Instruction: Generate impression based on findings.

Input: Female, 70 years old, with left lower extremity radicular pain. Prior imaging showed L5-S1 nerve impingement. A trace retrolisthesis of L5 relative to S1 is noted. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved. A Schmorl's node is evident at L1-2. Mild endplate degenerative signal is seen at L5-S1. No concerning marrow replacement is detected. Edema is demonstrated within the L5 pedicles.The visualized distal spinal cord and conus are unremarkable. No epidural abnormalities are suspected.Since the prior examination, loss of disc height has progressed at L1-2 and L5-S1. All of the lumbar discs demonstrate loss of T2 signal. Additional level specific findings are as follows:L1-2: Mild facet hypertrophy. Bulging disc asymmetric to the right with a possible right foraminal protrusion. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing, slightly progressed. L2-3: Facet hypertrophy and ligamentum flavum thickening. Minimal bulging disc. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Facet hypertrophy and ligamentum flavum thickening. Minimal bulging disc. Mild spinal canal narrowing. No significant foraminal narrowing. No interval changes. L4-5: Facet hypertrophy and ligamentum flavum thickening, progressed, particularly on the left. Bulging disc, not significantly changed. Generalized spinal canal stenosis with particular effacement of the left lateral recess and likely impingement of the descending left L5 nerve root. The neural foramina are not significantly narrowed. L5-S1: Facet hypertrophy. Mild bulging disc. A previously seen left paracentral and subarticular protrusion has resolved. There is no significant spinal canal stenosis. Severe right and moderate left foraminal narrowing, unchanged.

Output: 1.Progressive facet and ligamentous degeneration on the left at L4-5 which results in a worsened left lateral recess narrowing and possible impingement of the descending left L5 nerve root.2.A previously seen disc protrusion at L5-S1 has resolved with no significant residual canal stenosis or nerve impingement. The right foramen at this level is, however, significantly narrowed.3.No additional areas of high-grade spinal canal or foraminal stenosis are seen.


Instruction: Generate impression based on findings.

Input: 34-year-old female patient with cirrhosis and liver failure. Note that the examination is suboptimal secondary to previous injection of gadolinium contrast.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. There is a segment 4B exophytic lesion measuring 5.3 x 5.1 cm (series 1101 image 151) that does not demonstrate enhancement, but does demonstrate slight washout on portal venous and delayed imaging. This lesion does not have T2 hyperintensity or diffusion restriction. There is no intra or extrahepatic biliary duct dilatation. The portal vein is mildly diminutive. The hepatic vasculature is patent. There is perihepatic ascites and paraumbilical collaterals.Gallbladder wall thickening likely secondary to hypoalbuminemia and there is vicarious excretion of prior contrast into the gallbladder lumen.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The inferior vena cava is mildly enlarged.BOWEL, MESENTERY: There is bowel wall thickening that is most likely secondary to hypertensive colopathy.BONES, SOFT TISSUES: Diffuse anasarca. Right breast implant with intracapsular rupture noted.OTHER: Intra-abdominal ascites.

Output: 1.Suboptimal examination due to the previous administration of intravenous contrast.2.Cirrhotic liver morphology and findings consistent with portal hypertension.3.Segment 4B exophytic lesion with features that not meet strict criteria for hepatocellular carcinoma. Follow up of this lesion is recommended.4.Right breast implant with intracapsular rupture.


Instruction: Generate impression based on findings.

Input: 60-year-old male status post OLT for HCC/HCV. Evaluate for lesions and assess hepatic vessel patency. ABDOMEN:LIVER, BILIARY TRACT: No suspicious focal hepatic lesions. Mild wedge-shaped T2 signal abnormality in segment 8 is likely related to perfusional change due to thrombosed portal vein (see below). No intra-or extrahepatic biliary ductal dilatation. Mild pneumobilia, similar to prior CT on 2/10/2015.The proper hepatic artery and its branches are patent. Limited evaluation of the common hepatic artery due to artifact from surgical clips. Main portal vein, left portal vein, and most of the right portal vein are patent. A segment 8 branch of the portal vein is thrombosed, similar to prior CT on 11/18/2014 (series 103/43). Hepatic veins are patent.SPLEEN: Splenomegaly with the spleen measuring 15.2 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple peri-splenic and gastroesophageal varices are again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Complex collection within the anterior abdominal wall seen on prior CT on 2/10/2015 is decreased in size with small residual collection measuring up to 2.6 x 1 cm (series 8/13).OTHER: No significant abnormality noted.

Output: 1. Postsurgical changes from liver transplantation. No suspicious focal hepatic lesions. Stable appearance of the hepatic vasculature as detailed above.2. Complex collection within the anterior abdominal wall seen on prior CT has decreased in size.


Instruction: Generate impression based on findings.

Input: Lumbar radiculopathy, evaluate for nerve compression at L5-S1. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is moderate levoscoliosis of the lumbar spine with apex at the L2-L3 level. Bone marrow signal is benign. The conus medullaris is normal in position. There are multilevel degenerative changes with disc desiccation throughout the lumbar spine and loss of height which is particularly worse at the L4-L5 and L5-S1 levels. There are fatty associated endplate marrow signal changes.Multilevel degenerative changes are seen, as described below:T12-L1: There is mild spinal canal stenosis related to mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is mild to moderate left greater than right neural foraminal narrowing.L1-L2: Minimal disc bulge and bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.L2-L3: Disc height loss particularly on the right. There is mild disc bulge with small central protrusion. There is bilateral facet arthropathy, with likely small subchondral cyst involving the left facet joint. There is also ligamentum flavum thickening. These changes contribute to mild to moderate spinal canal stenosis at this level. There is moderate to severe right neural foraminal stenosis where there may be impingement of the right L2 nerve root. There is moderate left neural foraminal stenosis.L3-L4: Mild disc bulge and moderate bilateral facet arthropathy. There is mild bilateral right worse than left neural foraminal stenosis. There is mild to moderate spinal canal stenosis.L4-L5: There is disc height loss and minimal bulge. There is facet arthropathy, left worse than right. There is mild to moderate left and mild right neural foraminal stenosis. No significant spinal canal stenosis.L5-S1: There is disc height loss and disc bulge. There is bilateral facet arthropathy, left worse than right. There is moderate left neural foraminal stenosis and mild to moderate right neural foraminal stenosis. No significant spinal canal stenosis.Small cysts are noted involving the bilateral kidneys. Paraspinous soft tissues are grossly unremarkable.

Output: Multilevel degenerative changes throughout the lumbar spine. There is moderate levoscoliosis with apex at the L2-L3 level. There is mild to moderate spinal canal stenosis at L2-L3 and to a slightly lesser degree at the L3-L4 level. There is moderate to severe right L2-L3 neural foraminal stenosis where there may be impingement of the right L2 nerve root. There is also moderate left L5-S1 neural foraminal stenosis. Please see additional levels as above.


Instruction: Generate impression based on findings.

Input: 46-year-old woman with history of left breast MRI guided biopsy with pathology results of focal ALH. Family history of breast cancer in her sister, diagnosed at the age of 37. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are a few areas of benign parenchymal enhancement bilaterally, which are not significantly changed from the most recent prior examination. Notably, background enhancement has significantly decreased when compared to the older comparison examinations. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 66-year-old man right native kidney nephrectomy for renal cell seen. Assess contralateral native kidneys for cystic changes and 4 right kidney fossa. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Two lesions in the spleen previously identified on the MR reidentified. One near the splenic hilus which is hypodense on image 29/170 measuring 1.9 x 1.7 cm in the peripheral subcapsular area measuring 2.1 x 1.9-cm which is hypervascular. These likely represent hemangiomas and are unchanged in size from the MRI.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Postsurgical changes right renal fossa with no evidence of local recurrence.The left kidney is small with numerous cysts consistent with chronic medical renal kidney disease. Most of the cysts are typical. On the lateral cortex two cysts are high density but do not enhance. These is seen pre-contrast coronal image 51/129 and delayed image 73/114. The larger more cephalad lesion measures 1.6 cm in diameter and it abuts a smaller more caudal lesion measuring 1.4 cm in diameter neither of which show significant change in density.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prominent measuring 6.4-cm transverse by 5.2-cm AP is seen on axial image 137/170.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Renal allograft in the right iliac fossa demonstrates normal nephrogram and excretion. Heavy calcifications surrounding the dorsal aspect of the renal allograft is identified. This could represent a calcified old hematoma or foreign body. Correlate clinically.

Output: No evidence of local recurrence in right renal fossa. None of the lesions in the left kidney is suspicious for neoplasm. Prominent prostate. Calcified structure dorsal to renal allograft correlate with surgical history.


Instruction: Generate impression based on findings.

Input: 40-year-old male with a history of thymic cancer with left femur pain. Evaluate for bony lesion. There is thickening and heterogeneity of the cortex of the left femoral diaphysis which likely reflects periosteal reaction as seen on recent radiographs, which is nonspecific but perhaps due to hypertrophic osteoarthropathy. We suspect a similar process affects the right femur as seen on the large field-of-view coronal images. There is avascular necrosis of the left femoral head appearing similar to the prior pelvic MRI study from February 26 of 2015. There is patchy intermediate signal intensity within the medullary space of the left femur that appears similar to that seen on the right and likely represents residual or reconverted red marrow. There is a 1.5 cm ovoid focus of low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging within the subtrochanteric left femur that we suspect also reflects more concentrated red marrow although we cannot entirely exclude the possibility of a small metastatic focus. A presumed metastatic focus is again noted within the posterior column of the right acetabulum, appearing similar to that seen on the prior pelvis MRI. There is avascular necrosis of the right femoral head also appearing similar to the prior study. There is metallic susceptibility artifact within the distal right femur and proximal tibia presumably related to prior ACL repair. There are small bilateral knee and hip joint effusions.The musculature of the thigh appears atrophic. There is relatively increased signal intensity of the vastus medialis, lateralis and intermedius muscles on fluid sensitive sequences that is nonspecific and could reflect mild edema or subacute atrophy. There are similar findings, suggested on the large field-of-view coronal sequence, affecting the contralateral side, which appear less pronounced. There is also mild edema within the soft tissues along the adductor musculature of the hips bilaterally as well as confluent edema and/or crescentic fluid between the IT band and underlying proximal quadriceps musculature. This is also noted, to a lesser degree, on the contralateral side. We see no masslike collection to suggest abscess formation. There is reticulation of the subcutaneous fat along the lateral aspect of the hips suggestive of mild edema.

Output: 1. Cortical thickening and heterogeneity of the cortex of the femoral diaphysis is nonspecific but may reflect hypertrophic osteoarthropathy and corresponds to the findings seen on prior radiographs.2. Avascular necrosis of the femoral heads, appearing similar to the prior study.3. Heterogeneity of the medullary space of the proximal femora bilaterally is favored to represent residual reconverted red marrow. A slightly more prominent focus in the subtrochanteric left femur may also represent reconverted red marrow although a small metastatic lesion cannot be excluded. Further evaluation with a skeletal scintigraphic examination could be considered if clinically warranted.4. Right acetabular metastatic focus, appearing similar to the prior study.5. Muscular atrophy and nonspecific inflammatory changes of the soft tissues as described above.


Instruction: Generate impression based on findings.

Input: Female 4 days old Reason: Where are the pulmonary veins draining? History: infant with TAPVR Left VentricleThe left ventricle is normal. There are no regional wall motion abnormalities present. There is no intracardiac thrombus.Left AtriumThe left atrium is normal, however no pulmonary veins are going to it. There is an osteomyelitis second and a as the superiorly to the coronary sinus. Right VentricleThe right ventricle is dilated. Right AtriumThe right atrium is moderately dilated. Hemostasis secundum ASD about the coronary sinus is noted. Open (image 7a series 1101) Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation visualized. Dedicated through plane imaging was not performed.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation visualized. Dedicated through plane imaging was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation visualized. Dedicated through plane imaging was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. Pulmonary veins are merging in a common single collecting chamber posterior and inferiorly to the left atrium and drains into the right atrium via the coronary sinus (image 30, series 2401). No other alternative vessel was identified as a possible source of venous return from the lungs.PericardiumThere is a small pericardial effusion.Extracardiac FindingsPossible bibasilar lung consolidation. Partial view of the solid organs of the upper abdomen are normal..

Output: 1. Total anomalous pulmonary venous return to the right atrium as described.2. Osseous secundum ASD.3. Right atrial and ventricular dilatation.4. Small pericardial effusion.5. Bibasilar opacities likely atelectasis.6. Mild to moderate tricuspid regurgitation.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: Leg mass Note that the exam is limited by motion artifact. The patient was unable to complete several sequences and no contrast was administered. Also note that the right lower extremity was imaged in external rotation.There is severe osteoarthritis of the knee. Evaluation is somewhat limited given the presence of artifact from prior ACL repair. Along the anterior portion of the mid diaphysis of the tibia is a cystic collection which measures approximately 9 x 1.5 cm in the greatest craniocaudal and AP dimensions. This collection appears to connect to an additional lobulated collection within the posterior joint space of the knee (series 12 image 17/70). The underlying marrow signal of the tibia in this area is normal.

Output: Cystic collection within the medial knee which appears to extend to an additional collection anteriorly. This may represent a complex Baker's cyst with extension although further evaluation is limited given details provided above.


Instruction: Generate impression based on findings.

Input: 22-year-old male with history of lateral knee pain status post ACL repair MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: Old mild deformity of an impaction fracture of the lateral femoral condyle is seen overlying the anterior horn of the lateral meniscus. The overlying articular cartilage appears intact. The remainder of the articular cartilage is within normal limits. There is mild edema type signal within the intracondylar eminence of the tibia, particularly within the medial tibial spine just posterior to the graft, which may be reactive in etiology.LIGAMENTS: The patient is status post ACL reconstruction with the graft appearing slightly thickened and mildly heterogeneous in signal intensity, but otherwise intact. There is focal increased signal intensity within the anterior fibers of the graft, which can be seen in graft impingement. A small focus of intermediate signal intensity immediately anterior to the graft may represent scar tissue, also seen on the prior exam. The PCL is intact. The medial and lateral collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps tendon is intact. The patella tendon is bisected and thickened, representing changes from prior graft harvesting, appearing similar to the prior exam.ADDITIONAL

Output: Postoperative changes of ACL graft reconstruction appearing similar to the prior exam, with slight heterogeneity of the graft that could represent impingement in the appropriate clinical setting. We see no articular cartilage injury, meniscal tear or loose body.


Instruction: Generate impression based on findings.

Input: BRAIN MRI:There is bilateral predominantly parietal subdural hemorrhages with mixed hyper and isointense signal on T1-weighted images and associated septations and strong susceptibility artifact. These collections produce mass effect with effacement of the sulci. There is no evidence of brain herniation. The widest thickness of the collection measures 15 mm on the right and 13 mm on the left. The dura overlying the collections is thickened and enhancing, which extends to involve almost the entire cerebral dura on the left and somewhat less so on the right. On postcontrast images, there is a suggestion of contrast permeation into the collections.Since the prior examination, substantial periventricular white matter volume loss has occurred giving the false impression of improvement in the degree of both periventricular T2 signal abnormality and the previously seen, biopsy proven benign periventricular enhancement. A 4 mm focus of enhancement is seen within the right insula, which is new compared to the previous study.High signal seen in the peripheral right frontal bone due to biopsy related burr hole.Normal flow voids of the visualized internal carotid arteries and of the cerebral arteries.PITUITARY MRI:The pituitary gland is normal in enhancement and in size. No evidence of pituitary adenoma or distinct mass.

Output: 1. Bilateral subdural hematomas with mixed intensities, suggestive of a combination of older and newer blood product.2. Diffuse dural enhancement, likely reactive to the the subdural hematomas. 3. Substantial periventricular white matter volume loss giving the false impression of improving T2 signal and enhancement in the periventricular regions. 4. A new 4 mm focus of enhancement in the right insula is nonspecific. Follow-up is suggested.5. Normal pituitary evaluation.


Instruction: Generate impression based on findings.

Input: 63 year-old female history of HCV and cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Segment 7/8 mildly T2 hyperintense focus with persistent and delayed enhancement is stable from prior. No lesions fitting the criteria for HCC.Hepatic vessels are 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: No evidence of HCC.


Instruction: Generate impression based on findings.

Input: 37 year-old female with persistent pain and effusion of the left knee. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: A small contusion is present at the medial femoral condyles, which may relate to recent trauma. Suboptimal images secondary to habitus limits evaluation of the patellar cartilage. Otherwise, the articular cartilage appears within normal limits.LIGAMENTS: No significant abnormality noted. Specifically, the medial collateral ligament is intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Bony contusion of the medial femoral condyle.2.Baker's cyst in the posteromedial aspect of the knee.3.The medial collateral alignment is intact, as clinically queried.


Instruction: Generate impression based on findings.

Input: Images are motion degraded secondary to claustrophobia. Given this caveat:Cervical spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Left facet hypertrophy causes mild left neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, uncinate hypertrophy (left greater than right), and bilateral facet hypertrophy (left greater than right). There is mild flattening of the anterior cord surface without intrinsic cord signal abnormality. There is severe left neural foraminal and mild right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, uncinate hypertrophy (right greater than left), and minimal left facet hypertrophy. There is mild flattening of the anterior cord surface without intrinsic cord signal abnormality. There is moderate left and severe right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild flattening of the anterior and posterior cord surfaces, without intrinsic cord signal abnormality. There is mild central and moderate to severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy (left greater than right). There is minimal central, moderate to severe left neural foraminal, and mild to moderate right neural foraminal stenosis.C7/T1: Mild disc bulge and left facet hypertrophy. There is mild left neural foraminal stenosis.T1/2: Left-sided facet hypertrophy causes mild left neural foraminal stenosis.Lumbar spine:Dextrorotoscoliosis is present centered at approximately L3. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: UnremarkableL2/3: Diffuse annular disc bulge, slight ligamentum flavum thickening, and mild left facet hypertrophy. There is mild bilateral neural foraminal stenosis.L3/4: Asymmetric bulge to the left, ligamentum flavum flavum thickening, and moderate bilateral facet hypertrophy. There is a tiny left facet fusion, and reactive marrow changes are noted within bilateral L3 and L4 pedicle secondary to the facet arthropathy. There is mild central, moderate to severe left neural foraminal, and mild right neural foraminal stenosis.L4/5: Asymmetric bulge to the right, ligamentum flavum thickening, and mild to moderate bilateral facet hypertrophy. There is a small left facet effusion. There is mild central, mild left neural foraminal, and moderate right neural foraminal stenosis.L5/S1:Mild disc bulge and mild bilateral facet hypertrophy without significant stenosis.

Output: 1.Images are motion degraded secondary to claustrophobia.2.C2/3: Mild left neural foraminal stenosis.3.C3/4: Severe left neural foraminal and mild right neural foraminal stenosis.4.C4/5: Moderate left and severe right neural foraminal stenosis.5.C5/6: Mild central and moderate to severe bilateral neural foraminal stenosis.6.C6/7: Minimal central, moderate to severe left neural foraminal, and mild to moderate right neural foraminal stenosis.7.C7/T1: Mild left neural foraminal stenosis.8.T1/2: Mild left neural foraminal stenosis.9.L2/3: Mild bilateral neural foraminal stenosis.10.L3/4: Mild central, moderate to severe left neural foraminal, and mild right neural foraminal stenosis.11.L4/5: Mild central, mild left neural foraminal, and moderate right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 69-year-old male with past medical history of COPD, DM, HTN presents to the Emergency Department with left-sided weakness and right eye deviation since 3am today. There is focal diffusion restriction involving the posterior limb of the right internal capsule with superior extension along caudothalamic groove. This is a recent acute/subacute ischemic infarct. In addition, there is extensive confluent periventricular cerebral hemispheric T2/FLAIR hyperintensity without diffusion restriction which represents chronic microvascular ischemia. Patchy similar findings are present the right cerebral peduncle and along the right cortical spinal tract.There is a small focus of susceptibility effect involving the left middle cerebellar peduncle which may represent tiny focus of hemorrhage. Accounting for basal ganglia calcification, there is no supratentorial intraparenchymal hemorrhage.The right eye globe is elongated (versus staphyloma) while the left eye lens is absent.Dynamic contrast imaging was performed. However, the quality of the examination is not optimal, as judged by the arterial input function curve. However, there is no significant asymmetry on the color coded rCBV, rCBF and MTT maps between the 2 cerebral hemispheres.

Output: 1.Diffusion restriction in the posterior limb of the right internal capsule is compatible with an acute/subacute infarct in the right anterior choroidal artery territory.2.There is no significant asymmetry between the two cerebral hemispheres on the perfusion maps but the study is technically limited as described above.3.There is no other acute infarct in the brain. Extensive cerebral white changes are most compatible with chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: Counting of the vertebral bodies is limited due to motion between upper and lower spine sequences. L5 is probably sacralized. The last fully formed disc is at L4-L5 and the L5-S1 disc appears rudimentary. The last visualized rib is at T11.The conus medullaris is seen at the level of mid L1 with non-thickened fatty filum. The fatty filum extends from L1 to the distal end of the thecal sac. There is appropriate the ventral motion of the cord on prone imaging. There is prominence of the central canal at the distal cord and the conus. The central canal measures 2 x 2 mm at the mid T11 level although there is further more ill-defined prominence of the central spinal canal from T6 to T12.There is prominence of the CSF space along the posterior and inferior aspect of the cerebellum which favors mega cisterna magna. The fourth ventricle does not appear enlarged. There may be minimal inferior vermian hypoplasia although this is difficult to completely assess on this dedicated spine exam.The bladder is severely distended.

Output: 1. Normal conus termination with non-thickened fatty filum. Appropriate ventral motion of the cord on prone imaging. No MR imaging findings to support tethered cord.2. Trace prominence of the central canal from T6 to T12, most conspicuous at the mid T11 level where it measures up to 2 mm. The more caudal findings may relate to a ventricularis terminalis, although the greater extent of subtle abnormal signal may relate to underlying trace syringohydromyelia. Follow-up imaging and clinical correlation may be helpful.3. Significant focal prominence of the CSF space along the posterior and inferior aspect of the cerebellum which favors mega cisterna magna along the Dandy-Walker spectrum with questioned mild inferior vermian hypoplasia. If there is clinical concern, MRI of the brain may be obtained for further evaluation.


Instruction: Generate impression based on findings.

Input: Male, 83 years old. Right shoulder pain. ROTATOR CUFF: The rotator cuff tendons are intact, without evidence of tear. There is no significant atrophy of the rotator cuff muscles. There are multiple subcortical cysts along the rotator cuff insertions on the humeral head, likely degenerative in etiology.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is trace fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There degenerative changes of the glenohumeral joint with subchondral cysts in the glenoid. Anterior and posterior horns of the labrum are irregular compatible with degeneration. There is a small amount of fluid within the joint.BICEPS TENDON: The tendon of the long head of the biceps is normal in course and morphology. ADDITIONAL

Output: 1.No evidence of rotator cuff tear.2.Osteoarthritis of the shoulder with associated labral degeneration as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Left leg weakness x 3 weeks. Moderate low back pain. History of malignancies. Signs and symptoms: As above. Pre-and post-enhanced lumbar MRI:The signal intensity of vertebral column demonstrate changes related degenerative disk disease. There is also uniformly T1 hyperintensity of L5 and visualized S1 and S2 levels of cervical spine consistent with radiation changes.The signal intensity and caliber over the lower most visualized thoracic cord, conus and cauda equina is also within normal.Post enhanced images demonstrate no detectable abnormal enhancement the vertebral column, cord, leptomeninges or the cauda equina to suggest metastatic disease.T12 -- L1 is unremarkable.L1 -- L2 demonstrate mild degenerative changes are unremarkable otherwise. Incidental note at this level is made of severely atrophic right kidney. Multiple cystic like lesions within the large left kidney is noted.L2 -- L3 demonstrate mild disk disease and moderate bilateral ligamentum flavum hypertrophy and mild facet degenerative changes. Constellation of above changes results in mild to moderate central spinal stenosis and moderate bilateral neural foraminal compromise.L3 -- L4 demonstrate advanced degenerative disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy and resultant significant central spinal stenosis with severe right and mild left neural foraminal compromise. Degenerative changes at this level also results in mild grade 1 anterolisthesis.L4 -- L5 demonstrate moderate disk disease and loss of disk height, moderate to severe right and moderate left facet and ligamentum flavum hypertrophy. Constellation of changes results in moderate central spinal stenosis and moderate left neural foramina compromise.L5 -- S1 demonstrate moderate disk disease and loss of disk height and asymmetric moderate left facet and ligamentum flavum hypertrophy. There is no central spinal stenosis. Mild to moderate left neural foraminal compromise is however noted.Pre-and post enhanced brain MRI:Negative diffusion weighted images.Flair and T2 weighted images demonstrate minimal small foci of periventricular and subcortical flair hyperintensity which are nonspecific however considering patient's stated age of 75 the often represent microvascular ischemic changes.Signal intensity and overall anatomical morphology of brain parenchymal otherwise remains within normal on all MRI sequences. The signal void of major intracranial arterial branches are identified.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable calvarium and orbits and without evidence of abnormal enhancement.There is normal pneumatization signal pattern of all paranasal sinuses and bilateral mastoid air cells and the middle ear cavities.

Output: 1.Pre-and post enhanced MRI of the lumber spine demonstrate no evidence of study disease. Marrow signal changes suggestive of prior radiation is noted at L5, S1 and S2. Extensive degenerative changes of the lumbar spine results in central spinal stenosis at L2 -- L3, L3 -- L4 and L4 -- L5 levels as detailed. Degenerative changes also results in neural foraminal compromise as detailed per level.2.Pre-and post enhanced brain MRI demonstrates findings suggestive of minimal chronic non-hemorrhagic small vessel ischemic strokes and unremarkable otherwise.


Instruction: Generate impression based on findings.

Input: The study is motion degraded, given this caveat:Brain MRI:T2 hyperintensities are present within periventricular and subcortical white matter without restricted diffusion, susceptibility abnormality, or enhancement. Additionally, there is a small focus of T2 hyperintensity involving the cortices and underlying subcortical white matter of the anteromedial left occipital lobe without restricted diffusion.There is diffuse volume loss without a specific lobar predominant atrophy pattern.The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Note is made of an empty sella. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. 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. Cervical spine MRI:Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is no abnormal enhancement.C2/3: UnremarkableC3/4: UnremarkableC4/5: Posterior osteophyte disc complex, bilateral facet hypertrophy, and ligament flavum thickening. There is mild central, moderate left neural foraminal, and mild right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral facet hypertrophy, and ligament flavum thickening. There is mild central and mild to moderate bilateral neural foraminal stenosis.C6/7: Minimal posterior osteophyte disc complex as well as bilateral uncinate hypertrophy. There is mild bilateral neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.Chronic small vessel ischemic disease.2.Small right anteromedial occipital lobe chronic infarct.3.Diffuse volume loss without a specific lobar predominant atrophy pattern.4.C4/5: Mild central, moderate left neural foraminal, and mild right neural foraminal stenosis.5.C5/6: Mild central and mild to moderate bilateral neural foraminal stenosis.6.C6/7: Mild bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Contrast opacified the radiocarpal articulation in the expected fashion. Contrast extended into the midcarpal joint initially via a defect in the lunotriquetral ligament. With gentle manipulation of the wrist, communication of contrast between the radiocarpal and midcarpal joints was also noted via the scapholunate interval; however, I suspect that this communication is of limited significance, as the dorsal component of the scapholunate ligament appears intact on preliminary review of the MR images. No contrast extended into the distal radioulnar joint indicate a triangular fibrocartilage tear. Please refer to the subsequent MRI report for further information.Exposure time: Three minutes and 14 seconds

Output: Tears of the lunotriquetral and scapholunate ligaments as described above, of questionable clinical significance.


Instruction: Generate impression based on findings.

Input: Ankle swelling TENDONS: There is a small amount of fluid within the tendon sheaths of the posterior tibialis and flexor digitorum longus as they cross posterior to the medial malleolus. The amount of fluid is slightly more than typically expected and is suggestive of mild tenosynovitis. There is also a mild amount of edema in the overlying subcutaneous fat. The remaining tendons appear normal.LIGAMENTS: The lateral collateral ligament complex is intact. The distal tibiofibular ligament complex is intact. The visualized components of the deltoid ligament complex appear intact. A mild amount of edema is noted within the sinus tarsus which is of uncertain clinical significance.ARTICULAR SURFACES AND BONE: The marrow signal of the ankle is normal and there are no osteochondral defects identified. ADDITIONAL

Output: Mild tenosynovitis of the posterior tibialis and flexor digitorum longus tendons with additional findings described above.


Instruction: Generate impression based on findings.

Input: Female 28 years old Reason: assess for invasive endometrial cancer. If needs contrast, please do. History: vaginal bleeding, grade 1 endometrial cancer PELVIS:UTERUS, ADNEXA: Uterus measures 8.0 x 4.8 x 5.1 cm. The anterior junctional zone is thickened. Endometrial stripe is normal in thickness. Bilateral ovaries contain follicles. There are scattered cervical nabothian cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Cystic area adjacent to the right ovary likely represents portion of the cecum. No bowel obstruction is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic ascites.

Output: 1.Mild thickening of the anterior junctional zone may be due to adenomyosis. No discrete endometrial mass.


Instruction: Generate impression based on findings.

Input: Clinical question: Memory loss. Evaluate for chronic vascular changes. Non-infused head CT:Images through posterior fossa again identify a right-sided cerebellopontine angle extra axial primarily fatty density mass measuring 14.7 x 11.6-mm in size. There is no appreciable interval change in the size or morphology of this lesion. Finding likely present a lipoma however an MRI examination is recommended for more precise evaluation. Images through posterior fossa are otherwise unremarkable.Anatomical variation of partially empty sella is also again identified with no change.Images supratentorial space demonstrate diffuse patchy areas of low attenuation in the subcortical and periventricular white matter of bilateral cerebral hemispheres. Although nonspecific these findings however are often result of small vessel ischemic strokes. These findings were present on prior exam and precise comparison is not possible.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Calvarium is intact. Visualized orbits, mastoid air cells and middle ear cavities are unremarkable.Limited images of the paranasal sinuses again demonstrate complete opacification of right chamber of the sphenoid sinus with no change since prior examination from 2008.

Output: 1.Small vessel disease of indeterminate age.2.Revisualization of complete opacification of right chamber of sphenoid sinus.


Instruction: Generate impression based on findings.

Input: Female 25 years old with history of left shoulder pain, eval shoulder labrum ROTATOR CUFF: No evidence of rotator cuff tear. The infraspinatus, supraspinatus, subscapularis, and teres minor muscles and tendons appear normal.SUPRASPINATUS OUTLET: The acromial clavicular joint is normal for age.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a superior labral tear with contrast extension underneath the anterior and posterior labrum consistent with a SLAP (superior labrum anterior posterior) tear. The glenohumeral joint alignment is within normal limits without evidence of joint effusion.BICEPS TENDON: The tendon of the long head of the biceps is unremarkable. ADDITIONAL

Output: Superior labral anterior posterior tear of the left shoulder.


Instruction: Generate impression based on findings.

Input: 30-year-old male with history of meniscal injury, partial ACL tear now with recent injury and pain along the medial jointline. Inability to bear weight and decreased range of motion with flexion. MENISCI: The medial meniscus appears intact. There is increased signal abnormality within the posterior horn of the lateral meniscus. Some of this extends to the tibial articular surface suggestive of superficial tearing/fraying (image 21; series 10). No fluid-filled tear is identified.ARTICULAR CARTILAGE AND BONE: There is increased signal abnormality within the lateral femoral condyle on fluid sensitive sequences which may represent a bone contusion. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: Increased signal abnormality about the ACL on fluid sensitive sequences suggesting a sprain or partial tearing of the proximal fibers. The PCL appears intact. The LCL appears intact. There is increased signal abnormality on fluid sensitive sequences within the proximal fibers of the superficial band of the MCL, anteriorly, indicating partial tearing. There is fluid within the MCL bursa indicating a bursitis. There is nonspecific subcutaneous edema in the surrounding area.EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a small amount of increased signal abnormality within the proximal fibers of the patellar tendon which may represent a very mild patellar tendinosis.ADDITIONAL

Output: 1. Partial tear of the MCL. 2. Partial tearing/sprain of the ACL. 3. Superficial fraying/tearing of the posterior horn of the lateral meniscus. No fluid-filled tear is evident.4. Bone contusion within the lateral femoral condyle.5. Moderate sized joint effusion.


Instruction: Generate impression based on findings.

Input: There is no acute cord compression.Degenerative changes in the cervical spine resulting several levels of central canal stenosis with cord abutment and flattening. Susceptibility artifact is present from aortic stent grafting. Degenerative changes of the lower lumbar spine resulting in central and neural foraminal stenoses. There is no abutment of the conus.

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


Instruction: Generate impression based on findings.

Input: 76-year-old female with left shoulder pain. Reevaluation to determine with there is now a full-thickness rotator cuff tear. ROTATOR CUFF: Again seen is increased signal intensity within the distal supraspinatus tendon near its insertion at the greater tuberosity with associated foci of increased signal within the articular and bursal surfaces compatible with partial tear of the supraspinatus tendon. Similar findings are present within the infraspinatus with no evidence of full-thickness tear. There is increased fatty atrophy of the supraspinatus muscle from prior study as well as mild fatty atrophy of the infraspinatus muscle. The teres minor muscle and tendon appear normal. Again seen are foci of increased signal intensity within the distal fibers of the subscapularis tendon likely a combination of tendinosis and interstitial tearing. There is mild fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: Mild arthritic changes of the acromioclavicular joint. Again seen is small amount of fluid within the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. Alignment is normal. There is a small joint effusion, however this is improved from prior study. No definite findings to suggest a labral tear on this non-arthrogram study.BICEPS TENDON: Again seen is a atleast a partial-thickness tear of the tendon of the long head of the biceps at its transition from the intertubercular groove to the rotator interval. There is a small amount of fluid communicating with the long head biceps tendon distally.ADDITIONAL

Output: 1. Tear of the long head of the biceps tendon similar to prior study.2. Tendinosis and partial-thickness rotator cuff tear with no discrete full-thickness tear as described above.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect or midline shift. There is no suspicious intracranial enhancement. There is no hippocampal signal abnormality or volume loss. There are moderate nonspecific periventricular and subcortical white matter T2 signal abnormalities again seen, grossly stable from the prior exam, although evaluation is somewhat limited due to motion artifact present on the prior exam. The ventricles are unchanged. There is no hydrocephalus.

Output: 1.No evidence of intracranial metastases.2.Moderate nonspecific white matter signal abnormalities grossly unchanged.3.No findings to explain patient's new onset seizure.


Instruction: Generate impression based on findings.

Input: Evaluate one year status post sarcoma resection, index finger, and middle finger removed. There has been surgical resection of the second and third rays at the carpometacarpal articulation. No abnormal enhancement is identified. There is no specific evidence of tumor recurrence.

Output: No specific evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: 68 year old man with remote history of colon cancer, and more recent diagnosis of carcinoid of the liver with tricuspid valve involvement and severe tricuspid regurgitation, referred for cardiac MRI as part of a pre-surgical evaluation for possible valve replacement. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVEDV is 167 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 76 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 109 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Native T1 relaxation time is 990-1020ms, which is normal. There is no evidence of myocardial iron overload. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. The interatrial septum bulges to the left, consistent with elevated right atrial pressures. Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 190 ml/m2 (normal range 82+/-16), the RVEDV is 372 ml (normal range 142+/-31), the RV end systolic volume index is 102 ml/m2 (normal range 31+/-9), and the RVESV is 190 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely with trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve leaflets are thickened, calcified, with severely restricted motion, consistent with the diagnosis of carcinoid tricuspid valve disease. The tricuspid annulus is severely dilated with severe malcoaptation. There is severe tricuspid regurgitation with evidence of diastolic tricuspid regurgitation and also forward flow acceleration due to the substantial volume of TR.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (34mm). Venous AnatomyThe SVC drains normally into the right atrium. The IVC is dilated.PericardiumThere is a small pericardial effusion. Extracardiac FindingsThere is hepatic vein dilation. There is a pre-tracheal calcified lymph node. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with normal systolic function (EF 55%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. Severely dilated right ventricle with mildly reduced systolic function (EF 49%). 3. The tricuspid valve leaflets are thickened, calcified, with severely restricted motion, consistent with the diagnosis of carcinoid tricuspid valve disease. The tricuspid annulus is severely dilated with severe mal-coaptation. There is severe tricuspid regurgitation with evidence of diastolic tricuspid regurgitation and also forward flow acceleration due to the substantial volume of TR.4. Mild dilation of the main pulmonary artery. 5. Severe right atrial dilation with evidence of increased RA pressures.6. Small pericardial effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with history of left frontal meningioma status post stereotactic radiosurgery. Follow-up examination. Redemonstrated is evidence of prior right-sided craniotomy for tumor resection. Small areas of encephalomalacia in the right inferior frontal gyrus are unchanged.An extra-axial mass along the left superior frontal gyrus does not appear to have changed significantly from the prior examination. Within the limitations of this noncontrast examination, no definite additional intracranial tumors are seen.No restricted diffusion is evident. Scattered nonspecific foci of white matter T2 hyperintensity are unchanged. No evidence of parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is suspected. The ventricles are stable and normal in size.

Output: Redemonstrated are postoperative findings related to right-sided tumor resection. Within the limitations of this noncontrast examination, no definite evidence of recurrent tumor is seen. A small presumed meningioma along the left superior frontal gyrus also shows no significant interval change.


Instruction: Generate impression based on findings.

Input: Forthcoming odontoid procedure, apnea, possible venous sinus thrombosis There is localized restricted diffusion on the right front lobe alongside with interhemispheric fissure without evidence of hemorrhagic transformation. This lesion may represent acute ischemic infarction likely embolic in nature.No evidence of hemorrhagic lesion on the scan.There is a 27 mm x 11 mm sized fluid collection on the right high frontoparietal area scalp, no change of its size since prior CT scan.There is no evidence of venous congestive encephalopathy.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Left PCAs fetal origin.2D brain noncontrast enhanced MRV with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal craniofugal flow related enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus. These findings indicate venous blood flow within the major dural sinuses has been maintained. Multifocal signal drops on the distal superior sagittal sinus and proximal left transverse sinus as well as bilateral proximal internal jugular vein are likely to be artifactual considering no evidence of associated venous congestive encephalopathy. However, the diameter of distal superior sagittal sinus as well as bilateral transverse sigmoid sinuses appear to be a bit larger and than normal, these findings could represent mild to dural sinus malformation with maintaining cranial fugal flow. Therefore, follow-up imaging including brain MRI about 3-6 months is later can be considered.

Output: 1. Restricted diffusion on the right frontal lobe as described above indicating possible acute ischemic stroke. No evidence of hemorrhagic lesion.2. Normal brain MRA3. Ectatic venous sinuses with demonstration of craniofugal venous flow without evidence of congestive venous encephalopathy. No evidence of venous sinus thrombosis.4. Follow up brain MRI can be considered since the diameter of dural sinuses appears to be a bit larger than normal, thus possibility of mild dural sinus malformation may need to be excluded.


Instruction: Generate impression based on findings.

Input: Reason: pain History: pain ROTATOR CUFF: There is minimal heterogeneity of the supraspinatus tendon suggesting mild tendinosis, but we see no discrete tear. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. There is increased signal intensity along the deep fibers of the subscapularis tendon likely representing a combination of tendinosis and undersurface tearing, but we see no full-thickness subscapularis tear. There is perhaps mild fatty atrophy of the superior fibers of the subscapularis muscle. There are foci of signal abnormality within the lesser tuberosity which are likely degenerative in etiology.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint. There is no fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Mild osteoarthritis affects the glenohumeral joint. There is a small amount of fluid within the glenohumeral joint extending into the subscapular recess. There is poorly defined intermediate signal intensity within the joint, anteriorly, which may represent a synovitis. There is mild degeneration of the anterior superior labrum, but otherwise the labrum appears normal for age.BICEPS TENDON: The tendon of long head of the biceps appears perched on the lesser tuberosity, suggesting pulley dysfunction and its margins are irregular within the proximal bicipital groove indicating partial thickness tearing.ADDITIONAL

Output: 1. Undersurface degeneration and tearing of the subscapularis tendon. There is also partial thickness tearing of the long head of the biceps tendon which appears perched on the lesser tuberosity, suggesting pulley dysfunction.2. Osteoarthritis of the acromioclavicular and glenohumeral joints. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Shoulder pain. ROTATOR CUFF: Moderate supraspinatus tendinopathy. No discrete tears. The infraspinatus, subscapularis and teres minor tendons are intact. No significant muscle atrophy.SUPRASPINATUS OUTLET: Mild AC joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is anatomic. No definite labral tear. BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Moderate supraspinatus tendinopathy with no discrete rotator cuff tears.


Instruction: Generate impression based on findings.

Input: Posterior knee pain MENISCI: There is increased globular signal within the posterior horn of the medial meniscus. There may be a small focus of extension to the tibial articular surface (series 4 image 13/32) but otherwise there is no discrete extension to either articular surface. Additionally, the root of the medial meniscus appears intact and these findings directly representing intrasubstance degeneration. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a small full-thickness cartilage defect within the lateral femoral condyle anteriorly measuring approximately 5 mm. There is associated underlying degenerative marrow signal abnormality. This is superimposed upon mild thinning of the articular cartilage. The articular cartilage of the medial femoral condyle also demonstrates diffuse thinning with a small partial-thickness defect of the femoral condyle anteriorly as well. There is diffuse thinning of the articular cartilage of the patellofemoral compartment without full-thickness defect.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Abnormal signal within the posterior horn of the medial meniscus thought to represent intrasubstance degeneration although there may be a small focus of extension to the tibial articular surface. The root of the meniscus is intact.2. Small areas of full-thickness cartilage loss within both the medial and lateral femoral condyle anteriorly.


Instruction: Generate impression based on findings.

Input: 53-year-old male with new brain tumor, questionable metastases versus primary brain tumor with increased FDG uptake in the right shoulder on recent PET examination. ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear normal for age. The subscapularis and teres minor muscles and tendons appear intact. There is a fusiform, near fluid signal intensity, small mass within the teres minor muscle, measuring approximately 1.5 cm in the long axis and 7 mm in the short axis. There is no enhancement of this mass on post gadolinium images and we suspect that this represents an intramuscular ganglion or less likely a benign nerve sheath tumor. It does not correspond to the morphology of the increased uptake seen on the patient's recent PET/CT examination.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial bursa which may not be of any clinical significance. The acromioclavicular joint appears normal for age.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild enhancement of the glenohumeral joint indicating a mild synovitis that corresponds to the increased uptake seen on recent PET/CT examination. The glenohumeral joint alignment is within normal limits. There is intermediate signal intensity within the posterior superior labrum suggesting degeneration, but we see no fluid-filled tear.BICEPS TENDON: There is mild circumferential enhancement of the tendon sheath of the long head of the biceps tendon representing a tenosynovitis, perhaps an extension of synovitis from the glenohumeral joint. ADDITIONAL

Output: 1. Mild synovitis of the glenohumeral joint with extension of the synovitis along the tendon of the long head of the biceps which corresponds in morphology to the increased uptake seen on recent PET/CT examination.2. Small nonenhancing mass in the teres minor muscle likely represents a ganglion or less likely a benign nerve sheath tumor.3. No findings to suggest metastatic disease or a primary tumor of bone.


Instruction: Generate impression based on findings.

Input: Numbness, headaches. There is no significant interval change in the numerous high T2 signal lesions in the cerebral white matter bilaterally. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: No significant interval change in the numerous intracranial presumed demyelinating lesions.


Instruction: Generate impression based on findings.

Input: Female, 37 years old, with a submucosal mass, approximately 1 cm in size, at the right tonsillar pillar/soft palate. The right palatine tonsil is mildly enlarged relative to the left, measuring up to 16 x 12 mm in the axial plane compared to 15 x 9 mm on the left. At the junction of the right palatine tonsil and soft palate, a 3 mm cystic focus is also identified (see image 35 series 901). The signal intensity of the right palatine tonsil on T1, T2 and diffusion-weighted images is identical to that seen on the left with the exception of the small cystic focus. The pattern of enhancement is also similar to that seen on the left.The aerodigestive mucosa is otherwise unremarkable. No evidence of pathologic adenopathy is detected in the neck. The salivary glands and the thyroid are free of focal lesions. The bone marrow signal characteristics are within normal limits.

Output: Mild asymmetric enlargement of the right palatine tonsil is seen along with a 3 mm cystic focus at the junction of the tonsil with the soft palate. Otherwise, signal characteristics and pattern of enhancement of the right palatine tonsil are identical to those of the left.The differential diagnosis for these findings would include an asymmetrically reactive or inflamed tonsil. A neoplastic process is not excluded, though the lack of a discrete lesion, and lack of any differential enhancement or signal compared to the normal left tonsil, would argue against this possibility.


Instruction: Generate impression based on findings.

Input: Biopsy-proven idiopathic hypertrophic pachymeningitis Again seen is a retroclival mass extends inferiorly through the craniocervical junction to the C1 level. There is no significant change in size compared to 5/30/2015. Mass measures approximately 13 mm in thickness at the level of the medulla similar to prior with near complete effacement of the premedullary cistern. The craniocaudal extent measures approximately 5.4 cm and extends from the dorsum sella to the upper C2 level. No significant change allowing for differences in scanning technique and head position. Also noted is dural based thickening T1-T3 levels which is partially imaged and was present previously.The cervical vertebral bodies are appropriate in height. Alignment is unchanged including mildly exaggerated cervical lordosis, mild retrolisthesis of C4 on C5, and mild anterolisthesis of T2 on T3. Postsurgical changes of posterior spinal fusion are again seen with hardware including lateral mass screws at C3, C4, and C5 and paraspinous rods which extend inferiorly into the upper thoracic spine outside the field-of-view. Hardware may be better assessed by radiographs or CT. Bone marrow signal is within normal limits. The cervical spinal cord has grossly normal signal characteristics and overall morphology with artifact related to susceptibility slightly limiting evaluation. There is mild spinal canal stenosis at the C4-C5 level similar to prior. There is otherwise no significant spinal canal or neural foraminal stenosis in the remainder of the cervical spine. Paraspinous soft tissues aside from postsurgical changes are unremarkable.

Output: Compared to 5/30/2015, there is no significant change in enhancing dural-based retroclival mass which extends from the dorsum sella to the craniocervical junction and effaces the premedullary cistern. Dorsal dural based enhancement involving the upper thoracic spine is again seen and partially imaged.


Instruction: Generate impression based on findings.

Input: Syncope and collapse. Suspicion of seizure-like activity. There are a few punctate T2 FLAIR hyperintense lesions, and scattered in the subcortical white-matter. There is no associated abnormal contrast enhancement or diffusion restriction. There is no acute infarct or mass. There is no mass-effect, midline shift or brain herniation. The ventricles and the other CSF-containing spaces are normal in size. Major intracranial vascular flow voids are preserved. The skull, scalp, and orbits are grossly unremarkable. Partially empty sella has not changed since the previous examination.

Output: Scattered subcortical punctate T2/FLAIR-hyperintense lesions. Similar lesions have been described in patients with migraine. The lesion are otherwise are nonspecific. There is no other intracranial abnormality.


Instruction: Generate impression based on findings.

Input: 68Yrs old female history of IgG Lambda SII multiple myeloma; evaluate for lytic lesions and prep for clinical trial. SKULL: Two views of the skull show numerous lucent lesions, compatible with multiple myeloma, stable from prior exam accounting for positional differences.CERVICAL SPINE: Two views of the cervical spine are provided. Evaluation of the lower cervical spine is limited due to overlying anatomy. The bones appear demineralized, which may reflect diffuse myelomatous involvement. The C2 vertebra appears deformed, which may in part be artifactual related to positioning, however we cannot exclude the possibility of myelomatous involvement or prior trauma. This can be further evaluated with CT or MRI if clinically warranted.THORACIC SPINE: Single view of the thoracic spine is provided. Multiple compression fractures are redemonstrated, most severely affecting the T9 vertebral body. Loss of height of T7 appears to have progressed slightly when compared to the prior study. Severe compression deformities of T4 and T5 are additionally noted. LUMBAR SPINE: Two views of the lumbar spine are provided. The bones appear diffusely demineralized. Multiple compression deformities appear similar to the prior exam, with cement in the L4 vertebral body. Degenerative arthritic changes appear similar to the prior study.RIBS: Rib radiographs demonstrate multiple bilateral rib fractures, most of which appear to be healing or healed, though some are new when compared the prior study and are presumably related to underlying myelomatous deposits. Bone formation along the inferior margin of the scapula bilaterally may represent healing pathologic fractures. Right chest wall port catheter terminates in the right atrium. The lungs are underinflated. Streaky atelectasis is noted in the right mid lung zone.PELVIS: Single view of the pelvis is provided. The bones appear demineralized, perhaps representing widespread myelomatous deposition. Moderate osteoarthritis affects the right hip. Left hip hemiarthroplasty device appears similar to the prior exam. New heterotopic ossification about the lesser and greater trochanters is noted.UPPER EXTREMITY: Right humerus: Two views of the right humerus show small, poorly defined lucencies and endosteal scalloping appearing similar to the prior study, compatible with myelomatous deposits.Left humerus: Two views of the left humerus show small, poorly defined lucencies and endosteal scalloping appearing similar to the prior study, compatible with myelomatous deposits. Lucent lesion of the distal left clavicle also appears similar to the prior study.Right forearm: Single view of the right forearm demonstrates poorly defined lucencies in the radius which may represent myelomatous deposits, appearing similar to the prior exam.Left forearm: Single view of the left forearm demonstrates poorly defined lucencies in the radius which may represent myelomatous deposits, appearing similar to the prior exam.LOWER EXTREMITY: Right femur: Two views of the right femur demonstrate lucent lesions of the femoral diaphysis compatible with myeloma, appearing similar to the prior study. Moderate osteoarthritis affects the right knee.Left femur: Two views of the left femur demonstrate a bipolar hemiarthroplasty device situated in near anatomic alignment without evidence of hardware complication. Small lucent lesions in the distal left femoral diaphysis are consistent with myeloma, appearing similar to the prior study. Moderate osteoarthritis affects the left knee.Right tibia/fibula: Single view of the right tibia/fibula shows tiny poorly defined lucencies which may represent myelomatous deposits, appearing similar to the prior study.Left tibia/fibula: Single view of the left tibia/fibula shows tiny poorly defined lucencies which may represent myelomatous deposits, appearing similar to the prior study.

Output: Findings compatible with widespread myeloma appearing similar to the prior study, with possible progression of thoracic vertebral compression fractures and rib fractures and possible healing scapular tip fractures.


Instruction: Generate impression based on findings.

Input: 77-year-old male with known prostate cancer and history of head and neck cancer presents with altered mental status and negative head CT. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Periventricular white matter T2/FLAIR hyperintense foci are seen, likely representing mild small vessel ischemic disease. Nonspecific T2/FLAIR hyperintense lesion is also seen within the right cerebellum measuring up to 1.0 cm (image 11, series 401). There is no associated enhancement or diffusion restriction. 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.No evidence of acute infarct, intracranial mass or mass effect. No evidence of intracranial metastatic disease. 2.Mild chronic small vessel ischemic disease. Rounded T2/FLAIR hyperintense lesion in the right cerebellar hemisphere is nonspecific and may also represent sequela of prior ischemia or possibly treatment-related injury.


Instruction: Generate impression based on findings.

Input: 4-year-old male with recent seizure-like activity, ex-28 week premature gestation Several sequences are degraded secondary to artifact induced by the patient's ventricular shunt reservoir. Given this caveat:Redemonstrated is a right parietal approach ventriculostomy catheter which crosses the midline with its tip terminating at the lateral aspect of the left lateral ventricle, unchanged in position. There has been interval increase in size of the dysmorphic lateral ventricles. The third and the fourth ventricles are unchanged in size. Left hemispheric dysmorphism is unchanged.A previously demonstrated prominent left extra-axial fluid space which has been becoming more hypodense on CT demonstrates mid intensity on T1, hyperintensity on T2, with diffuse enhancement. This extends to also involve the tentorium and falx, as well as to a lesser extent the right hemispheric dura. Overlying this is a second area of crescentic abnormality measuring up to 6 mm in maximal depth over the parietal-occipital region which is nonenhancing, lower intensity on T1and T2 when compared to the overlying process, yet appearing hyperintense on T1 and T2 compared to CSF.Hemosiderin staining along the epididymal surface of the lateral ventricles is not as well demonstrated as previously. Redemonstrated is residual from germinal matrix hemorrhage. Previously demonstrated hemorrhagic debris in the right occipital horn as well as hemorrhagic foci within the posterior fossa are not visualized secondary to the aforementioned artifact.There is no midline shift or basal cistern effacement. Myelination within the uninvolved brain appears mature. Redemonstrated is thinning of the corpus callosum and volume loss in the white matter.Major intracranial flow voids appear present. Paranasal sinuses are completely opacified. Mastoid air cells and middle ear cavities are clear. Orbital contents are unremarkable.

Output: 1.Redemonstrated is a right parietal approach ventriculostomy catheter which crosses the midline with its tip terminating at the lateral aspect of the left lateral ventricle, unchanged in position. 2.There has been interval increase in size of the dysmorphic lateral ventricles. 3.Diffuse dural enhancement is present, especially notable along the left hemisphere, however also involving the falx, tentorium, and to a lesser extent the right hemisphere. There is a superimposed crescentic abnormality measuring up to 6 mm in maximal depth over the parietal-occipital region which is nonenhancing as described in detail above. The enhancing aspect is most likely secondary to dural reaction from changes of ventricular sizes and intracranial pressures. The nonenhancing crescentic portion most likely represents an evolving hemorrhage within the dura.


Instruction: Generate impression based on findings.

Input: Evaluate for interval changes in HCC ABDOMEN:LIVER, BILIARY TRACT: Centrally located (just above right/main portal vein junction) 2.2 x 1.5 cm right hepatic lesion measuring on image 31 series 100 demonstrates heterogeneous arterial enhancement with subsequent washout. Lesion shows restricted diffusion and increased T2 signal. Additional tiny arterially enhancing focus seen more anteriorly in hepatic segment 8 on image 28 series 10, no corresponding restricted diffusion or washout seen, nonspecific but may be a perfusional anomaly. Hepatic steatosis. 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: Spinal degenerative disease.OTHER: No significant abnormality noted.

Output: Centrally located right hepatic segment 8/7 lesion measuring 2.2 x 1.5 cm, fulfills imaging criteria for hepatocellular carcinoma.


Instruction: Generate impression based on findings.

Input: Reason: eval for scapholunate disassociation History: left wrist pain after trauma LIGAMENTS: There is linear fluid signal intensity within the membranous portion of the scapholunate ligament which may represent a partial thickness tear, but we see no gadolinium traversing the ligament to indicate a full-thickness tear. Similar findings affect the membranous portion of the lunotriquetral ligament, but again we see no gadolinium traversing the ligament indicate a full-thickness tear.TRIANGULAR FIBROCARTILAGE COMPLEX: Gadolinium extends from the radiocarpal joint through a full-thickness perforation of the articular disc of the triangular fibrocartilage near its radial attachment extending into the distal radial ulnar joint.TENDONS: The flexor and extensor tendons appear intact. Gadolinium is identified within the extensor carpi ulnar tendon sheath which is likely iatrogenic.BONES: There is branching signal abnormality and edema within the triquetrum indicating a mildly displaced comminuted fracture. The main fracture plane appears oriented in the coronal plane through the volar aspect of the body of the triquetrum. There is also a mild amount of poorly defined edema type signal within the capitate that may represent a bone contusion.

Output: 1. Triquetral fracture as described above.2. Tear of the articular disc of the triangular fibrocartilage as described above.3. Linear signal abnormality within the scapholunate and lunotriquetral ligaments may represent partial-thickness tears, but we see no gadolinium traversing either ligament to confirm a full-thickness tear.These findings were relayed to Dr. Meislin and by phone at 10:00 AM on 2/3/2016.


Instruction: Generate impression based on findings.

Input: Resected pituitary adenoma in 2007: surveillance. There are postoperative findings related to transsphenoidal surgery. There is a pituitary mass that measures up to 12 mm craniocaudally, previously 15 mm. There is mild mass effect upon the bilateral medial cavernous sinuses. There is no mass effect upon the optic apparatus. The pituitary stalk remains deviated to the right. There is diffuse cerebral volume loss and scattered foci of cerebral white matter T2 hyperintensity.

Output: Interval decrease in size of the pituitary macroadenoma.


Instruction: Generate impression based on findings.

Input: Metastatic head and neck cancer with new brain lesion. There is a presumably ring-enhancing mass that measures up to 12 mm in the left superior frontal gyrus with associated vasogenic edema. There is a defect in the left caudate head, which may represent a chronic lacunar infarct. There are also a few punctate foci of nonspecific T2 hyperintensity in the cerebral white matter. There is no midline shift or herniation. There is no evidence of hydrocephalus. The skull, orbits, and scalp soft tissues are unremarkable.

Output: Limited treatment planning MRI demonstrates a mass that measures up to 12 mm with associated vasogenic edema in the left superior frontal gyrus, which is compatible with metastatic disease.


Instruction: Generate impression based on findings.

Input: Female 15 years old Reason: evaluate for cruciate ligament tear History: right knee injury and pain MENISCI: The posterior and anterior horns of both the medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a focal depression of the lateral femoral condyle near the junction of the weightbearing and nonweightbearing portions with underlying high T2 signal compatible with impaction. There is thinning of the articular cartilage at the area of impaction. Additionally, there is associated high T2 signal in the posterior lateral tibial plateau.LIGAMENTS: High T2 and low T1 signal is evident within the anterior cruciate ligament consistent with an ACL tear. The posterior cruciate ligament is intact. The lateral collateral and medial collateral ligament complexes are normal in signal and morphology.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.High T2 and low T1 signal within the anterior crucial ligament consistent with an ACL tear.2.Contusion and impaction of the lateral femoral condyle with associated high signal in the posterolateral tibial plateau.3.No evidence of meniscal injury.


Instruction: Generate impression based on findings.

Input: Prostate cancer. Staging exam.Additional history per EMR: PSA 2010 2.46 ng/mL, biopsy, Gleason 3+3=6 in four cores with maximum involvement 60%. Active surveillance. March 2011, PSA 3.27, prostate biopsy Gleason 3+3=6 in one core 10%. March 2013, PSA 5.52, prostate biopsy Gleason 3+3=6 in three cores, maximum involvement 20%. October 2014, PSA 8.57 prostate biopsy Gleason 3+4=7 in two cores with maximum involvement 35%. PSA 6/19/2015 was 8.27. PELVIS:PROSTATE:Exam is limited by artifact from right hip prosthesis, markedly degrading diffusion-weighted images.Prostate Size: 5.6 x 4.6 cm.Peripheral Zone: Area of T2 hypointense signal in the left medial mid gland with suggestion of enhancement. This is incompletely evaluated without interpretable diffusion weighted images, though suspicious for patient's known prostatic adenocarcinoma.Central Gland: Marked nodularity and hypertrophy of the central zone without suspicious focal lesion.Seminal Vesicles: Seminal vesicles are unremarkable.Extracapsular Extension: There is no evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Left inguinal, left pelvic sidewall, and left external iliac prominent lymph nodes are noted. Left external iliac node measures 1.9 x 1.3 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited exam due to degradation of diffusion weighted images by artifact related to right hip prosthesis.2.Abnormality in the medial left mid gland is suspicious for patient's known prostatic adenocarcinoma. No evidence of extracapsular extension or seminal vesicle invasion.3.Prominent left inguinal, pelvic sidewall, and external iliac lymph nodes.


Instruction: Generate impression based on findings.

Input: Reason: s/p OLT History: s/p OLT ABDOMEN:LIVER, BILIARY TRACT: Status post hepatic transplant. Patent hepatic vasculature. Of note, there is mild stenosis of the anastomosis of the hepatic artery (1201:191) with minimal poststenotic dilatation - the lumen measures approximately 3 mm. No suspicious hepatic lesion.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: Large amount of blooming artifact inferior to the right kidney of uncertain significance. On prior radiograph a small metallic density was seen in the vicinity.BOWEL, MESENTERY: Large amount of blooming artifact within the stomach may be from Dobbhoff tube tip.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Poststernotomy wires.

Output: 1.Status post hepatic transplant. No suspicious hepatic lesions. Patent hepatic vasculature. Mild hepatic artery stenosis at the anastomotic site as detailed above.


Instruction: Generate impression based on findings.

Input: Chronic myelomonocytic leukemia not having achieved remission [C93.10] / Nontraumatic subarachnoid hemorrhage, unspecified [I60.9] / Transplanted organ and tissue status, unspecified [Z94.9] / Toxoplasmosis, unspecified [B58.9], Reason for Study There is evidence of encephalomalacia on the right parietal lobe superior parietal lobule and right superior and middle frontal gyri indicating chronic ischemic infarct. These lesions are new comparing to prior scan.There is no abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Fluid collections on the right mastoid air cells.

Output: 1. Interval development of right superior and middle frontal gyri as well as right parietal lobe superior lobe middle indicating chronic ischemic infarct.2. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: There has been interval decrease in size and number of enhancing metastatic lesions throughout the brain. For example, a right cingulate gyrus lesion measures 7 mm in diameter, previously 14 mm, and an inferior vermis lesion measures up to 6 mm, previously 12 mm. The degree of associated vasogenic edema has also diminished. Otherwise, a small left parafalcine dural based extra-axial calcified lesion is unchanged. The ventricles and sulci are within normal limits. There is no midline shift. There is no evidence of acute infarction or hemorrhage. There is nonspecific fluid signal in the left mastoid air cells. There is also mild scattered paranasal sinus mucosal thickening. The orbits are unremarkable.

Output: 1. Interval decrease in size and number of the numerous intracranial metastases.2. An unchanged small left parafalcine mass may represent a meningioma.


Instruction: Generate impression based on findings.

Input: 48 year old female with BRCA mutation and family history of pancreatic cancer, presents with abdominal fullness. LIVER, BILIARY TRACT: No suspicious hepatic lesions or biliary ductal dilatation. No filling defects seen within the biliary tree. Patent hepatic vasculature.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology without suspicious lesions. Nondilated pancreatic duct.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: Bilateral breast implants, unchanged.

Output: Unremarkable MRI/MRCP of the abdomen, without any specific findings to suggest pancreatic neoplasm.


Instruction: Generate impression based on findings.

Input: Syncope and collapse, T6 sensory level abnormality. There are partially imaged findings related to posterior fossa decompression and low-lying cerebellum with brainstem compression. The imaged portions of the spinal cord grossly display normal signal and morphology, although motion artifacts limit assessment. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. The imaged portions of the spinal cord appears to be grossly unremarkable, although motion artifacts limit assessment. No evidence of spinal canal stenosis.2. Partially imaged findings related to posterior fossa decompression and low-lying cerebellum with brainstem compression. Please refer to the recent brain MRI report for additional details.


Instruction: Generate impression based on findings.

Input: Altered mental status [780.97], Reason for Study: ^Reason: CVA? History: altered mental status Due to patient incorporation, the exam was prematurely ended. As a consequence, there is no acquisition of gradient echo sequences.There is a focal high signal intensity on diffusion weighted image (series #406, image 200/32), with restricted diffusion on the right precentral gyrus.There is a focal encephalomalacia seen on the left side of upper pons most likely representing previous stroke.Underlying brain shows patch confluent high signal intensity on periventricular white matter on FLAIR images indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Bilateral mastoid air cell show fluid collection.Nonvisualization of right eyeball lens.

Output: 1.Focal acute ischemic infarction, right precentral gyrus as described above.2. Chronic infarction with encephalomalacia seen on the right upper pons with nonspecific small vessel ischemic disease.3. Hemorrhagic lesions cannot be precisely evaluated due to Mr. Gradient-echo sequences, however, there is no other evidence suggesting intracranial acute hemorrhagic lesion on the scan.


Instruction: Generate impression based on findings.

Input: 34 years Male (DOB:12/16/1981)Reason: 3T scanner, CCM Protocol, QSM/permeability; s/p cavernoma resection on 4/8/16. History of prior resections and radiation. History: Bilateral weakness, rt. side numbness, gait problems, double vision, s/p craniotomyPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is redemonstration of a hemorrhagic lesion centered in the left pons but also involving the left middle cerebellar peduncle which currently measures 32 x 41 mm . On the 4/10/2016 exam it measured 38 x 41 mm. When compared to the 4/10/2016 exam a previously noted cystic component along the medial aspect of the lesion has regressed.. A hemorrhagic lesion within the right cerebral peduncle is redemonstrated. There is more susceptibility effect the associated with the current exam versus the prior exam.Another hemorrhagic lesion in the left upper posterior midbrain has also changed character but appears to have less T2 signal hyperintensity centrally slightly less cystic.A high signal intensity lesion on T2 imaging in the left medulla remains stable. T2 signal hyperintensity along the posterior aspect of the left cerebellar hemisphere also remains stableThere is a developmental venous anomaly redemonstrated in the left cerebellar hemisphere inferiorly.The patient is status post suboccipital craniotomy.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus as well as minor opacities in the left ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is redemonstration of multiple cerebral cavernous malformations in the brainstem and cerebellum associated with a left cerebellar developmental venous anomaly. These have mildly changed character and size when compared to the prior exam from 4/10/16.2.Status post posterior fossa surgery.


Instruction: Generate impression based on findings.

Input: Headache after trauma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered foci of cerebral white matter T2 hyperintensity. 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. There is fluid within the right mastoid air cells.

Output: Scattered foci of cerebral white matter T2 hyperintensity are nonspecific, but may represent chronic small vessel ischemic disease. No evidence of acute intracranial hemorrhage, mass, or acute infarct. Fluid in the right mastoid air cells may indicate mastoiditis.


Instruction: Generate impression based on findings.

Input: Female 43 years old Reason: s/p pelvic tumor resection History: s/p pelvic tumor resection. Additional history from EPIC notes; status post retroperitoneal approach resection of sacral mass 03/13/15. PELVIS:UTERUS, ADNEXA: There has been interval hysterectomy. Unremarkable appearance of the bilateral ovaries. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the right anterolateral pelvic wall.OTHER: Postsurgical changes status post resection of presacral mass. There is a 7.1 x 3.7 cm nonenhancing, mixed solid and fluid collection in the presacral space extending along the right internal iliac vessels. The appearance is suggestive of postsurgical hematoma. There is additional perirectal hematoma.There is a 1.7 x 1.6 cm ( series 1405, image 400) T2 isointense/progressively enhancing focus along the right S2/S3 neural foramen nerve root which is consistent with residual tumor.

Output: 1.Postsurgical changes in the presacral space with moderate postoperative hematoma. 2.1.7-cm enhancing focus along the right S2/S3 neural foramen consistent with residual tumor.


Instruction: Generate impression based on findings.

Input: 68 years Female (DOB: 12/22/1947)Reason: Pt with 4-6 week hx of dizziness/lightheadedness, L leg weakness, numbness, spasticity, ? of urinary retention; rule out vessel occlusion, stroke History: Pt with 4-6 week hx of dizziness/lightheadedness, L leg weakness, numbness, spasticity, ? of urinary retention; rule out vessel occlusion, strokePROVIDER NAME: TAO XIE TAO XIE MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are 7 mm enhancing lesions present in each internal auditory canal. These were not present on the exam from 10/20/2014. 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.Incidental note is made of partial empty sella.The visualized portions of the paranasal sinuses demonstrate some minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:There is diffuse leptomeningeal nodular enhancement throughout the thoracic spinal cordThe thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine. There is a mild dextrocurvature to the thoracic spine.There is a 13 mm x 16 mm axial dimension well-circumscribed lesion along the posterior surface of the right lobe of the liver which does not enhance following contrast administration. It is bright on T2 and dark on T1 suggesting it is cystic.Lumbar spine:There is nodular enhancement present within the thecal sac along the conus medullaris, cauda equina and within the full-thickness of the thecal sac at the S2 level. There is enhancement following the sacral exiting nerve roots. There is nerve root enhancement along many of the nerve roots in the cauda equina.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Findings suggest a lesions in the internal auditory canals bilaterally and symmetrically. Given the leptomeningeal enhancement within the spine this is most likely represents leptomeningeal enhancement. These were not present on the exam from 10/20/2014. Please correlate with clinical history. Given the fact that these lesions in the internal auditory canals did not exist in the 2014 exam schwannoma is unlikely.2.There is leptomeningeal disease predominantly involving the thoracic spinal cord, cauda equina and sacral exiting nerve roots. One possibility is that this represents leptomeningeal carcinomatosis. Other differential considerations include granulomatous disorder including sarcoid and tuberculosis.