specific findings to account for the patient's seizure.


Instruction: Generate impression based on findings.

Input: Reason: Left tibia pain x 4 months, no specific injury, xrays taken in January and April with Continued abnormality of the medial cortex of the proximal tibia, evaluate for possible lesion History: Left tibia pain. There is minimal prominence of the medial aspect of the proximal tibial diaphysis associated with a tiny defect in the cortex, perhaps representing a healed fibrous cortical defect. No underlying edema or enhancement. The bone marrow signal intensity of the tibia and fibula appears normal. The musculature of the leg appears normal. Please note, this study was not protocoled for evaluation of the intrinsic structures of the knee.

Output: Possible small healed fibrous cortical defect, but no finding to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Female, 31 years old, with metastatic breast cancer, assess for brain metastases. No evidence of mass, mass effect or parenchymal edema is seen. A single 3 mm focus of T2 hyperintensity within the left subinsular white matter is nonspecific. No restricted diffusion is evident.There is no evidence of intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricular system is normal in size and morphology. Marrow signal characteristics of the calvarium are unremarkable.

Output: 1.A single small focus of signal abnormality within the left subinsular white matter is nonspecific.2.No definite evidence of intracranial metastases is seen without the benefit of IV contrast.


Instruction: Generate impression based on findings.

Input: Child with GH deficiency and short stature. The pituitary gland is not enlarged and enhances homogeneously. The posterior pituitary bright spot is intact. The infundibulum is also intact. There is no evidence of sellar or suprasellar mass lesions. The cavernous sinuses are unremarkable. There is mucosal thickening within the bilateral sphenoid sinuses. There is a canalis basalis medianus. There is a partially-imaged prominent retrocerebellar cerebrospinal fluid space.

Output: No evidence of pituitary lesions.


Instruction: Generate impression based on findings.

Input: For the purposes of this dictation, the last well formed disk space is referred to as L5-S1. There is motion degradation limiting evaluation. Further, due to low GFR, patient was unable to receive IV contrast which further limits evaluation. Given these limitations, there is a 28 x 33 mm expansile heterogeneously T2 hyperintense and T1 hypointense mass in the spinous process, lamina and pedicles of the L1 vertebral body with 5 mm thick posterior epidural tumor extending superiorly up to the mid T12 level. There is diffuse heterogeneous low T1 osseous marrow signal consistent with osseous metastatic disease.The conus appears to terminate at superior aspect of L2, however this is limited by motion artifact. There is ventral displacement of the conus and the cauda equina nerve roots without significant edema within the conus. There is additional T2 hyperintense signal abnormality in the L4 spinous process as well. There are numerous scattered low T1 and high T2 signal lesions in the sacrum and bilateral iliac bones, again consistent with osseous metastases.There is mild grade 1 retrolisthesis L2 on L3, mild anterolisthesis of L4 on L5 and L5 on S1. There is disk desiccation at all levels in the lumbar spine with severe loss of disk height at L2-3. There is mild diffuse posterior epidural lipomatosis which contributes to minimal narrowing of the spinal canal diffusely.T12-L1: Diffuse disk bulge with no significant spinal stenosis.L1-2: Diffuse disk bulge and left far lateral disk protrusion with posterior epidural tumor causing mild spinal canal stenosis. There is mild bilateral neural foraminal stenosis secondary to expansile tumor in the pedicles of L1.L2-3: Diffuse disk bulge, bilateral facet arthropathy and ligamenta flava thickening causing no significant spinal canal stenosis and moderate bilateral neural foraminal stenosis.L3-4: Diffuse disk bulge and moderate bilateral facet arthropathy with ligament flava thickening causing mild right and moderate left neural foraminal stenosis with no significant spinal canal stenosis.L4-5: Diffuse disk bulge asymmetric to the right, and severe bilateral facet arthropathy with ligament flava thickening causing moderate right and mild left neural foraminal stenosis with no significant spinal canal stenosis.L5-S1: Diffuse disk bulge asymmetric to the right with bilateral facet arthrosis and ligament flava thickening causing severe right and mild to moderate left neural foraminal stenosis. Disk material encroaches upon the bilateral subarticular zones (right greater the left) without significant subarticular zone stenosis.

Output: 1.Diffuse osseous metastatic disease, with prominent expansile tumor in the L1 posterior elements extending into the posterior epidural space causing mild spinal canal stenosis at this level.2.Lumbar spondylosis as described above.3.Findings were discussed with the clinical service by the radiology on call resident at time of initial interpretation.


Instruction: Generate impression based on findings.

Input: Female 73 years old Reason: rectal adenocarcinoma staging History: as above Overall image quality: GoodPELVIS:UTERUS, ADNEXA: Uterus is surgically removed or atrophic.BLADDER: No significant abnormality noted. LYMPH NODES: At least 5 scattered mesorectal fascial lymph nodes, largest measuring up to 6 mm.BOWEL, MESENTERY: Rectal Tumor:Circumferential involvement of an approximately 7.1 cm (image 30/series 1001) segment of rectosigmoid colon. This tumor signal likely extends at least to the muscularis layer with possible minimal extension into the mesorectal fat, T3.Tumor appearance on T2-weighted images: Grey, circumferentialTumor location: Begins at the upper anal sphincter about 2.7 cm from the anal verge.Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): In the same image described immediately below where it extends to the anterior where the tumor extends to the anterior mesorectal fascia, the posterior vaginal wall is also adjacent to the signal abnormality, but has a relatively preserved plane. Some gray signal extending into the wall may be desmoplastic reaction, but underlying tumor is not excluded.Tumor Distance to Mesorectal Fascia: Extending directly to the anterior mesorectal fascia (axial oblique series 801:37)BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Few nonspecific prominent bilateral inguinal lymph nodes. A couple nonspecific right external iliac subcentimeter lymph nodes. The aortic bifurcation is not imaged but there are no common iliac lymph nodes.

Output: 1.Approximately 7 cm long rectosigmoid T3 tumor with several associated mesorectal lymph nodes (>5) and less than 1 mm mesorectal fascial margin as described above. Minimal involvement of the posterior vaginal wall cannot entirely be excluded as above.


Instruction: Generate impression based on findings.

Input: Female, 11 years old, with history of pilocytic astrocytoma with VP shunt. Yearly follow-up exam. Heterogeneous T2 hyperintense, partially cystic signal characteristics are evident within the right basal ganglia and thalamus, right hypothalamus, and to a lesser degree the left hypothalamus. Pathologic signal extends inferiorly to involve the medial right temporal lobe structures, and in particular, the right amygdala is T2 hyperintense and perhaps mildly thickened relative to the left.The region of abnormal parenchyma involving the right basal ganglia and thalamus is surrounded by patchy intrinsic T1 hyperintensity. A focus of intrinsic T1 hyperintensity is also seen within the right cerebral peduncle. No clear evidence of any true enhancement is seen above and beyond this intrinsic T1 signal.A right parietal approach ventricular catheter is in place and appears to terminate within the body of the right lateral ventricle. The right lateral ventricle is of normal caliber while the left is collapsed. No evidence of any ventricular dilatation is seen.There is no evidence of any significant parenchymal edema or mass effect. The abnormal right basal ganglia/thalamic tissue shows patchy susceptibility effect likely representing chronic blood product. No acute intracranial hemorrhage or other abnormal collections are suspected. A cystic pineal lesion which measures approximately 1 cm in diameter is likely benign and incidental.

Output: Patchy abnormal signal with evidence of hemosiderin staining and cystic tissue is seen involving predominantly the right basal ganglia and thalamus. Signal abnormality, however, does extend inferiorly into the medial temporal lobe. Without prior examinations for comparison, interpretation of these findings is somewhat limited though they may very well represent the sequelae of a treated or involuted pilocytic astrocytoma as indicated in the clinical history.If prior examinations can be made available, we will be happy to perform a comparison and addend this report.


Instruction: Generate impression based on findings.

Input: CNS lymphoma, evaluate for recurrence: fatigue. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle. There is a cystic cavity in the surrounding right frontal lobe parenchyma that measures up to 31 mm. The ventricles and basal cisterns are unchanged in size and configuration, with mild diffuse cerebral volume loss. There is mild diffuse periventricular white matter T2 hyperintensity. There is no midline shift or herniation. The major cerebral flow voids are intact. There is persistent high T2 signal and enhancement in the clivus, with prominent trabeculae. There is mild left maxillary sinus mucosal thickening.Orbits: There is persistent mild diffuse enhancement along the bilateral optic nerve sheaths, but otherwise no evidence of intraorbital mass lesions. There are bilateral staphylomatous globe deformities and a left lens implant. Spine: There is persistent mild enhancement along multiple cauda equina nerves roots diffusely and along the surface of portions of the thoracic spinal cord. The spinal cord otherwise displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is degenerative spondylosis involving multiple levels of the lower lumbar spine with inflammatory changes in multiple facet joints, but no significant spinal canal or neural foraminal stenosis. Aside from degenerative signal alterations, the vertebral bone marrow signal is unremarkable. However, there is persistent signal abnormality in the bilateral iliac bones. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial tumors.2. Cavitation surrounding the right transfrontal Ommaya catheter may represent sequela of necrosis.3. The ventricles are unchanged in size. 4. Persistent mild diffuse enhancement along the bilateral optic nerve sheaths, which may be related to lymphoma or represent perineuritis, but otherwise no evidence of intraorbital mass lesions.5. Persistent mild enhancement along multiple cauda equina nerves roots diffusely and along the surface of portions of the thoracic spinal cord likely related to lymphoma.6. Nonspecific persistent abnormality in the clivus and iliac bones.7. Multilevel degenerative spondylosis in the lower lumbar spine, with inflammatory facet arthropathy.


Instruction: Generate impression based on findings.

Input: 49-year-old male patient with history of IPMN. Follow-up imaging. ABDOMEN:LIVER, BILIARY TRACT: Again seen is a septated cystic lesion in the uncinate process of the pancreas that measures 1.4 x 1.0 cm (series 3 image 43), previously 1.7 x 0.8 cm. A similar tubular cystic lesion in the pancreatic head measures 1.0 cm (series 3 image 53), unchanged. There are a few smaller cystic projections seen in the body and tail, which also appears similar compared to prior examination and are all less than 1 cm in size. These smaller cystic projections appear to communicate with the pancreatic duct, likely representing side branch IPMNs.Incomplete pancreatic divisum.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Similar size of probable IPMNs in the uncinate process and pancreatic tail as well as punctate probable side branch IPMNs. No suspicious enhancement.


Instruction: Generate impression based on findings.

Input: History of elevated PSA. PELVIS:PROSTATE:Prostate Size: 3.5 x 4.7 x 4.2 cmPeripheral Zone: No discrete suspicious lesion is seen within the peripheral zone.Central Gland: In the transition zone at the apex there is a ill-defined T2 hypointense focus measuring 1.2 x 1.2 cm (series 701/10) with associated restricted diffusion (series 1103/36) suspicious for prostatic adenocarcinoma.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymphadenopathy is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Approximately 1.2 cm lesion in the transition zone of the apex is suspicious for prostatic adenocarcinoma and is amenable to MRI/Ultrasound fusion biopsy.


Instruction: Generate impression based on findings.

Input: Clinical question: Backache, numbness in right leg and left shoulder pain. Signs and symptoms: As above. Nonenhanced lumbar MRI:There is normal anatomical alignment the vertebral column.Normal stimuli thoracic spine and thoracic cord is unremarkable. T11 -- T12 is unremarkable.T12 -- T11 demonstrate mild disk disease and unremarkable otherwise.L1 -- L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate mild disk disease and mild bilateral ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.L3 -- 4 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis however moderate right neural foraminal compromise is noted.L4 -- 5 demonstrate advanced disk disease with significant loss of disk height, moderate to significant left and moderate right facet and ligamentum flavum hypertrophy is present. Constellation of changes results in mild central spinal stenosis and moderate bilateral (left greater than right) neural foraminal compromise.L5 -- S1 demonstrate mild degenerative changes and unremarkable otherwise.

Output: 1.Degenerative changes of disk and the posterior elements at L4 -- L5 with mild central spinal stenosis and moderate (L>R) neural foraminal compromise as detailed.2.Degenerative changes at the L3 -- L4 results in moderate right neural foraminal compromise.3.Minimal degenerative changes at other levels however without spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Other specified disorders of bladder [N32.89] / Unspecified urinary incontinence [R32], Reason for Study: ^Reason: Evaluate for tethered cord History: day time and night time enuresis Redemonstration of right frontal parietal craniotomy with right frontal tissue loss especially anterior aspect of right inferior frontal lobe, lateral orbital gyrus as well as encephalomalacia of right medial orbital gyrus and the right rectus gyrus indicating postoperative changes, unchanged since prior scan.There is about 2.8mm sized nodular enhancing lesion on the superior aspect of resection margin just inferior lateral aspect of the right lateral ventricle frontal horn.This lesions were not seen on prior scan. Thus could represent small focal recurrence of tumor.There is another small enhancing lesion on inferolateral aspect of the right middle frontal gyrus and associated with adjacent dural enhancement. The lesion appears to be slightly smaller than prior especially brain MRI performed on Jul 9 2014, thus indicating postoperative reactive changes. Diffuse dural enhancement is still seen which has not been changed since prior scan. Thickening of anterior cranial fossa especially right side lesser wing of sphenoid is again seen, unchanged.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Focal nodular enhancing lesion on the resection margin of the original tumor, at the inferolateral aspect of the right lateral ventricle frontal horn. Diagnostic possibility includes recurrent tumor. Follow up imaging is recommended.2. Otherwise stable postresection status of large right subfrontal meningioma since prior scan.


Instruction: Generate impression based on findings.

Input: Female, 50 years old. Left tibial pain The left tibia and fibula appear normal. The soft tissues of the leg appear normal. We see no findings to account for the patient's tibial pain.Abnormal signal intensity in the right tibial plateau as seen on the large field-of-view images is presumably degenerative in etiology.

Output: Normal-appearing left tibia without findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Cirrhosis status post OLT in 1994, evaluate for lesions and hepatic vessel patency The exam is limited secondary to respiratory motion.ABDOMEN:LIVER, BILIARY TRACT: The liver has a cirrhotic morphology. There are no suspicious hepatic lesions. The portal and hepatic veins are patent. The hepatic artery is suboptimally evaluated on this limited study but appears patent.SPLEEN: No significant abnormality noted.PANCREAS: 1 cm cystic lesion along the anterior aspect of the pancreatic body has increased in size the prior exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cirrhosis without evidence of suspicious hepatic lesions on this limited exam. 2.Hepatic and portal veins are patent. The hepatic artery is suboptimally evaluated on this limited study, but appears patent.3.Cystic lesion along the anterior aspect of the pancreatic body is slightly larger compared to prior.


Instruction: Generate impression based on findings.

Input: Blurry vision and numbness/tingling, rule out demyelinating diease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

Output: No evidence of demyelinating lesions, acute intracranial hemorrhage, mass, or acute infarction.


Instruction: Generate impression based on findings.

Input: Stated history of liver cysts. ABDOMEN:LIVER, BILIARY TRACT: Several T2 hyperintense nonenhancing foci in the liver compatible with simple hepatic cysts. No suspicious liver lesion biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum. No stigmata of acute or chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right breast implant with intracapsular rupture.OTHER: No significant abnormality noted.

Output: Hepatic cysts. No suspicious liver lesion. Pancreas divisum


Instruction: Generate impression based on findings.

Input: Female, 58 years old. History of fracture with recent MRI indicated non-union of a small 3mm fragment at radial base. Pain at base of 5th MC. There is deformity of the base of the fifth metacarpal indicating a healing fracture. There is scalloping of the anterior surface of the base of the fifth metacarpal that we presume represents chronic mechanical erosion as suggested on the recent MRI study. A 2 mm density adjacent to the medial aspect of the base of the fourth metacarpal may represent the small ununited fracture fragment suggested on MRI, but this is equivocal. Mild osteoarthritis affects the basilar joint and IP joints, and additional small cysts are seen in multiple carpal bones. There is slight widening of the scapholunate interval. A tiny ossicle adjacent to the ulnar styloid is unchanged.

Output: Posttraumatic deformity of the base of the fifth metacarpal representing a healing fracture with other findings as described above.


Instruction: Generate impression based on findings.

Input: Right ethmoid/nasal mass with possible bony erosion: epistaxis. There is a heterogeneously enhancing mass in the posterior right nasal cavity and ethmoid sinuses, which measures up to 5 cm. The tumor extends to the right medial cribriform plate, where there is a dehiscence demonstrated on CT. Otherwise, there is no discernible intracranial extension of tumor. There are trapped secretions and/or hemorrhage in the right sphenoid, ethmoid, and bilateral maxillary sinuses and surrounding recesses, with mild underlying mucosal thickening. There is sclerosis in the bone marrow surrounding the right sphenoid sinus. The orbits are unremarkable.

Output: A mass in the posterior right nasal cavity and ethmoid sinuses that measures up to 5 cm likely represents an neoplasm, such as an inverted papilloma, melanoma, or carcinoma, for example. The tumor extends to the right medial cribriform plate, where there is a dehiscence demonstrated on CT. Otherwise, there is no discernible intracranial or intraorbital extension of tumor.


Instruction: Generate impression based on findings.

Input: Clinical question: Blunt trauma. Signs and symptoms: Loss of consciousness. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal limits. Very small focus of low-attenuation in the periventricular white matter is believed to represent a small was ischemic disease as was noted on prior MRI examcalvarium is intact. No evidence of hemorrhage or swelling of the scalp is detected.Mastoid air cells and middle ear cavities are pneumatized and unremarkable.Visualized paranasal sinuses are unremarkable.Limited images through the orbits are unremarkable.

Output: With the exception of minimal small vessel ischemic disease of indeterminate age this study is within normal limits.


Instruction: Generate impression based on findings.

Input: 57-year-old male with left knee pain, medial sided. MENISCI: There is fragmentation and maceration of the posterior horn, body and anterior horn of the lateral meniscus. There are associated subcentimeter foci of fluid signal abnormality along the posterior aspect of the meniscus consistent with parameniscal cyst formation.There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. Some of the signal extends to the tibial and femoral articular surface consistent with degenerative tearing/fraying which extends to the body of the meniscus. There is a linear focus of signal abnormality within the posterior horn of the medial meniscus which extends to the femoral articular surface consistent with a complex tear with a horizontal component.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the lateral facet of the patella with large areas completely devoid of articular cartilage. There is degenerative underlying subchondral signal abnormality. There is near full-thickness to full-thickness articular cartilage degeneration of the articular cartilage along the lateral facet of the femoral trochlea with underlying degenerative subchondral signal abnormality. There is near full-thickness articular cartilage degeneration along the lateral tibiofemoral compartment particularly affecting the posterior aspect of the lateral tibial plateau. The medial tibiofemoral compartment appears relatively spared.LIGAMENTS: The PCL appears intact. The ACL is indistinct with associated foci of lobulated fluid signal abnormality. These findings likely represent a combination of chronic tearing as well as mucoid degeneration. There is thickening of the proximal fibers of the superficial band of the MCL which may reflect prior injury or sprain. The MCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Degenerative tearing of the medial and lateral meniscus with parameniscal cyst formation as described above.2. Findings consistent with disruption of the ACL.3. 14 mm loose body within the joint as described above.4. Full-thickness articular cartilage degeneration most pronounced along the patellofemoral and lateral tibiofemoral compartments.5. Nonspecific subcutaneous edema along the anterior medial aspect of the knee.


Instruction: Generate impression based on findings.

Input: Male, 60 years old. Evaluate for source of knee pain following fall and twisting. Five views of the right knee demonstrate swelling along the anterior aspect of the knee which could represent a hematoma. Soft tissue swelling limits evaluation of the extensor mechanism. There are small ossicles in the distal quadriceps tendon which suggest chronic tendinosis. If there is clinical concern for an acute quadriceps tendon rupture, MRI can be considered. We see no fracture.

Output: Soft tissue swelling anterior to the patella which may represent a hematoma. This limits evaluation of the extensor mechanism. If there is clinical concern for a quadriceps tendon tear, then MRI can be considered.Findings were discussed by telephone with Dr. DiMaggio at 2:30 PM on 3/28/2016


Instruction: Generate impression based on findings.

Input: 20-year-old male with instability. Evaluate for labral tear. ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: No significant fluid is identified within the subacromial subdeltoid bursa. No intra-articular gadolinium extends into the bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is linear increased signal abnormality traversing the posterior superior labrum indicating a tear. The glenohumeral joint alignment is anatomic. No full-thickness articular cartilage defects are identified.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Posterior glenoid labral tear as described above.


Instruction: Generate impression based on findings.

Input: Obsessive-compulsive disorders. Preoperative planning for laser ablation. There is no evidence of intracranial hemorrhage or mass. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. There is a subcentimeter left maxillary sinus retention cyst. There are retained nasopharyngeal secretions.

Output: Unremarkable preoperative planning MRI.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact. There is a mass that measures up to 5 cm centered within the left aspect of the frontal bone that erodes through the inner table and results in mass effect upon the left frontal lobe without significant edema. There is also another subcentimeter lesion in the left squamous temporal bone. There are multiple lesions with associated vasogenic edema at the grey-white matter junctions in the bilateral cerebral hemispheres, the largest of which is in the right superior frontal gyrus, measuring up to 15 mm. There are multiple additional small patchy foci of T2 hyperintensity throughout the deep cerebral white matter that are nonspecific. There is a punctate focus of susceptibility effect within the left thalamus compatible with a chronic micro hemorrhage. There is a subcentimeter defect in the right pons, which may represent a chronic lacunar infarct. However, there is no evidence of acute cerebral infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mucosal thickening within the right ethmoid and bilateral maxillary sinuses, right greater than left. There is heterogeneous signal within the C3 vertebral body.

Output: 1.A left frontal bone mass with erosion through the inner calvarial table and mild mass effect on the left frontal lobe likely represents a metastasis. Another subcentimeter left squamous temporal bone lesion also likely represents a metastasis. 2.Several bilateral cerebral hemispheric lesions likely represent metastases, although these are incompletely characterized. However, there is no evidence of associated midline shift or hemorrhage.3.An apparent lesion within the C3 vertebral body may also represent a metastasis, although incompletely characterized. 4.Numerous patchy foci of T2 hyperintensity within the supratentorial white matter are nonspecific without contrast, although many have the appearance of chronic small vessel ischemic disease.5.A small chronic microhemorrhage within the left thalamus is likely hypertensive in etiology.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact. There is no evidence of mass or acute infarct. There are multiple patchy foci of T2 hyperintensity within the periventricular and infratentorial white matter with some involvement of the corpus callosum. Many of these lesions demonstrate T1 hypointensity. There is also mild global volume loss greater than expected for the patient's stated age.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 and scalp soft tissues are unremarkable. There is disconjugate gaze and minimal paranasal sinus mucosal thickening. There is mild fluid within the mastoid air cells bilaterally.

Output: Multiple nonspecific supratentorial and infratentorial white matter lesions and mild global volume loss may represent demyelinating process especially given callosal involvement or advanced chronic small vessel ischemic disease. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 59-year-old male with previous stroke for evaluation of acute worsening left leg weakness. Multiple areas of ischemia of different ages are noted in the pons. A focus of diffusion restriction with increased T2/FLAIR signal is now noted in the right aspect of the pons, compatible with. There has been interval small chronic infarct in the ventral left aspect of the pons. There has been interval evolution of a now chronic focus infarct involving the mesial dorsal pons. Scattered foci of T2 hyperintensity in the periventricular and subcortical white matter compatible with chronic small vessel ischemic changes. There are also small chronic bilateral thalamic and basal ganglia lacunar infarcts. Note is made of a prominent perivascular space in the left insula. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable. Note is again made of a 13 mm sebaceous cyst overlying the left zygoma.MRA head:There is approximately 70% narrowing of the mid to distal M1 segment of the right middle cerebral artery proximal to its bifurcation. The anterior and middle cerebral arteries do not otherwise demonstrated areas of significant stenoses. The posterior communicating arteries are diminutive bilaterally. The V4 segment of the right vertebral artery is mildly narrowed with loss of flow related enhancement. The left vertebral artery is dominant. The basilar artery and posterior cerebral arteries are normal in caliber. No significant intracranial aneurysm. MRA neck:The left common carotid artery originates off of the innominate artery. The carotid arteries are widely patent with normal contour and caliber throughout. The left vertebral artery is normal caliber and contour for the remainder of its course. The origin of the right vertebral artery remains stenotic. Mild stenosis of the distal vertebral artery is again noted as it pierces the dura. This is compatible with a dissection of indeterminate age. There is a subcutaneous lipoma incidentally noted in the right posterior paraspinal soft tissues.

Output: 1. Acute to subacute lacunar infarct in the right aspect of the pons. Remote lacunar infarcts involving the mesial dorsal and ventral left aspects of the pons. 2. Unchanged stenoses of the right vertebral artery origin and distally as it enters the dura with associated findings suggesting slow flow.3. Right middle cerebral artery stenosis, as on the prior examination. No evidence of new flow-limiting stenosis, occlusion, or aneurysm in the major intracerebral arteries.4. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5. chronic lacunar infarcts in the bilateral basal ganglia and thalami.


Instruction: Generate impression based on findings.

Input: Female 20 years old Reason: evaluate for SB inflammation or masses History: patient with NF1, chronic diarrhea ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense lesion in the left lateral segment of the liver measures 1.5 x 1.6 cm on image 10/series 4. The lesion has peripheral nodular enhancement and progressive fill and is most compatible with a hemangioma.Hepatic and portal veins are patent. No suspicious hepatic lesions.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: Small bowel is normal in caliber and course. The terminal ileum is normal in caliber. No focal enhancement or mural thickening.There are small retroperitoneal and mesenteric lymph nodes.BONES, SOFT TISSUES: Multiple small cutaneous T2 hyperintense foci likely represent small neurofibromas.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Probable arcuate uterus, suboptimally evaluated as the study was not tailored to evaluate the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: Small cutaneous neurofibromas. OTHER: No significant abnormality noted.

Output: 1.Unremarkable examination of the small bowel without focal areas of inflammation or obstruction.2.Left hepatic lobe hemangioma.3.Possible arcuate uterus.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with weakness in the left quadriceps muscle, evaluate lumbar spondylosis, specifically the left L3 nerve root. Trace retrolisthesis of L4 relative to L5 is unchanged. Spinal alignment is otherwise unremarkable.Mild anterior wedging of the T11 and T12 vertebral body is unchanged. Vertebral body heights are otherwise preserved. Marrow signal characteristics are slightly heterogeneous which in part represents endplate degenerative signal abnormality. No focal worrisome marrow replacement or marrow edema is seen.Mild focal myomalacia of the spinal cord at the T11-12 level is unchanged. Elsewhere, the visualized distal spinal cord, conus and nerve roots of the cauda equina are normal in signal characteristics.Diffuse loss of disc height is seen with the exception of L5-S1 which demonstrates relatively preserved disc height. The discs show uniformly T2 signal. Additional level specific findings are as follows:T11-12: Evidence of prior posterior element surgery. Left facet arthropathy. Disc bulging with a small left foraminal protrusion. Mild generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. No interval changes. T12-L1: Facet arthropathy. Ligamentum flavum thickening. Minimal disc bulge. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes.L1-2: Facet arthropathy. Ligamentum flavum thickening. Moderate generalized spinal canal stenosis with some crowding of the cauda equina. Mild bilateral foraminal narrowing.L2-3: Facet arthropathy. Ligamentum flavum thickening. Disc bulging. Mild generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. No interval changes. L3-4: Facet arthropathy, left worse than right. Minimal disc bulging. Mild generalized spinal canal stenosis. Severe left and moderate right foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Ligamentum flavum thickening. Bulging disc with a small right paracentral protrusion. Mild generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. No interval changes. L5-S1: Facet arthropathy. Ligamentum flavum thickening. Bulging disc with a small central protrusion. Mild generalized spinal canal stenosis. Severe left and mild right foraminal narrowing. No interval changes.

Output: Multilevel degenerative disease of the discs and posterior elements is redemonstrated without significant interval change. As on the prior examination, severe foraminal narrowing is demonstrated on the left at L3-4 and on the left at L5-S1. Moderate spinal canal stenosis is seen at L1-2 with some crowding of the cauda equina. Mild spinal canal narrowing is also evident at additional levels as above.


Instruction: Generate impression based on findings.

Input: Biliary obstruction. Abdominal pain. History of ovarian/fallopian cancer. ABDOMEN:LIVER, BILIARY TRACT: Fatty liver. Numerous bilobar mildly and very hyperintense subcentimeter lesions in the liver. The number, distribution and enhancement characteristics suggest that this is primarily biliary hamartomas. No extra hepatic biliary ductal dilatation. There is moderate bilobar intrahepatic ductal dilatation with abrupt narrowing of the common hepatic duct (series 401/24) at the level of the patient's porta hepatis lymphadenopathy.Mild narrowing of the extrahepatic portal vein. Moderate to severe narrowing of the left portal vein.SPLEEN: The spleen measures 13.8 cm in craniocaudal length with a small non-specific hypoenhancing focus.PANCREAS: Pancreas divisum without pancreatic ductal dilatation or focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate bilateral T2-weighted hyperintensities, probable cysts.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal lymphadenopathy. Porta hepatis lymphadenopathy. Extensive peripherally enhancing serosal implants along the falciform ligament, of the left lobe of the liver and posterior aspect of the antrum. Portocaval lymphadenopathy.BOWEL, MESENTERY: There is moderate volume of loculated ascites with thin septations suspicious for peritoneal carcinomatosis. Nodular implants along the greater curvature of the stomach, better evaluated on recent CT.BONES, SOFT TISSUES: Metastatic pulmonary nodules are partially imaged. Small right anterior abdominal hernia containing a short-segment or wall of small bowel, unchanged.OTHER: No significant abnormality noted.

Output: Intrahepatic biliary ductal dilatation to the level of the common hepatic duct where there is porta hepatis lymphadenopathy as well as tumoral implants. Numerous punctate liver lesions likely represent multiple biliary hamartomas. Mild narrowing of the extrahepatic portal vein. Moderate to severe narrowing of the left portal vein.Peritoneal carcinomatosis including moderate volume of loculated ascites and serosal implants along the stomach and liver.