Instruction: Generate impression based on findings.

Input: Female 63 years old. Reason: eval for RA, pain/swelling in joints. History: eval for RA, pain/swelling in joints. Three views of the right hand are provided. The bones appear normal for age without erosions or other specific findings of rheumatoid arthritis. Three views of the left hand are provided. The bones appear normal for age without erosions or other specific findings of rheumatoid arthritis. There is a tiny ossicle distal to the ulnar styloid which may be secondary to prior injury. Four views of the right knee demonstrate tiny osteophytes indicating minimal osteoarthritis. There is no joint effusion or erosion. There is a lucency partially traversing the fibular styloid, probably representing a normal variant. If there is clinical concern for fracture in this location, further imaging with MRI can be obtained.Four views of the left knee demonstrate small osteophytes indicating mild osteoarthritis. There is no joint effusion or erosion. Three views of the right foot demonstrate bone demineralization but no erosions or other specific findings of rheumatoid arthritis. There is soft tissue swelling along the dorsal aspect of the foot. There are small plantar and posterior calcaneal spurs.Three views of the left foot demonstrate bone demineralization but no erosions or other specific findings of rheumatoid arthritis. There is a bipartite medial sesamoid bone, which is a normal variant. There is a small plantar calcaneal spur.

Output: 1. No specific findings to suggest rheumatoid arthritis.2. Mild knee joint osteoarthritis, right foot soft tissue swelling and other findings as described above.3. Lucency partially traversing the right fibular styloid. This finding likely represents a normal variant, however, if there is clinical concern for a fracture in this location, further imaging with MRI can be obtained.


Instruction: Generate impression based on findings.

Input: Reason: signs of pseudotumor and pineal cyst. History: headaches. MRI: There is a cystic pineal gland that measures up to 10 mm. There is no evidence of intracranial hemorrhage 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRV: There is no evidence of venous sinus thrombosis.

Output: 1. The cystic pineal gland measures up to 10 mm.2. No evidence of venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: 32-year-old female with elbow pain status post fall. Small linear calcific density with questionable small joint effusion. Appears most consistent with more remote/chronic changes to the ulnar collateral ligament. Follow-up advanced imaging, such as with MRI, should be considered if more acute injury is clinically appropriate. No acute fracture or malalignment.

Output: Probable remote trauma/chronic degenerative changes of the ulnar collateral ligament. Consider follow-up advanced imaging if more acute injury is clinically suspected.


Instruction: Generate impression based on findings.

Input: Multiple uterine fibroids. PELVIS:UTERUS, ADNEXA: Enlarged lobular uterus containing multiple well-defined T2 hypointense and T2 heterogeneous masses compatible with multiple leiomyomata. The uterus measures 12.2 x 9.4 cm in the sagittal plane.A right anterior fundal subserosal fibroid measures 9.6 x 5.7 cm. An anterior intramural body fibroid measures 7.9 x 6.1 cm. A dorsal intramural body fibroid measures 3.7 x 3.3 cm. Note is made of an anterior body/fundal submucosal fibroid measuring 1.6 x 1.5 cm.All the fibroids aside from the posterior/dorsal 3.7 cm fibroid demonstrate postcontrast enhancement.The endometrium/endometrial cavity is distorted by the fibroids but is normal in thickness and is homogeneously T2 weighted hyperintense in signal intensity, normal. The inner myometrium/junctional zone is well-defined and is normal in thickness.The left ovary is normal in size but contains a T2 mildly hyperintense 2.2 x 1.7 cm lesion which demonstrates peripheral thick rim enhancement and crenulated margins. The right adnexa is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple large fibroids most of which demonstrate contrast enhancement as described above.2.2.2 cm left adnexal lesion is likely a corpus luteal cyst, however 4-6 week pelvic ultrasound is recommended to confirm resolution.


Instruction: Generate impression based on findings.

Input: Cognitive decline with prior strokes and Parkinson disease: please assess for burden of cerebrovascular disease. There are small areas of encephalomalacia in the bilateral deep grey matter structures and anterior right frontal lobe superimposed upon a background of diffuse bilateral cerebral hemisphere white matter T2 hyperintensity, primarily in a periventricular distribution. There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse cerebral volume loss. There is an unchanged subcentimeter extra-axial lesion with susceptibility effect along the anterior right frontal convexity. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and mastoid air cells are grossly unremarkable. There is a subcentimeter nodule in the left occipital scalp, which may represent an inclusion cyst, but has gradually increased in size.

Output: 1. Small chronic infarcts in the bilateral deep grey matter structures and anterior right frontal lobe superimposed upon a background of chronic small vessel ischemic disease, but no evidence of acute acute infarct.2. An unchanged subcentimeter extra-axial lesion with susceptibility effect along the anterior right frontal convexity may represent a calcified meningioma.3. A subcentimeter nodule in the left occipital scalp may represent an inclusion cyst, but has gradually increased in size and is incompletely characterized.


Instruction: Generate impression based on findings.

Input: 38-year-old male with popping of left knee, inability to bear weight and severe left knee pain. MENISCI: The lateral meniscus appears intact. There is a bucket-handle tear of the medial meniscus.ARTICULAR CARTILAGE AND BONE: There is a focus of fluid signal intensity within the proximal aspect of the medial tibial plateau which may represent a subchondral cyst. There is partial-thickness articular cartilage degeneration along the lateral facet of the patella with underlying degenerative subchondral signal abnormality. Note is made of a 5 mm focus of decreased signal abnormality along the anterior aspect of the medial femoral condyle which may represent a loose body within the joint.LIGAMENTS: There is increased signal abnormality within the proximal fibers of the meniscofemoral ligament indicating a sprain. The superficial band of the MCL appears intact. The LCL appears intact. The ACL and PCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intactADDITIONAL

Output: 1. Bucket handle tear of the medial meniscus as described above.2. Articular cartilage degeneration as described above. Subcentimeter focus of signal abnormality may represent a loose body/articular cartilage fragment as described above.3. Joint effusion and Baker's cyst.4. Sprain of the meniscofemoral component of the deep fibers of the MCL.


Instruction: Generate impression based on findings.

Input: History of cholangiohepatitis with known biliary stricture. History of hepatolithiasis status post left hepatic resection at outside hospital. Recurrent stone formation. Presents with abdominal pain and nausea. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from left hepatectomy and cholecystectomy.There is apparent persistence of the hepatic-gastric cardia fistula as seen on the ERCP dated 8/13/2015 (series 7/11) at the level of the proximal common hepatic duct/confluence of the right hepatic duct. There is narrowing at the confluence of the right hepatic ducts with mild intrahepatic biliary ductal dilatation, a narrow smooth short segment stricture of the proximal common hepatic duct measuring 1.9 cm in length (series 9/2) and an approximately 1.4 cm stricture of the distal common hepatic duct at the level of the head of the pancreas. Proximally the common duct measures 8 mm in caliber. Overall the morphology of the biliary duct system is unchanged from the prior study.No focal lesion or abnormal postcontrast enhancement. No hepatolithiasis or choledocholithiasis.Subcentimeter punctate arterial enhancing focus at the dome of the liver is unchanged and likely represents a flash filling hemangioma.Suspected artifact at the orifice of the right hepatic vein. The vessels are otherwise patent.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: 1.No significant change in the morphology of the biliary ductal system including focal stenosis at Klatskin's point, short focal stricture of the proximal common hepatic duct and short focal stricture at the level of the head of the pancreas.2.Persistent fistulous communication between the proximal common duct and the gastric cardia.3.No suspicious hepatic lesion, hepatolithiasis or choledocholithiasis.


Instruction: Generate impression based on findings.

Input: Pain. Left ilium lesion. There is a mixed sclerotic/lucent lesion within the left ilium adjacent to the sacroiliac joint corresponding to that seen on prior CT and MRI studies measuring approximately 5 cm in maximum dimension. Based on the previous studies I suspect that this represents an intraosseous lipoma which would showed fat signal intensity, suggestive of a suspect this represent an intraosseous lipoma at or potentially a intraosseous "hemangioma". Surgical clips are noted within the pelvis on the left.

Output: Mixed lucent/sclerotic lesion in the left ilium containing fatty components on prior imaging studies. This may represent an intraosseous lipoma or perhaps a intraosseous "hemangioma".


Instruction: Generate impression based on findings.

Input: Intermittent shaking spells, history of craniopharyngioma status post resection. There are findings related to left frontal craniotomy with a small areas of anterior left frontal lobe encephalomalacia. There is also minimal diffuse periventricular white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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 are secretions that complete fill the right maxillary sinus. There is a small amount of fluid in the bilateral mastoid air cells.

Output: Post-treatment findings in the left frontal lobe, but no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Cerebellar hemangioblastomatosis treated with surgery in 2002 and SRS in 2004: headache and gait difficulty. There are postoperative findings related to left suboccipital craniotomy. There has been interval increase in size of the left inferior cerebellar hemisphere enhancing lesions, which now measure up to 18 and 8 mm each, previously 15 and 5 mm, respectively. There is also increased associated vasogenic edema and susceptibility effect. There are unchanged nonspecific punctate foci of T2 hyperintensity in the supratentorial brain. There is no evidence of acute infarct. There is an enlarged partially-empty sella. The ventricles are stable in size and configuration. There is no midline shift or herniation. Thre is fluid within the right mastoid air cells. The extracranial soft tissues are unremarkable. There are bilateral lens implants.

Output: Interval increase in size of the left inferior cerebellar hemisphere hemangioblastomas, along with increased associated vasogenic edema.


Instruction: Generate impression based on findings.

Input: Reason: r/o metastatic dz History: h/o lymphoma in remission, night pain The bone marrow signal intensity is within normal limits. No acute fracture or malalignment is evident. The image musculature of the pelvis is normal in appearance there is no evidence of lymphadenopathy. No enhancing mass lesions are identified on postcontrast sequences. Minimal degenerative disc disease affects image lower lumbar spine including intervertebral disc desiccation. Please see the patient's dedicated MRI of lumbar spine examination report for additional details. There is a 2 cm cystic lesion within the right adnexa, likely physiologic in a patient of this age. There is a small amount of peritrochanteric inflammation, right greater than left, which is not necessarily of any clinical significance. There is a small amount of fluid identified within the hips also not necessarily of any clinical significance. The sacroiliac joints are normal in appearance.

Output: No findings to account for the patient's pain. No evidence of lymphadenopathy or enhancing mass lesion.


Instruction: Generate impression based on findings.

Input: New onset seizure, CLL patient There is about 5 mm sized enhancing nodule on the left cerebral hemisphere and about 2 mm sized left precuneus enhancing lesion which may indicate possible metastasis. However, left precuneus lesion could be vascular structure since it shows a bit elongated shape and seems to be connected to a vascular structure.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.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: About 5mm sized enhancing nodule on the left cerebellar hemisphere, indicating possible metastatic lesion.Another enhancing lesion on the left precuneus which could be an enhancing vascular structure or another metastatic lesion.No evidence of acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for pathology. Signs and symptoms: Bilateral clonus on exam. Nonenhanced total spine MRI:Examination demonstrates normal signal intensity and anatomical alignment of the vertebral column. Examination of cervical spine demonstrate a small disc extrusion at C4-C5 which results in complete effacement of ventral subarachnoid space and subtle flattening deformity of the cord. No evidence of central spinal stenosis. There is however suspected increased T2 signal intensity of the cord on sagittal T2 STIR series 501 image 8. This needs to be further evaluated with dedicated complete MRI of cervical spine. This study was recommended however patient was unwilling to continue with the study and refused.There is normal signal intensity and caliber of the cervical- thoracic cord as well as conus and cauda equina otherwise.No evidence of central spinal stenosis at any level. There is an isolated ligamentum flavum hypertrophy at T2 level.Unremarkable visualized paraspinal soft tissues.

Output: 1.No evidence of mass effect on the cord or central spinal stenosis.2.Small disc protrusion at C4-C5 with effacement of ventral subarachnoid space as detailed. Suspicious tiny focus of cord increased T2 signal intensity at this level. Correlate with neurological exam and consider follow-up with a dedicated cervical MRI.3.Asymmetric prominent ligamentum flavum hypertrophy at T2 and unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. Incidental note is made of persistent FLAIR T2 signal within a left sided perivascular space. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is appropriate. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's abnormal movements.


Instruction: Generate impression based on findings.

Input: 5-month-old male with hearing loss. Evaluate for inner ear pathology. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no evidence of abnormal 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable, aside from what appears to be a punctate focus of fluid in the right mastoid air cells.

Output: 1. No evidence of cochlear nerve deficiency or inner ear lesions.2. No evidence of structural abnormalities in the brain.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left parieto-occipital intracerebral hemorrhage. Possible diagnosis of arteriovenous malformation. There is a 37 mm x 26 mm x 41 mm sized left parieto-occipital intracerebral hemorrhage with the surrounding edema.There is a mass effect towards left lateral ventricle occipital horn, however, there is no evidence of midline shift or transtentorial herniation.There is no evidence of acute ischemic infarct.There is a prominent vascular structure arising from anterior superior aspect of the intracerebral hemorrhage, otherwise there is no evidence of significantly increased vascularity.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. There are fluid collections on the right mastoid air cells.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, left transverse sinuses, left sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus. Right transverse and right sigmoid sinus as well as right jugular bulb are not visualized on this MR venogram but prominent right occipital venous plexus which may indicate hypoplastic right side dural sinuses which is a normal variation..

Output: 1, Acute ICH with surrounding edema on the left parieto occipital lobe.2. A prominent vascular structure was seen on superior and anterior aspect of the ICH, otherwise no remarkable finding. 3. No other abnormal enhancing lesion.4. Normal MR venogram with hypoplastic right side transverse and sigmoid sinuses.


Instruction: Generate impression based on findings.

Input: Unspecified viral encephalitis [A86], Reason for Study: ^Reason: F/u encephalitis History: seizure 22 years Male (DOB:7/6/1994)Reason: F/u encephalitis History: seizurePROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no abnormal enhancement.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 major intracranial arterial system.The visualized portions of the orbits are intact.Mucosal thickenings on bilateral maxillary sinuses, sphenoid sinus and ethmoid sinus are seen.Bilateral mastoid air cell show near complete opacifications which appear to be progressed since prior scan.

Output: 1. MRI of the brain is within normal limits2. Mucosal thickenings on paranasal sinuses and possible progression of bilateral mastoid air cell opacifications.


Instruction: Generate impression based on findings.

Input: Soft tissue swelling. Ulceration. Evaluate for osteomyelitis. Evaluation of the right ankle reveals normal bone marrow throughout. There is subcutaneous inflammation and swelling especially on the lateral aspect of the ankle. The Achilles tendon is unremarkable. The tibialis posterior, flexor hallucis longus, flexor digitorum longus tendons are unremarkable. The peroneal tendons are unremarkable. The lateral collateral ligaments are unremarkable.

Output: Extensive inflammation in the subcutaneous tissues especially of the lateral ankle. No radiographic evidence of osteomyelitis


Instruction: Generate impression based on findings.

Input: There are no definite new foci of enhancement. Numerous previously seen bilateral cerebral and cerebellar intra-axial foci of enhancement are stable to questionably minimally smaller. For example, there is a lesion in the anterior left temporal lobe on series 13 image 76 which measures 3 mm today compared to 4 mm previously. There is a lesion in the right medial temporal lobe on series 13 image 93 which measures 4 mm compared to 5 mm previously. There is no significant edema surrounding any of these lesions. There is apparent increased enhancement in the bilateral internal auditory canals which is likely related to normal vascular enhancement.There is no acute infarct, mass effect, midline shift or herniation. There are multiple scattered small to punctate foci of susceptibility effect associated with the lesions in the bilateral cerebral hemispheres which are overall stable, likely representing a combination of mineralization, chronic microhemorrhages and/or post treatment changes.

Output: Overall interval stability in numerous intra-axial enhancing lesions most consistent with metastases. A few lesions may be questionably minimally smaller as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pain and effusion, evaluate for torn meniscus. BONES: Osseous alignment is within normal limits. There is increased bone marrow signal in the posterolateral medial tibial plateau with linear hypointense signal on proton density sequence, which likely represents insufficiency fracture.MENISCI: There is truncation and loss of triangular shape of the posterior horn of the medial meniscus, consistent with tear. The lateral meniscus is normal in morphology and signal characteristics.ARTICULAR CARTILAGE AND BONE: Grade II to III chondromalacia of the medial compartment and medial facet of the patella. Grade II chondromalacia of the lateral compartment.LIGAMENTS: Anterior and posterior cruciate ligaments are unremarkable. There is increased signal around the medial collateral ligament suggestive of mild sprain. Lateral collateral ligament is unremarkable. EXTENSOR MECHANISM: Quadriceps mechanism and patellar ligament are within normal limits.ADDITIONAL

Output: Insufficiency fracture of the posterolateral medial tibial plateau.Tear of the posterior horn of the medial meniscus.Large Baker's cyst.Mild MCL sprain.


Instruction: Generate impression based on findings.

Input: Female, 43 years old, history of multiple sclerosis, with weakness and urinary incontinence. Brain:Areas of periatrial T2 hyperintensity are unchanged as are a few additional scattered juxtacortical foci of T2 hyperintensity. No new or enhancing lesions are seen. No significant parenchymal edema or mass effect is detected. No abnormal extra axial fluid collections are observed. A focus of susceptibility within the left thalamus compatible with chronic microhemorrhage is unchanged. The ventricular system is stable and normal in size.Lumbar spine:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No pathologic intrathecal enhancement is seen. No epidural abnormalities are suspected.The intervertebral discs are preserved. No herniation or significant disc bulging is seen. No significant compromise of the spinal canal or neural foramina is noted.

Output: 1.Scattered lesions in the brain compatible with demyelinating disease are unchanged. No findings to suggest new or active lesions are seen.2.Unremarkable evaluation of the lumbar spine with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Clinical question: subarachnoid hemorrhage. Signs and symptoms :subarachnoid hemorrhage. Nonenhanced head CT:Residual blood within the fourth ventricle with interval decrease since prior study.Interval decrease in the supratentorial subarachnoid hemorrhage. Extensive residual hemorrhage is still present.Hematoma in the interhemispheric fissure measuring 28.7-mm in transverse axis not significantly changed since prior study. There is effacement of all cortical sulci. There are one suspected areas of cortical low attenuation in the left frontal and parietal region concerning for air the onset of ischemic stroke. Follow-up with an MRI is recommended.Shunted lateral ventricles remain stable in size since prior study and no evidence of hydrocephalus. Residual blood within the lateral ventricles demonstrate no definitive interval change.

Output: 1.No evidence of new hemorrhage since prior study.2.Slight interval decrease in the amount of subarachnoid hemorrhage and blood within the fourth ventricle.3.Stable size of ventricular system and intraventricular hemorrhage in the lateral and third ventricle.4.Suspected areas of low attenuation of the cortex in the left hemisphere concerning for possible early onset of ischemic strokes. For further evaluation an MRI exam is recommended.


Instruction: Generate impression based on findings.

Input: 79 years, Female, parotid cancer status post chemoradiation, now with brain metastasis. Examination is obtained for treatment planning and limited to SWI and post gadolinium 3-D SPGR sequences. There is an enhancing lesion involving the left medial temporal lobe measuring 15 x 15 x 16 mm (previously 12 x 13 x 13 mm) and abutting the left cerebral peduncle and the left optic tract. There is a second enhancing lesion involving the right superior cerebellar vermis measuring 13 x 11 x 11 mm previously 11 x 12 x 11 mm and abutting the right tentorial surface. No findings to suggest associated hemorrhage. There are however additional foci of susceptibility effect including the left cerebellar hemisphere, right parietal lobe, and right temporal lobes compatible with chronic microhemorrhages and are nonspecific in etiology.No findings to suggest intracranial mass effect, midline shift, or herniation. No hydrocephalus. No extra-axial collections. Major vascular structures are patent. No destructive calvarial lesions are appreciated.There is evidence of right-sided parotidectomy. There is enhancement of the right facial nerve including its labyrinthine, tympanic, and mastoid segments, similar to prior.

Output: 1. Two enhancing lesions involving the left medial temporal lobe and right cerebellar vermis consistent with metastatic disease. These lesions measure slightly larger than on outside study from 8/26/2015. No new lesions.2. Multiple scattered foci of susceptibility effect compatible with chronic microhemorrhages and are nonspecific in etiology. There is no associated enhancement to suggest that these represent active metastases. 3. Evidence of right-sided parotidectomy and enhancement of the right facial nerve. The right facial nerve enhancement appears similar to prior and favored to be related to prior surgery involving the facial nerve. Suggest attention on follow-up however to exclude the small possibility of perineural tumor spread.4. Please note this MRI examination is limited to sequences for radiation treatment planning.


Instruction: Generate impression based on findings.

Input: 75-year-old female with a history of a left adrenal mass. ABDOMEN:LIVER, BILIARY TRACT: There are multiple scattered subcentimeter hypervascular foci which do not persist on delayed imaging which are too small to characterize but do not demonstrate washout kinetics. There is a 1.3 x 0.9 cm hypervascular focus in segment IVA of the liver which does not demonstrate washout kinetics and has the imaging characteristics of a FNH but also remains too small to characterize. SPLEEN: No significant abnormality noted.PANCREAS: Mildly dilated main pancreatic duct is of unclear etiology. No focal mass lesion is identified. ADRENAL GLANDS: There is a round left adrenal mass which demonstrates heterogeneous but predominately increased T2 signal abnormality and avid enhancement, measuring 2.8 x 2.8 cm.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left adrenal mass with imaging characteristics suggestive of a pheochromocytoma although a lipid poor adrenal adenoma remains as a differential consideration.2.Multiple scattered nonspecific hypervascular foci in the liver are too small to characterize but may represent focal nodular hyperplasia. 3.Mild dilation of the main pancreatic duct without evidence of a focal mass lesion is of unclear etiology and clinical correlation is indicated.


Instruction: Generate impression based on findings.

Input: Female 64 years old; Reason: To reassess for carcinoid mets in liver History: Carcinoid tumor metastatic ABDOMEN:LIVER, BILIARY TRACT: Unchanged resection cavity in segment 4/5, measuring 2.4 x 1.9 cm, previously 2.4 x 1.8 cm (series 4, image 17). Multiple scattered hyperintense foci on diffusion weighted images, consistent with metastases, appear similar in size and distribution compared to the prior study but increased in number when compared to the prior study dating back to 2009. The reference right posterior liver lesion is unchanged at 7 mm, previously 7 mm (series 4, image 17). Again seen is a segment 5/8 lesion which demonstrates washout on delayed contrast enhanced sequences, measuring 1.2 x 1.0 cm, previously 1.1 x 1.0 cm (55; series 13). Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Fat-containing lesion in the inferior left kidney likely represents an angiomyolipoma given loss of signal on fat suppressed imaging and is unchanged from the prior study. T2 hyperintense nonenhancing lesions are seen in the right kidney consistent with simple cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of prior hemicolectomy. Otherwise, no significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change when compared to more recent prior imaging in the multiple reference liver lesions suspicious for metastases, see discussion above.2.No interval change in the liver resection cavity.


Instruction: Generate impression based on findings.

Input: The study is somewhat degraded due to motion artifact. Given this caveat:There is no acute cord compression. Please see lumbar spine MRI dictation for the diagnostic lumbar spine MRI performed earlier today for details of thoracolumbar findings.

Output: No acute cord compression. Dedicated segment-specific MRI is recommended if symptomology localizes/persists.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess probable cavernoma. Signs and symptoms: None Pre-and post-enhanced brain MRI:No evidence of restricted diffusion.Examination demonstrate two round foci of susceptibility and T2-hypointensity in the inferior left cerebellum highly suggestive of cavernous malformation. The lesions measure both at approximately 8.6 mm in size. There is evidence of a large associated developmental venous anomaly of the left cerebellum occupying a large segment of the cerebellum. Post-enhanced images demonstrate enhancement of this large developmental venous. The appearance the developmental venous anomaly on post enhanced images is suggestive of possibly two separate developmental venous anomaly. The largest developmental venous anomaly appears to extend inferiorly and to the midline and is smaller more superior located venous anomaly extends superiorly to the level left tentorial leaf. There is no evidence of prior hemorrhage, parenchymal edema or encephalomalacia with this finding. The fourth ventricle remains within normal and in midline. No evidence of any additional cavernoma.There is a thin band of T2/T2 flair hyperintensity in the left frontal lobe extending from the cortex to the left lateral ventricle without abnormal enhancement. This finding is new since prior exam from Silver Cross hospital dated 11 -- 26 -- 14. Findings to represent a nonspecific focus of encephalomalacia/gliosis.The anatomical morphology and signal intensity brain parenchyma is otherwise within normal on all MRI sequences and without detectable abnormal enhancement.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Two small (both approximately at 8.6-mm) cavernomas in the left cerebellum are identified. There is a large single or more likely two adjacent developmental venous anomaly associated with the cavernomas detected. No evidence of associated hemorrhage, surrounding edema or encephalomalacia is present. No significant change since prior study.2.Nonspecific linear encephalomalacia in the left frontal lobe which is new since prior MRI exam from 11 -- 26 -- 14.3.Unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Diagnosis: Anesthesia of skinClinical question: right face numbness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate T2 and FLAIR signal hyperintense lesion present along the anterior aspect of the right external capsule. There are several subcortical white matter lesions present along the frontal lobes.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Diagnosis: HeadacheClinical question: 3T scannerSigns and Symptoms: headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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 intracranial mass lesion to explain patient's headaches.2.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 31-year-old female with lumbago and sciatica presents with back and lower extremity pain. Evaluate stability. There is perhaps mild degenerative disc disease of the lower lumbar spine. The alignment is within normal limits with no frank instability between flexion and extension. The vertebral body heights are preserved.

Output: Mild degenerative disc disease without evidence of instability.


Instruction: Generate impression based on findings.

Input: Chronic alcoholic pancreatitis. Pancreatic pseudocyst post drainage and stent removal. Evaluate pancreatic parenchyma ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is interval removal of a cystogastrostomy. There is a focal area of necrosis and main pancreatic duct stricture at the site of prior cystogastrostomy. There is discontinuity of the pancreatic duct, with upstream ductal dilatation. There is increased size of a pancreatic tail collection measuring 4.0 x 1.6 cm, which extends superiorly and is contiguous with the main pancreatic duct. ADRENAL GLANDS: There is a small left adrenal nodule measuring 1.0 cm. Normal right adrenal gland. 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: Progression of chronic pancreatitis with focal pacreatic necrosis and pancreatic stricture at site of prior cystogastrostomy and increased size of pancreatic tail collection.


Instruction: Generate impression based on findings.

Input: 12-year-old female patient with knee injury/pain. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of all three compartments is intact. Bone marrow signal is within normal limits.LIGAMENTS: The collateral and cruciate ligaments are intact. The popliteus muscle and tendon are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: MRI Brain:Examination is motion degraded. There is however no evidence of acute infarct, mass, or mass effect. There is moderate degree of periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease, similar to prior. There is moderate degree of global parenchymal volume loss. Chronic lacunar infarct involving the right cerebellum again seen. No hydrocephalus. No extra-axial collections. There is no midline shift or herniation. The major cerebral flow voids are intact. Bone marrow signal and extra cranial soft tissues are grossly unremarkable.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms within the limits of motion degradation.

Output: 1. No evidence of acute infarct, edema, or intracranial mass effect. 2. Mild to moderate chronic small vessel ischemic disease which appears similar to prior study.3. No significant stenosis in the intracranial vasculature.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Disequilibrium for 2 - 3 months. Evaluate for evidence of strokes. There is a subcentimeter T2 hyperintense lesion in the left pons. There are also scattered punctate foci of T2 hyperintensity in the cerebral white matter. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift, mass effect, or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. A subcentimeter T2 hyperintense lesion in the left pons may represent a chronic lacunar infarct, but is incompletely characterized. Follow up with a brain MRI with contrast may be useful if there are no contraindications.2. Nonspecific scattered punctate foci of T2 hyperintensity in the cerebral white matter may represent the effects of chronic small vessel ischemic disease.3. No evidence of acute intracranial hemorrhage or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Testicular cancer, status post skull lesion resection: restaging. There is no significant interval change in size of numerous non-enhancing lesions with susceptibility effect in the bilateral cerebral hemispheres and left cerebellar hemisphere. There are no discernible extra-axial lesions. There is no evidence of acute intracranial hemorrhage, edema, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged, including the left frontal cranioplasty site. The orbits and paranasal sinuses are clear.

Output: Stable treated intracranial metastases, without evidence of progression.


Instruction: Generate impression based on findings.

Input: 28 year old male with history of testicular cancer. Abdomen:LIVER, BILIARY TRACT: Reference lesion in the right liver is T2 hyperintense and demonstrates progressive nodular enhancement pattern suggestive of hemangioma. It measures 7 x 7 mm on series 501, image 33, and measured 8 x 9 mm on prior CT. Additional T2 hyperintense lesion located more superiorly in the right lobe demonstrates similar imaging characteristics and likely represents an additional hemangioma (series 501, image 42). No gallstones or biliary ductal dilatation. Hepatic vasculature patent. 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: Scattered prominent left retroperitoneal/paraaortic lymph nodes, none of which are pathologically enlarged by CT size criteria. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.Pelvis:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of metastatic disease in the abdomen/pelvis. 2.Scattered T2 hyperintense liver lesions likely represent hemangiomas and are not significantly changed.


Instruction: Generate impression based on findings.

Input: Postoperative evaluation of his subdural and epidural empyema andcraniectomy. There is increased depression of the scalp by up to approximately 4 cm through the left frontoparietal craniectomy defect associated with compression of the underlying brain parenchyma and 8 mm of midline shift to the right, as well as partial effacement of the left lateral ventricle. There is persistent diffuse dural thickening and enhancement involving the left cerebral convexity, and to a lesser extent right anterior cerebral convexity. There is a 3 mm wide left cerebral convexity nonenhancing area within the thickened dura anterior to the craniectomy defect. There is also persistent prominent left cerebral hemisphere pial vascularity. There are subcentimeter defects in the right pons, bilateral basal ganglia, and right corona radiata, which likely represent chronic infarcts. There are also patchy areas of cerebral white matter T2 hyperintensity. There is no evidence of acute infarction.

Output: 1. Increased sunken scalp through the left frontoparietal craniectomy defect associated with compression of the underlying brain parenchyma and 8 mm of midline shift to the right.2. Persistent diffuse dural thickening and enhancement involving the left cerebral convexity, and to a lesser extent right anterior cerebral convexity with what appears to be a nonspecific 3 mm wide left cerebral convexity subdural collection anterior to the craniectomy defect, which may represent a residual hematoma, although superimposed infection cannot be excluded.


Instruction: Generate impression based on findings.

Input: 53-year-old male with lymphoma and persistent altered mental status. There is no evidence of intracranial hemorrhage or acute infarct. There is diffuse, mild, confluent, thin, high T2 signal along the bilateral ventricles, with a more focal area of increased T2 signal along the posterior horn of the left lateral ventricle. There is also a focus of increased T2 signal in the left cerebral hemisphere, which measures up to 8 mm. There is a right choroid fissure cyst. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are innumerable enhancing lesions distributed throughout the calvarium, which correspond to lytic lesion seen on the prior CT examination. There is high T2 signal in the bilateral mastoid air cells, suggestive of effusions. The orbits and scalp soft tissues are grossly unremarkable.

Output: 1. Innumerable enhancing lesions throughout the skull are consistent with lymphoma.2. Small lesions in the left cerebellar hemisphere and left periventricular white matter are nonspecific, but may represent sequelae of treated central nervous system lymphoma, prior infection, or chronic ischemia.3. No evidence of intracranial hemorrhage or acute infarct.


Instruction: Generate impression based on findings.

Input: History of left leg extremity numbness and weakness, evaluate structural lesion, nerve root impingement, disc herniation. Five lumbar type vertebral bodies are presumed to be present. There is mild decrease in height of L5 vertebral body likely of chronic etiology. Rest of the vertebral body heights are within normal limits. Bone marrow signal is benign. There is slight straightening of the normal lumbar lordosis. The conus medullaris is normal in position. There is increased T2 signal within the visualized distal cord along the upper T12 level, although axial images are not available through this level. There is thin linear intrinsic T1 signal at the lower L1 level within the dorsal thecal sac consistent with a fatty filum. There is mild narrowing of L1-L2, L2-L3, and L5-S1 discs with associated mild desiccation. Mild developmental distal narrowing of the lumbosacral spine is noted secondary to shortened pedicles.Multilevel degenerative changes are seen, as described below:T12-L1: On sagittal imaging there is disc bulging seen causing moderate central stenosis.L1-L2: There is ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L2-L3: There is disc bulge with bilateral foraminal prominence. There is mild to moderate bilateral foraminal stenosis. There is ligamentum flavum thickening and mild facet hypertrophy. There is effusion within the bilateral facet joints. There is mild spinal canal stenosis.L3-L4: There is disc bulge with moderate to severe bilateral foraminal narrowing right more than the left. There is no central canal stenosis.L4-L5: There is broad-based disc bulge causing right foraminal prominence. There is moderate right foraminal stenosis and mild to moderate left foraminal stenosis. There is evidence of central annular fissure. There is ligamentum flavum thickening and facet hypertrophy. There is facet effusion. There is moderate spinal canal stenosis at this level.L5-S1: There is evidence of vacuum disc component with broad-based disc bulge causing moderate to severe bilateral foraminal narrowing. There is mild ligamentum flavum thickening and facet hypertrophy with small amount of fluid is seen in the facet joints. There is moderate spinal canal stenosis is seen at this level.Paraspinous soft tissues are within normal limits.

Output: 1. Moderate multilevel degenerative disease mostly affecting L5-S1 causing moderate to severe bilateral foraminal narrowing.2. Moderate spinal canal stenosis at L4-L5 and L5-S1 associated with mild developmental canal l narrowing.3. Abnormal area of increased T2 signal visualized within the distal cord on sagittal imaging at upper T12 vertebral level. Recommend dedicated MRI of the thoracic spine for further evaluation of this finding.4. Linear increased T1 hyperintensity at the lower L1 vertebral level within the dorsal thecal sac most likely representing incidental fatty hilum. However, this can be associated with tethered cord, and clinical correlation is recommended.5. Decreased body height of L5 vertebra most likely chronic in nature.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: 1. Mild distention of the left optic nerve sheath and mild flattening of the globes. This finding can be seen with intracranial hypertension and can be correlated with CSF opening pressure, as clinically indicated.2. There is a 4 mm pineal cyst which is incidentally seen. Brain MRI is otherwise unremarkable. No suspicious intracranial mass or evidence of mass effect. Preserved CSF spaces and biphasic CSF flow at the foramen magnum, without evidence of Chiari I information.3. Spine MRI appears within normal limits.


Instruction: Generate impression based on findings.

Input: HCC screening. Cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. There are numerous varices/collateral vessels. There is evidence of cavernous transformation of the portal vein and recanalization. No lesions suspicious for hepatocellular carcinoma. Cholelithiasis is again noted. There is also a stone in the distal common bile duct.SPLEEN: Severe splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No lesions suspicious for hepatocellular carcinoma.2.Choledocholithiasis.


Instruction: Generate impression based on findings.

Input: 2-day-old male with apnea and multiple bradycardic events. Assess for bleed. Note is made of curvilinear hyperattenuation along the right and left tentorium consistent with a small subdural hematoma layering along the tentorium. Note is made of diffuse generalized hypoattenuation affects the entire right cerebral hemisphere, which may be related to technical artifact, however, if high clinical suspicion for acute ischemia, further evaluation with MRI could be considered. There is no evidence of intracranial mass. There is no mass effect or midline shift. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. The calvaria and skull base are radiographically normal. The visualized mastoid air cells and paranasal sinuses are within normal limits.

Output: 1. Trace subdural hematoma layering along the tentorium. Close interval follow up examination is recommended. 2. Diffuse generalized hypoattenuation affects the entire right cerebral hemisphere, which may be related to technical artifact, however, if high clinical suspicion for acute ischemia, further evaluation with MRI could be considered.These findings and recommendations were discussed via direct phone call with Emily Weiss at 11:00 am on 4/13/13.


Instruction: Generate impression based on findings.

Input: 48-year-old male with history of back pain. The cranial-cervical junction is normal. There is slight straightening of the normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body heights are preserved. The bone marrow and end plates demonstrate a normal MR appearance. The spinal canal is developmentally narrowed. At the levels of C2-C7, there is decreased AP spinal cord measurement likely the result of a developmentally narrowed canal as well as mild degenerative disc disease which will be described in detail below. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: C2-C3: There is no significant disc abnormality. No spinal canal or neuroforaminal stenosis.C3-C4: There is a disc bulge resulting in mild spinal canal stenosis. No significant neuroforaminal stenosis.C4-C5: There is moderate disc bulge with a central prominence causing moderate spinal canal stenosis. No significant neuroforaminal stenosis.C5-C6: There is a moderate disc bulge with a right paracentral prominence causing moderate spinal canal stenosis. No significant neuroforaminal stenosis.C6-C7: There is no significant disc abnormality. No spinal canal or neuroforaminal stenosis.C7-T1: There is no significant disc abnormality. No spinal canal or neuroforaminal stenosis.

Output: 1. No evidence of acute cervical cord compression.2. Developmentally narrowed spinal canal with mild degenerative changes resulting in mild to moderate spinal canal stenosis worse at C4-5 and C5-6, with flattening of the cord.


Instruction: Generate impression based on findings.

Input: 57-year-old with history of metastatic renal cell cancer, presurgical for C4 vertebrectomy. Reversal of lordosis of the cervical spine is identified. There is a significant compression fracture at C4, as well multiple metastases seen throughout the posterior elements of the cervical spine as reported on today's MRI. A posterior laminectomy from C3 to C5 is also identified.

Output: Diffuse posterior element metastases, as well as a significant compression deformity of C4. For better characterization, please see today's dedicated MRI report.


Instruction: Generate impression based on findings.

Input: Stage 4 neuroblastoma with recurrent disease to posterior fossa; assess for progression of disease. Brain: There are postoperative findings related to suboccipital craniotomy. 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 are grossly unremarkable.Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is persistent left mastoid fluid signal.

Output: No evidence of intracranial neuroblastoma recurrence.


Instruction: Generate impression based on findings.

Input: Spells concerning for demyelinating disease: tremors and jerking. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are non-enhancing punctate foci of high T2 signal in the subcortical white matter of the left anterior insula and the anterior left temporal stem. There is a small developmental venous anomaly in the region of the left supramarginal gyrus. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Non-enhancing punctate foci of high T2 signal in the subcortical white matter of the left anterior insula and temporal stem are nonspecific. 2. Small developmental venous anomaly in the region of the left supramarginal gyrus.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with neuropathy and right arm weakness and pain. The cervical lordosis is straightened. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved. Marrow signal characteristics are slightly heterogeneous but there is no worrisome marrow replacement or marrow edema. The spinal cord demonstrates normal signal intensity and morphology except as discussed below.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C4-5: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C5-6: Posterior disc-osteophyte complex formation asymmetric to the right paracentral and right foraminal regions. There is slight flattening of the ventral cord but no evidence of cord signal abnormality. A mild to moderate generalized spinal canal stenosis is seen. The right neural foramen is moderately narrowed and the left is mildly narrowed. C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: Multilevel cervical spondylosis is seen most severely affecting C5-6 where there is a disc osteophyte complex asymmetric to the right paracentral and foraminal regions. This results in slight flattening of the ventral cord and a mild to moderate generalized spinal canal stenosis. The right neural foramen is also moderately narrowed at this level.


Instruction: Generate impression based on findings.

Input: Gait imbalance and veering to the side. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral and pontine white matter T2 hyperintensity. However, there cerebellum is unremarkable. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses are grossly unremarkable. There are bilateral lens implants. There is a 5 mm thick right frontal scalp lipoma. There is a 9 mm wide focus of high T2 and T1 signal in the left parietal calvarium that likely represents a hemangioma.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Scattered cerebral and pontine white matter T2 hyperintensity likely represents chronic small vessel ischemic disease.3. Mld diffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with low back pain, elevated CRP/ESR, evaluate for discitis/osteomyelitis. Signs and symptoms: As above. Nonenhanced total spine MRI:Evaluation of cervical region demonstrate normal signal intensity and alignment of vertebral column. Unremarkable signal intensity and caliber of the cervical cord. No evidence of spinal stenosis at any level. No detectable paraspinal soft tissue abnormality.Evaluation of the thoracolumbar spine demonstrate normal signal intensity and anatomical alignment of vertebral column. Unremarkable signal intensity of thoracic cord. No evidence of spinal stenosis at any level.No evidence of perispinal soft tissue abnormalities.

Output: No evidence of cord compression.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to C2 peripheral nerve sheath tumor resection and C2-4 posterior fusion. At C2-C3, there is a 10 x 9 mm enhancing lesion within the right neuroforamen, grossly unchanged in size compared to prior. There is mild facet hypertrophy at several levels. At C5-C6, there is uncovertebral osteophyte which results in moderate bilateral neural foraminal narrowing. There is mild effacement of the ventral thecal space. There is mild loss of disc height at this level. At C6-C7, there is endplate and uncovertebral hypertrophy with resultant bilateral neural foraminal narrowing. There may be minimal narrowing of the spinal canal at this level. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. The spinal cord is of normal caliber and signal. There is no pathological enhancement. There is a partially imaged T2 signal abnormality in the pons, which may be nonspecific and was better visualized on the MRI of the brain from 2/4/2015.

Output: 1. Postoperative findings related to C2 peripheral nerve sheath tumor resection and C2-C4 posterior fusion. Stable enhancing lesion in the right neural foramen at C2-C3, without significant interval change compared to prior and may represent residual or recurrent tumor.2. Degenerative changes in the cervical spine mostly at C5-C6 and C6-C7, unchanged.3. Partially imaged T2 signal abnormality in the pons, which is nonspecific and was better visualized on the MRI of the brain from 2/4/2015.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out stroke. Signs and symptoms: Patient with hemoglobin SC, severe headache. Nonenhanced head CT:No detectable acute intracranial findings. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.If concern for stroke is high recommend follow up with an MRI examination.Calvarium and soft tissues of the scalp are unremarkable.Limited images through the orbits, paranasal sinuses and mastoid air cells are unremarkable.Prominence of adenoids is noted.

Output: Negative nonenhanced head CT.


Instruction: Generate impression based on findings.

Input: Medial knee pain for 4 months. Evaluate meniscus. MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a distinct linear band of decreased T1 signal within the medial femoral condyle (image 18, series 7) with more diffuse low T1/high T2 signal surrounding it. These findings likely represents an occult stress fracture with surrounding bone edema. The articular cartilage of all three compartments is intact.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Occult fracture of the medial femoral condyle with surrounding edema.


Instruction: Generate impression based on findings.

Input: 39-year-old female with right shoulder pain and impaired movement, history of myeloma ROTATOR CUFF: The supraspinatus appears normal. There is perhaps mild insertional tendinosis of the infraspinatus with associated cysts within the humeral head, but no discrete tear. There is also mild edema type signal along the myotendinous junction of the infraspinatus which may indicate a mild strain. Teres minor tendon is intact. There is mild intermediate signal intensity within the subscapularis tendon which may indicate a mild tendinosis, however we see no discrete tear or abnormality within the musculature.SUPRASPINATUS OUTLET: There is perhaps mild acromioclavicular joint osteoarthritis. A small amount of fluid is present within the subacromial bursa which is of questionable significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is a small amount of fluid within the glenohumeral joint, but no frank effusion. Evaluation of the articular cartilage is limited due to motion and a non-arthrographic study, however there appears to be degeneration of the articular cartilage along the anterior aspect of the glenoid. Given the limitations of a non-arthrographic study, the glenoid labrum appears normal.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1.Heterogeneous bone marrow from multiple myeloma2.Mild rotator cuff tendinosis and strain of the infraspinatus, but no full-thickness rotator cuff tear is evident.3.Mild degeneration of the articular cartilage of the glenohumeral joint.4.A small amount of fluid in the subacromial bursa is of questionable significance.


Instruction: Generate impression based on findings.

Input: 28 year-old female with history of Crohn's colitis complaining of abdominal pain and vomiting. Rule out Crohn's flare, rule out obstruction. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple lymph nodes scattered throughout the mesentery, likely reactive.BOWEL, MESENTERY: Long segment thickening extending from the neoterminal ileum measuring approximately 7 cm may reflect chronic/resolving Crohn's disease. No bowel obstruction as clinically questioned.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse, patchy low-attenuation areas likely represents any infiltration secondary to previous inflammatory disease. No bowel obstruction as clinically questioned.BONES, SOFT TISSUES: Enhancing focus within the perirectal soft tissue extends superiorly to the levator ani terminating at the intersphincteric level may represent an abscess/fistula which appears grossly unchanged when compared to the previous MRI, 5/2005. This area of enhancement measures 9 x 27 mm, (image 141, series 3).OTHER: No significant abnormality noted

Output: 1. Long segment bowel wall thickening of the neoterminal ileum measuring approximately 7 cm may reflect chronic/resolving Crohn's disease, appears to have increased in comparison with prior study. 2. No bowel obstruction as clinically questioned.3. Enhancing focus within the perirectal soft tissue represents an abscess/fistula which appears grossly stable when compared to prior MRI, 5/2005.


Instruction: Generate impression based on findings.

Input: 87-year-old woman with history of elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No focal hepatic lesions are identified.The gallbladder is full of stones and sludge. The common bile duct measures up to 8 mm in diameter.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: Small left pleural effusion with adjacent pulmonary edema and atelectasis noted.

Output: 1.Cholelithiasis without evidence of cholecystitis.2.Mild common bile duct dilatation, but at the limits of normal for patient of this age. No ampullary stone or extrinsic mass identified.


Instruction: Generate impression based on findings.

Input: Female 79 years old Reason: Eval scoliosis History: severe chronic back pain. The bones are demineralized, suggestive of osteopenia. There is a compression fracture of T10 as seen on prior MRI study. There is multilevel degenerative disk disease throughout the spine, particularly affecting the upper and mid lumbar spine. There is grade 1 retrolisthesis of C3.There is approximately 45 degrees of dextroscoliosis of the thoracolumbar spine, as measured from the superior endplate of T5 to the inferior endplate of L2. This decreases to approximately 20 degrees with right bending, and increases to approximately 50 degrees with left bending. There is levorotoscoliosis of the lumbar spine of approximately 30 degrees as measured from the superior endplate of L2 to the inferior endplate of L4. This increases to approximately 32 degrees with right-sided bending, and decreases to approximately 28 degrees with left bending. There is approximately 2.5 cm of positive coronal balance. There is approximately 4.5 cm of positive sagittal balance. Moderate osteoarthritis affects both hips and the acromioclavicular joints. Surgical clips in the right hemiabdomen are likely from a prior cholecystectomy.

Output: Scoliosis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Right neck mass status post biopsy on 5/2015 with pathology as cyst. There is a T2 hyperintense, enhancing, right palatine tonsillar mass measuring 3.9 x 3.4 x 2.7 cm with extension into the soft palate and mild oropharyngeal airway narrowing. There may also be slight extension of tumor across the glossotonsillar sulcus. There is right level 2 lymphadenopathy, including a diffusely enhancing lymph node that measures 2.0 x 1.2 cm. In addition, there is an adjacent cystic lesion with layering debris or hemorrhage measures 2.2 x 2.6 cm. The salivary glands are unremarkable. There are right temporomandibular joint degenerative changes with an associated small effusion and subluxation. There is mild scattered paranasal sinus mucosal thickening. There is mild scattered periventricular and subcortical white matter T2 hyperintensity compatible with chronic small vessel ischemic disease. There is multilevel degenerative cervical spondylosis. The orbits are unremarkable.

Output: 1. A mass in the right palatine tonsil with extension into the soft palate likely represents a squamous cell carcinoma or minor salivary gland neoplasm.2. Right suprahyoid lymphadenopathy likely represents metastatic disease, juxtaposed to what may represent a branchial cleft cyst with prior hemorrhage and possible tumor encroachment.3. Advanced degenerative changes involving the right temporomandibular joint.


Instruction: Generate impression based on findings.

Input: Male; 70 years old. Reason: eval for lesions History: s/p OLT 10/12 for HCC, elevated AFP LUNG BASES: Status post sternotomy.ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes related to liver transplant. Paradoxical loss of signal on in-and-out of phase images, suggestive of iron deposition. No suspicious hepatic lesion. Stable mild extrahepatic biliary ductal dilation. The portal vein and its branches, as well as the hepatic artery and its branches, appear patent, though evaluation at the porta hepatis is limited by artifact from surgical clips. The hepatic vein and its branches are patent.SPLEEN: No significant abnormality noted.PANCREAS: Stable appearance of two T2 hyperintense lesions within the pancreas with the largest lesion in the pancreatic neck measuring 1 x 0.5 cm, unchanged (series 6/19). 1.0 x 0.5 cm No pancreatic duct dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintensities within the kidneys, likely representing cysts.RETROPERITONEUM, LYMPH NODES: Aortic graft, partially visualized.BOWEL, MESENTERY: Susceptibility artifact from metallic hardware in the region of the gastric body, which again limits evaluation of the adjacent structures.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Unilocular fluid collection in the region of the hepatic vein/IVC confluence and anterior to the right diaphragmatic crus measures up to 4.2 x 2.6 cm, unchanged (series 3/11) and again most likely due to a postsurgical fluid collection or seroma.

Output: 1.No suspicious hepatic lesion.2.Stable unilocular probable postsurgical fluid collection or seroma.3.Stable appearance of two cystic lesions in the pancreas, likely representing sidebranch IPMNs.


Instruction: Generate impression based on findings.

Input: Possible meniscal tear MENISCI: There is marked medial extrusion of the medial meniscus. The lateral meniscus is unremarkable..ARTICULAR CARTILAGE AND BONE: There is marked loss of cartilage of the medial femoral condyle and medial tibial plateau with joint fluid down to the underlying bone. There is associated bone marrow edema. In addition there is marked loss of articular cartilage along the medial facet of the patella with thinning of the articular cartilage on the lateral facet.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Medial extrusion of the medial meniscus with marked loss of medial articular cartilage. Severe osteoarthritis


Instruction: Generate impression based on findings.

Input: 60-year-old with personal history of right breast cancer and now known to have BRCA gene mutation. Patient desires prophylactic mastectomy. There is heterogeneous amount of fibroglandular tissue in the left breast. Mild parenchymal enhancement is noted in the left breast. The patient is status post right mastectomy and reconstruction. No suspicious enhancement in the right chest wall.There is a 6 mm reniform enhancing mass in the left lower outer quadrant anterior depth. This is probably an intramammary lymph node. No other enhancing masses or areas of non-mass enhancement are seen. No abnormal axillary lymph nodes are identified in either axillary region. Postoperative changes are identified in the right axilla.

Output: A 6 mm left breast mass is probably a normal intramammary lymph node, though establishing stability by comparing to prior examinations is recommended. If stability cannot be established, then targeted ultrasound should be performed to ensure that this has the sonographic appearance of a lymph node as well.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison.


Instruction: Generate impression based on findings.

Input: 46 years Female (DOB:10/4/1970)Reason: compare to prior MRI for brain mets History: NonePROVIDER/ATTENDING NAME: STEVEN J. CHMURA SERVICES ANCILLARY The patient status post left frontal craniotomy. There is encephalomalacia present along the left frontal lobe. It is unchanged compared to the prior exam.Patient is status post posterior fossa craniotomy. An enhancing lesion in the vermis has decreased in size compared to the prior exam. It currently measures 16 x 6 mm and previously measured 26 x 11 mm axial dimensions. There is associated enlargement of the fourth ventricle.A right paramedian pontine mass is present which measures 12 x 10 mm axial dimensions and previously measured 12 x 9 mm axial dimensions.There is a punctate right periventricular white matter enhancing lesion which is unchanged compared to the prior exam.There is a right occipital lobe lesion measuring 5 mm in diameter which previously measured the same is stable.There are FLAIR and T2 hyperintense lesions present in the left precentral gyrus, right frontal lobe and right temporal lobe which were also present on the prior exam and have not changed. These presumably related to previously treated lesions.Incidental note is made of a developmental venous anomaly in the right centrum semiovale.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam an enhancing lesion in the vermis has decreased in size and presumably represents postoperative change.2.There are multiple lesions in the brain parenchyma one in the pons and another in the right occipital lobe and one in the right centrum semiovale which are stable compared to the prior exam. Presumably these are related to metastatic disease.3.Since prior exam a pontine mass has remained stable. This is suspicious for neoplasm.


Instruction: Generate impression based on findings.

Input: 41-year-old female strong family history of breast carcinoma. Family history of breast cancer in her mother diagnosed at age 37, and a maternal aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally, somewhat limiting the sensitivity of the examination.Scattered T2 hyperintense cysts are visualized in both breasts. There is stable appearance of a benign morphology mass measuring 0.8 cm in the far inferior left breast, which demonstrates a typically benign kinetic profile, and T2 signal hyperintensity, likely representing fibroadenoma. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Right sided weakness and sensory change. There are punctate foci of restricted diffusion and high T2 signal in the upper left precentral gyrus and paracentral lobule. There is a background of diffuse patchy cerebral, brainstem, and cerebellar white matter T2 hyperintensity. There are punctate foci of encephalomalacia in the bilateral basal ganglia and corona radiata. There is also encephalomalacia and susceptibility effect in the left posterosuperior temporal lobe and inferior parietal lobule. There is a pineal cyst that measures 9 mm in diameter. There is diffuse mild cerebral volume loss. There is no midline shift or herniation. There is a 9 mm diameter basilar tip aneurysm. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Punctate recent infarcts in the left upper left precentral gyrus and paracentral lobule.2. Chronic lacunar infarcts in the bilateral basal ganglia and corona radiata. 3. Area of chronic hemorrhage in the left posterosuperior temporal lobe and inferior parietal lobule. 4. A background of diffuse patchy cerebral, brainstem, and cerebellar white matter T2 hyperintensity may represent chronic small vessel disease. 5. A 9 mm diameter basilar tip aneurysm appears to have gradually increased in size.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out cord compression. Signs and symptoms: Pain, right arm weakness and leg pain. Non-enhanced total spine MRI:Examination is performed utilizing cord compression and without dedicated axial images.Examination demonstrate normal height and alignment the vertebral column. There is diffuse marrow signal abnormality or vertebral column consistent with patient's known osseous metastatic lesions. There is no convincing evidence of any significant spinal canal compromise. Very subtle effacement of subarachnoid space at T10 is suggestive of mild epidural spread of tumor. There is no detectable mass effect on the cord and with maintained normal caliber and signal intensity of the cord. This finding can be further assess with a dedicated pre-and post enhanced thoracic MRI. Previously reported suspected signal abnormality of the cord at T3 and T4 is not identified on this exam.A well demarcated near CSF signal intensity collection in the soft tissues of the spine with interval decreased size since prior exam at L1 and L2 is again noted.

Output: 1.Normal signal intensity and caliber of the cord.2.Subtle epidural spread of tumor from diffuse osseous metastatic lesions at T10 with subtle effacement of subarachnoid space is noted. This finding is not associated with any cord signal abnormality.3.Diffuse osseous metastatic lesions without evidence of fracture or malalignment.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for signs of encephalitis, infection or prior disease. Signs and symptoms: Continued progression of encephalopathy with dystonia and myoclonus. Pre-and post-enhanced brain MRI:Diffusion weighted images are severely compromised due to large metallic fragment/shrapnel artifact obscuring the left hemisphere and the posterior fossa. Beyond the region of artifact no evidence of restricted diffusion.Flair and T2-weighted images are also significantly compromised in particular through the posterior fossa and left temporal secondary to metallic shrapnel artifact.The examination redemonstrates a single punctate focus of flair hyperintensity in the right frontal centrum semiovale similar to prior exam. The anatomical morphology and the signal intensity of brain parenchyma on the artifact remains within normal on all MRI sequences and without interval change. Ventricular system remains within normal and with maintained midline. Lumbosacral cortex, cortical sulci, ventricular system and CSF spaces beyond the artifact.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement. The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits. Note however should be made that there is artifactual T2 hyperintensity of the entire retropatellar space secondary to metallic artifact.

Output: 1.No evidence of an acute or new finding since prior exam.2.Single punctate focus of flair hyperintensity in the right frontal centrum semiovale as was noted on prior exam and of no clinical significance.3.Unremarkable and stable pre-and post enhanced brain MRI otherwise as detailed.4.Note should be made that a large artifact secondary to a shrapnel fragment obscures portions of the left hemisphere and posterior fossa as detailed above.


Instruction: Generate impression based on findings.

Input: Female, 24 years old. History of AML s/p matched sibling stem cell transplant with knee pain. History of steroid treatment. Evaluate for AVN. MENISCI: Medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: The cartilaginous surface is intact. No evidence of avascular necrosis or focal marrow occupying lesion. No bone marrow edema.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. No evidence of avascular necrosis or focal marrow occupying lesion.2. No meniscal, cartilaginous, or ligamental injury.


Instruction: Generate impression based on findings.

Input: Male, 42 years old, with grade 3 glioma recently started on Avastin plus CCNU, new regimen since prior MRI. Evaluate for interval changes. Redemonstrated is evidence of prior tumor resection with cavities in the right anterior temporal lobe and the inferior right frontal lobe. Evidence of prior stereotactic biopsy is also seen.Since the prior examination, marked T2 hyperintensity, mass effect and enhancement within the right frontal lobe and insula have dramatically improved. Mass effect has essentially resolved and only mild patchy enhancement persists. An area of enhancement along the right lateral ventricular atrium seen on the prior examination has also resolved. Within this area of general improvement, there has been an increase in diffusion restriction.The left cerebral hemisphere, brainstem and cerebellum remain uninvolved by tumor. No new lesions are seen. The size and morphology of the ventricular system have recovered to that seen on the pre-progression examination of 8/5/2015.

Output: A significant interval response to therapy is seen with much reduced enhancement, T2 signal abnormality and mass effect centered on the right frontal lobe. Progressive diffusion restriction within this tissue likely represents a treatment effect.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for cord compression History: b/l 3/5 weakness in quads, new onset. Hx metastatic urothelial ca The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.Degenerative changes affect the cervical spine, with multilevel disc dessication and bulging, more prominent at the C4-C5, C5-C6 and C6-C7 levels, where there is mild associated neural foraminal narrowing. Degenerative changes also affect the lumbar spine, with mild subluxation at L4-L5 associated with facet arthropathy, as well as disc bulging at L5-S1. There is a mild rightward curvature of the lower thoracic and upper lumbar spine. A small hemangioma within the L1 vertebral body is noted. Bilateral lower pole renal cysts are incompletely characterized on this study.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.Multilevel degenerative changes affect the cervical and lumbar spine without significant compromise to the spinal canal. There is some evidence for neural foramen narrowing, however, due to the screening nature of this protocol, further details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: 66-year-old female with spinal stenosis and low back pain. Five lumbar type vertebral bodies are identified. Mild retrolisthesis at L3-4. Lumbar levoscoliosis is present. Vertebral body heights are preserved. Disc space narrowing and associated degenerative endplate changes are present at L2-3 and L3-4; the bone marrow signal is otherwise within normal limits aside from some scattered Schmorl's nodes. The conus tip is at the level of L1-L2 and the visualized thoracic cord demonstrates normal caliber and signal. There is fatty atrophy of the paraspinal muscles but no paraspinal soft tissue mass.Multilevel degenerative changes are seen, as described below:T11-T12: Unremarkable.T12-L1: No central canal or foraminal stenosis.L1-L2: Small left paracentral disc protrusion causing mild left foraminal stenosis. No central or right foraminal stenoses.L2-L3: Moderate posterior disc bulge and bilateral facet hypertrophy. Mild central and right foraminal stenoses. No left foraminal stenosis.L3-L4: Mild retrolisthesis and associated disc uncovering. Diffuse disc bulge with superimposed right foraminal prominence. Prominent dorsal epidural fat. Bilateral facet hypertrophy. Moderate right foraminal narrowing. Mild central and left foraminal narrowing.L4-L5: Bilateral facet hypertrophy and ligamentum flavum thickening, left greater than right. Mild left foraminal narrowing. No central or right foraminal narrowing.L5-S1: Moderate facet hypertrophy without central or foraminal stenoses.Well-circumscribed T2 hyperintense lesion in the spinal canal at the level of S1-S2 is compatible with a Tarlov cyst.

Output: Multilevel degenerative changes as described above. Most notably, there is a diffuse disc bulge with small superimposed right foraminal prominence at L3-L4 which causes moderate right foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Reason: meniscus injury History: pain and swelling MENISCI: There is a complex tear of the posterior horn of the medial meniscus including a large horizontal and longitudinal component which extends to both the tibial and femoral articular surfaces. The lateral meniscus appears intactARTICULAR CARTILAGE AND BONE: There is blistering of the articular cartilage along the medial facet of the patella. There is relative sparing of the articular cartilage along the medial and lateral tibiofemoral compartments. No bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tear of the medial meniscus with both longitudinal and horizontal components.2. Moderate-sized joint effusion and Baker's cyst. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: altered mental status History: altered mental status There are scattered restricted diffusion involving left is a ganglia insular cortex and frontal as well as parietal lobe indicating acute ischemic infarct. There is no evidence of hemorrhagic transformation.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: Acute ischemic infarct involving left basal ganglia, insular cortex, frontal lobe and parietal lobe. No evidence of hemorrhagic transformation.


Instruction: Generate impression based on findings.

Input: 63-year-old female with right meniscus pain MENISCI: Mild globular intermediate signal within the lateral meniscus with blunting of the free edge (series 12, image 18). Loculated fluid along the anterior and lateral tibiofemoral compartment may represent a parameniscal cyst.The medial meniscus is diminutive with degenerative tearing of the posterior horn including a probable radial tear. There is medial extrusion of the body of the medial meniscus. ARTICULAR CARTILAGE AND BONE: Increased edema type marrow signal is noted at the patellofemoral compartment. Diffuse severe chondromalacia of the patellofemoral compartment, lateral worse than medial, with subchondral cysts and edema.Moderate degenerative disease affects the medial tibiofemoral compartment. Moderate degenerative disease affects the lateral tibiofemoral compartment. Bilateral tibiofemoral osteophytes.LIGAMENTS: The cruciate ligaments are intact. High signal at the femoral portion of the ACL may represent a ganglion. The medial collateral ligament is slightly thickened without abnormal signal, possibly chronic. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Degenerative tearing of the posterior horn of the medial meniscus as described above. Degenerative tearing of the lateral meniscus. 2.Loculated fluid along the anterior and lateral tibiofemoral compartment may represent a parameniscal cyst.3.Moderate to severe osteoarthritis worst at the patellofemoral compartment as described above. 4.Small joint effusion. Small Baker's cyst.


Instruction: Generate impression based on findings.

Input: Female, 6 years old, with history of ependymoma. Brain:Postoperative findings are seen compatible with occipital craniotomy. A right frontal approach EVD is in place. The tip of the catheter sits at the lateral margin of the right frontal horn and appears to have retracted somewhat when compared to the prior CT.Diffuse gyriform cortical restricted diffusion is seen involving the cerebral hemispheres symmetrically. Restricted diffusion is also demonstrated in the basal ganglia bilaterally, in the cerebellum bilaterally, with patchy involvement of the brainstem.Numerous heterogeneously enhancing masses are demonstrated intracranially. These are found primarily within the ventricles or the CSF spaces of the sulci and basal cisterns. Lesions range in size from punctate nodules to a bulky aggregate within the left suprasellar cistern which measures up to 5 cm. In addition to the discrete nodules, there is extensive dural enhancement and diffuse leptomeningeal enhancement particularly along the brainstem. Many of the tumor is demonstrated susceptibility effect and/or T1 signal compatible with blood product. The lateral and third ventricles are dilated similar to that seen on the prior examination. Periventricular T2 hyperintensity may reflect transependymal CSF flow. The fourth ventricle is somewhat distorted due to the presence of tumor and or postoperative changes.Spine:Diffuse dissemination of enhancing tumor is seen within the spine with areas of discrete nodularity as well as leptomeningeal spread. A very longitudinally extensive tumor is seen within the posterior lateral left spinal canal occupying the entire cervical spine and part of the thoracic spine. This lesion displaces and compresses the adjacent spinal cord. There is evidence of extensive spinal cord T2 signal abnormality which may reflect both edema and/or tumor invasion.Spinal alignment is anatomic. Vertebral body heights are preserved. Diffusely fatty marrow replacement may reflect prior radiotherapy. Bilateral airspace opacities and atelectasis of the left lower lobe are seen.

Output: 1.Findings are seen compatible with diffuse CSF dissemination of tumor involving the intracranial space and the spine. Bulky tumor deposits are evident within the ventricular system and in the subarachnoid spaces. Extensive tumor spanning the cervical and upper thoracic spine causes severe displacement and compression of the spinal cord.2.Evidence of diffuse hypoxic ischemic injury of the brain is demonstrated.3.Supratentorial ventricular dilatation appears similar to that seen on the prior CT examination. The right frontal approach EVD tip is positioned just at the lateral margin of the frontal horn and appears to have retracted relative to the prior CT.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Rule out intracranial hemorrhage and airway impingement. Signs and symptoms shortness of breath and anisocoria CT of brain without infusionnotice of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Calvarium remains intact. Examination remains is stable since prior study.Irregular high density material overlapping the cortex of right high convexity frontal -- parietal lobe is nonspecific and was present on the prior exam. There is no evidence of associated edema with this finding. Further evaluation with an MRI is recommended.CT of the soft tissues of the neck.Images through the skull base demonstrate no evidence of destructive lesions. Irregular shape of the left globe with internal calcification is redemonstrated with no interval change since prior exam.Minimal chronic sinus disease.Extensive opacification of left mastoid air cells remains stable since prior study. This finding is not associated with any bony changes.Lack of contrast infusion makes precise evaluation of the soft tissues difficult however within this limitation no definitive evidence of a mass is identified. Three visualization of multiple cervical lymph nodes. Endotracheal tube is identified.Images through the apices of the lungs demonstrate extensive pleural effusion. Please review the dictated report of chest x-ray performed the same date. Bony structures of the area of exam remains unremarkable.

Output: 1.Stable CT examination of brain without infusion. Not a specific cortical calcification in the right parietal with no interval change.2.Endotracheal tube noted on CT of the neck. Extensive pleural effusion.


Instruction: Generate impression based on findings.

Input: right side weakness, occlusion of the left ICA from 2-3cm above the bifurcation. There is no MR evidence of subacute hematoma on the wall of the left extracranial ICA.Instead, the left ICA from the occlusion point to the level of reconstitution (paraclinoid segment) shows luminal iso or slightly high signal intensities indicating intraluminal evolving thrombus. And the left ICA appears to be occluded.There is no other abnormal signal intensity on other craniocervical arterial system.3D MRA neck pre and post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate complete occlusion of the left extracranial ICA and reconstituted at the level of the left ophthalmic artery, no change since prior CT angiography.Otherwise, the right brachiocephalic, left common carotid, right CCA and left subclavian arteries appear to be normal. The vertebral artery origins are normal.

Output: 1. No MR evidence of arterial dissection on the left ICA (extracranial and intracranial).2. Complete occlusion of the left ICA from 2cm above the bifurcation and reconstituted at the level of the left ophthalmic artery.