Instruction: Generate impression based on findings.

Input: Left neck and shoulder pain. Prior cervical spine MRI was attempted on 4/15/2016, which was prematurely terminated due to patient's pain. Examination is mildly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. There is nonspecific heterogeneity of the bone marrow with T1 shortening involving the lower cervical vertebral bodies, possibly related to radiation/radioiodine ablation.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex. No significant compromise to the spinal canal. There is moderate narrowing of the bilateral neural foramina related to uncovertebral hypertrophy and facet arthropathy.C4-5: Minimal disc osteophyte complex and uncovertebral hypertrophy. No significant compromise to the spinal canal. Mild right and mild to moderate left neural foraminal narrowing.C5-6: There is a small disc osteophyte complex including a left foraminal disc extrusion. No significant compromise to the spinal canal. There is moderate left neural foraminal narrowing and mild right neural foraminal narrowing. C6-7: Minimal disc osteophyte complex. Mild to moderate narrowing of the left neural foramen. No significant spinal canal or right neural foraminal narrowing. C7-T1: No significant compromise to the spinal canal. Moderate narrowing of the neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine without significant spinal canal stenosis at any level. Motion degradation limits optimal evaluation, however there is neural foraminal narrowing at multiple levels, particularly on the left as detailed above.


Instruction: Generate impression based on findings.

Input: 91 years, Female, intracranial mass on head CT. Evaluate for abscess versus neoplasm.. There is a 2.2 x 2.2 x 2.0 cm (AP x transverse x craniocaudal) mass with nodular peripheral enhancement and central necrosis involving the lateral aspect of the right middle frontal gyrus. There is extensive surrounding FLAIR hyperintensity consistent with vasogenic edema. There is mild restricted diffusion involving the peripheral aspect of the lesion. No central restricted diffusion to indicate pus. There are punctate foci of susceptibility along the peripheral aspect of the lesion compatible with microhemorrhages. There is local mass effect with mild sulcal effacement as well as mild effacement of the right lateral ventricle. There is minimal leftward midline shift measuring 3 mm at the foramen of Monro.There is a 5 mm lesion with peripheral enhancement and minimal associated edema involving the left anterior middle frontal gyrus. There is also a 5 mm lesion involving the left paramedian parietal lobe.There is a punctate focus of susceptibility likely indicating chronic microhemorrhage in the right anterior frontal lobe and nonspecific. Patchy T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter is nonspecific but compatible with chronic small vessel ischemic disease.No hydrocephalus. No extra-axial collections. Major flow-voids are preserved. Sella and orbits are grossly unremarkable. There is minimal scattered paranasal sinus mucosal thickening. Calvarium and extracranial soft tissues are also grossly unremarkable.

Output: 2.2x2.2x2.0 cm mass in the right frontal lobe with peripheral nodular enhancement as well as 5 mm left frontal and left parietal lesions are highly suspicious for metastatic disease. Imaging features are not compatible with pyogenic abscesses although atypical infection may be considered in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: cT1N0 squamous cell carcinoma of the left lateral tongue.. There is a left lateral oral tongue enhancing lesion that measures up to approximately 5 mm in depth, 18 mm in length, and 18 mm in height. There is no evidence of extension into the tongue base or mandible. There is no evidence of significant suprahyoid lymphadenopathy. The salivary glands are unremarkable. The orbits are also unremarkable. There are bilateral retropharyngeal carotid arteries. There is minimal scattered paranasal sinus mucosal thickening. There is periventricular cerebral white matter T2 hyperintensity and partially-imaged right frontal encephalomalacia. There is multilevel degenerative spondylosis, with apparent indentation of the spinal cord at C6-7.

Output: 1. A left lateral oral tongue squamous cell carcinoma measures up to approximately 5 mm in depth, 18 mm in length, and 18 mm in height. 2. No evidence of significant suprahyoid lymphadenopathy. 3. Partially-imaged right frontal lobe chronic infarction.4. Multilevel degenerative spondylosis, with apparent indentation of the spinal cord at C6-7.


Instruction: Generate impression based on findings.

Input: Right lumbar radicular pain for several weeks. The most superior nonrib-bearing vertebral body is labeled as L1. There are hypoplastic ribs associated with the T12 vertebral body. There are 4 lumbar type vertebral bodies and a fifth sacralized transitional segment labeled S1 for the purposes of this study. Vertebral body heights are within normal limits. There are multiple small Schmorl's nodes, relatively more prominent at the inferior T11 and superior inferior L1 endplates. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Mild multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge without significant spinal canal stenosis. There is mild left and minimal right neural foraminal stenosis. L3-L4: Mild disc bulge with small central protrusion, ligamentum flavum thickening, and mild to moderate facet arthropathy without significant central spinal canal stenosis. There is partial effacement of the lateral recesses and mild left worse than right neural foraminal stenosis.L4-S1: Disc bulge with small central protrusion, ligamentum flavum thickening, and mild to moderate facet arthropathy. There is partial effacement of the lateral recesses without significant central spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.S1-S2: No significant disc disease, spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Mild multilevel degenerative changes as described above without significant central spinal canal stenosis at any level. There is mild or mild to moderate neural foraminal stenosis at multiple levels. No higher grade foraminal stenoses is appreciated.2. Transitional lumbosacral junction anatomy as described above with four lumbar type vertebral bodies.


Instruction: Generate impression based on findings.

Input: Knee injury, swelling. MENISCI: There is a complex tear with both vertical and horizontal components of the posterior horn and posterior aspect of the body of the medial meniscus. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is denuding of the articular cartilage of the lateral patellar facet with underlying subchondral edema which extends to the median eminence. There is significant thinning of the articular cartilage of the femoral trochlea with a region of full-thickness cartilage loss. There is complete loss of articular cartilage of the anterior and near-complete loss of the weight-bearing portion articular cartilage of the lateral femoral condyle up to above the posterior horn of the lateral meniscus. There is thinning of the posterior articular cartilage of the lateral femoral condyle. There is complete loss of the cartilage of the weight-bearing portion of the medial femoral condyle above the posterior horn with significant thinning of the remaining articular cartilage. Additionally there is complete loss of articular cartilage of the medial tibial plateau from the mid to posterior portions. Tricompartmental osteophytes are noted.There is increased T2 signal within the posterior medial tibial plateau with a linear component of low T1 and T2 signal which most likely represents a insufficiency fracture with surrounding edema. LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Insufficiency fracture of the medial tibial plateau.2. Complex tear of the medial meniscus.2. Chondromalacia is described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other disorders of facial nerve Unspecified abnormal involuntary movements Occlusion and stenosis of basilar arteryClinical question: Pt with multiple abnormal involuntary movements resembling hemifacial spasm, hemiballismus, tremorSigns and Symptoms: Pt with multiple abnormal involuntary movements resembling hemifacial spasm, hemiballismus, tremor MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain: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.The right AICA is duplicated. The right AICA meatal loop is readily identified in the right internal auditory meatus and originates from the superior origin of the right AICA. Together the AICA branches are dominant over the PICA. The left PICA is dominant. There is no evidence for intracranial aneurysm or cerebrovascular occlusion.There is no major artery abutting the trigeminal nerves.The anterior communicating artery is identified and is medium size. The left posterior communicating is very small. There is fetal origin of the right PCA. The right P1 segment is tortuous and small. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.MRI of the brain is within normal limits. No abnormal enhancing mass lesions are appreciated in the brain or skull base to explain hemifacial spasm.4.No arterial loop is identified to explain hemifacial spasm.


Instruction: Generate impression based on findings.

Input: Lumbar pain, leg pain, evaluate for spinal stenosis or nerve entrapment. Ataxia. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. There is mild diffuse heterogeneity of the bone marrow signal without discrete destructive osseous lesions. Small foci of T1 hyperintensity such as at L3 are compatible with foci of fat or small hemangiomas. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation with small right annular fissure and right foraminal disc protrusion. There is mild narrowing of the right neural foramen with contact of the right L4 nerve root without clear evidence of impingement. No spinal canal or left neural foraminal narrowing. Mild bilateral facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Mild degenerative changes in the lumbar spine including a small right foraminal disc protrusion at L4-L5 with mild right neural foraminal narrowing. Otherwise no significant spinal canal or neural foraminal stenosis in the lumbar spine.2. Mild facet arthropathy in the lower lumbar spine at L4-5 and L5-S1, which may be contributing to patient's low back pain. 3. Diffuse heterogeneity of the bone marrow signal which is nonspecific and can be seen with marrow reconversion related to chronic illnesses, anemia, and marrow proliferative disorders among various other etiologies. No discrete suspicious osseous lesion is demonstrated.


Instruction: Generate impression based on findings.

Input: Clinical question: History of GBM, status post chemotherapy RT, surveillance MRI. Signs and symptoms: None. Pre and postcontrast enhanced brain MRI:Negative diffusion-weighted images.Examination demonstrates significant interval improvement in postoperative changes of a large right anterior frontal and temporal craniotomy since prior exam.There is interval complete resolution of subgaleal CSF density collection over the craniotomy flap likely secondary to CSF leakage since prior exam. Extra-axial serosanguineous collection along the inner table of the surgical flap in the right frontal lobe is within expected postop change and measures approximately at maximum of 9.5 mm thickness. There is also overlapping pleural thickening with enhancement also within expected postop change.A well-demarcated CSF signal intensity surgical cavity in the right anterior/inferior frontal lobe measures approximately at 33 x 61 mm and with interval decreased size since prior study.There is mild surrounding FLAIR hyperintensity suggestive of residual edema or gliosis.There is a thin and uniform enhancement of the surgical cavity wall with significant interval improvement since prior exam. There is no convincing evidence of residual tumor on this exam at this time. Further follow-up is needed to exclude recurrence.Lateral ventricles are slightly prominent however without interval change or deviation of the midline. Revisualization of a chronic retention cyst in the sphenoid sinus.

Output: 1.No acute intracranial process.2.Interval improvement of postoperative changes of right anterior frontal lobe with decreased size of surgical cavity and interval decreased enhancement along the surgical cavity wall as detailed above. No convincing evidence of residual tumor.3.Interval complete resolution of right frontal subgaleal fluid collection over the craniotomy flap since prior study.4.Epidural collection along the inner table of craniotomy flap measuring maximum of 7.5 mm in thickness. Overlapping dural thickening with enhancement which is inseparable from the surgical cavity.


Instruction: Generate impression based on findings.

Input: Other speech disturbance(784.59)Clinical question: stroke?Signs and Symptoms: right side weak MRI of the brainThere is a 16x8mm axial dimension focus of diffusion restriction in the left pons associated with T2 and FLAIR signal hyperintensity.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain: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 70% stenosis at proximal portion of the intracranial RVA.There is 65% stenosis at the distal opthalmic segment of the RICA.There is 50% stenosis at the distal opthalmic segment of the LICA.There is 40% narrowing of the left PCA at the p2 segment.There is 67% stenosis of the right PCA at the p2 segment.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are tiny. The left vertebral artery is larger than right right vertebral artery.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 left vertebral artery. There is high grade stenosis at the origin of the right vertebral artery.The right vertebral artery is smaller than the left vertebral artery.

Output: 1.Acute infarction along the left pons.2.There is high grade stenosis at the origin of the right vertebral artery.3.There is 70% stenosis at proximal portion of the intracranial RVA.4.There is 65% stenosis at the distal opthalmic segment of the RICA.5.There is 50% stenosis at the distal opthalmic segment of the LICA.6.There is 67% stenosis of the right PCA at the p2 segment.7.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 49-year-old female presenting for bracketed preoperative needle localization for right breast cancer. On review of the prior studies, disease on MRI spreading almost 40 mm is visualized about 3.5 cm from the nipple. Target mixed calcifications morphology are located in the right breast in the upper inner quadrant region located in mid-breast 1 o’clock. A bracketed needle localization is performed. The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The right breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, two 7 cm Kopans needle was placed adjacent to the lesion, one anteriorly and one posteriorly. On orthogonal mammography, adequate positioning of the needles were confirmed after adjusting depth so the needle tip was approximately 2cm deep to the centers of the targets. A spring wire was then deployed through each needle. Repeat two view orthogonal mammograms reveal the spring wires to be in adequate position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Drs. Nagaraju and Tremblay performed the procedure under direct supervision of Dr. Abe, who was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the calcifications and clip and spring wires to be within the specimen. Dr. Jaskowiak excised more superolateral tissue (not imaged).

Output: Successful bracketed needle localization of the right breast calcifications.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 72-year-old male status post transphenoidal hypophysectomy. There is no evidence of intracranial hemorrhage or edema. Reidentified is a large, pituitary macroadenoma with extensive expansion of the sella and invasion of the sphenoid sinus and clivus which appears to be overall slightly smaller in size when compared to be presurgical MRI. There is no extension into the pre-pontine cistern There is bilateral involvement of the cavernous sinuses. There is significant extension of the tumor into the basal cistern.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. The paranasal sinuses and sphenoid sinus demonstrate opacification and air fluid levels which may be consistent with postsurgical blood and or packing material.

Output: Expected postsurgical changes as described above.


Instruction: Generate impression based on findings.

Input: 70-year-old female with recent mammogram without evidence of disease but with right-sided breast pain requesting MRI There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: History of recurrent squamous cell carcinoma of the right face involving the parotid gland. There are postoperative findings related to right parotidectomy with flap reconstruction. There is tumor along the right trigeminal nerve in the parapharyngeal space. The tumor measures up to approximately 30 mm in length and 7 mm in width. The tumor extends towards the foramen ovale, but there is no definite intracranial extension. There are denervation changes in the right masticator muscles. There are bilateral lens implants. There is no evidence of significant cervical lymphadenopathy. There is a chronic left basal ganglia infarct.

Output: Postoperative findings related to right parotidectomy with flap reconstruction with evidence of perineural tumor spread along the right trigeminal nerve into foramen ovale and associated right masseter muscle denervation. However, characterization is limited due to the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsionsClinical question: posterior circulation occlusionSigns and Symptoms: altered mental status MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small focus of encephalomalacia along the right inferior lobule. There is T2/FLAIR signal hyperintensity associated with local volume loss within the subcortical white matter of the left inferior parietal lobule.There is a small focus of signal loss on SWI within the right temporal lobe adjacent to the temporal horn of the right lateral ventricle. It measures 1.5mm on T2 imaging. There is an adjacent venous structure suspected to represent DVA draining into the right lateral atrial vein.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 small. There is triplication of the ACA. The posterior communicating arteries are small. The vertebral arteries are asymmetric in size. The right vertebral artery is significantly larger than the left vertebral artery. There is extra-cranial origin of the left PICA.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is a small focus of encephalomalacia along the right inferior parietal lobule. One possibility is that this is related to a vascular insult.4.There is an old microhemorrhage in the right temporal lobe. This is associated with a DVA. The lesion is too small to characterize further on this exam.5.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Female 69 years old Reason: diminished ROM History: pain in the shoulder. ROTATOR CUFF: There is a full thickness tear of the distal fibers of the supraspinatus tendon, with retraction of the tendon fibers to beneath the distal clavicle. The tear measures approximately 1.0 cm in the AP dimension. There is mild to moderate fatty atrophy of the supraspinatus muscle. Mild tendinosis affects the infraspinatus tendon with possibly a small undersurface tear at its insertion. There is minimal fatty atrophy along the myotendinous junction. The teres minor tendon and muscle appear normal. There is thickening and increased signal intensity of the distal subscapularis tendon indicating tendinosis and, perhaps, undersurface fraying at its insertion. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: There is mild to moderate osteoarthritis of the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid in the glenohumeral joint with extension into the subscapularis recess. There is also fluid anterior to the subscapularis tendon, suggesting a subcoracoid bursitis. The glenoid labrum appears normal for age. Mild osteoarthritis affects the glenohumeral joint.BICEPS TENDON: There is increased signal intensity within the tendon of the long head of the biceps compatible with mild tendinosis. The tendon also appears perched on the lesser tuberosity, which may reflect pulley dysfunction. There is a small amount of fluid in the biceps tendon sheath of questionable significance.

Output: 1.Full thickness tear of the supraspinatus tendon and an additional rotator cuff tendinosis as described above.2.Degenerative arthritic changes of the acromioclavicular and glenohumeral joints.3.Tendinosis of the long head of the biceps and other findings as described above.


Instruction: Generate impression based on findings.

Input: Female 57 years old; Reason: Question of meniscal injury. History: Knee pain s/p fall MENISCI: There is increased signal within the inner fibers of the lateral meniscus extending to the free edge/undersurface of the meniscus suggestive of degenerative fraying/tearing which may not be of any current clinical significance. No fluid-filled defect or other abnormality is seen to suggest an unstable meniscal tear.ARTICULAR CARTILAGE AND BONE: There is moderate to severe loss of the articular cartilage along the patella, particularly at the medial facet where there are areas devoid of cartilage. Focal near-full-thickness to full-thickness cartilage defects are also seen along the inferior aspect of the medial and lateral trochlear facets with associated underlying bone marrow reactive changes. There is focal degeneration of the articular cartilage of the lateral tibial plateau, beneath the free edge of the posterior horn of the lateral meniscus. The articular cartilage of the medial compartment appears normal for the patient's age. We see no fracture. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Findings compatible with hematomas in the anterior subcutaneous fat of the knee.2. Cartilage degeneration as described above.3. Possible degenerative tearing/fraying at the inner edge of the body of the lateral meniscus, which may not be of any current clinical significance. No fluid-filled defect or other abnormality is seen to suggest an unstable meniscal tear.


Instruction: Generate impression based on findings.

Input: Clinical question: History of follicular lymphoma are the brain status post 4 cycles of MTR in need of restaging. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates a slight prominence of cortical sulci and the supratentorial ventricular system without interval change since prior MRI exam from Michigan state University dated 12 -- 10 -- 14. Nonspecific band of flair hyperintensity surrounding the periventricular white matter without enhancement or interval change since prior exam is noted. Signal intensity of brain parenchyma is otherwise unremarkable.Post-enhanced images demonstrate no detectable abnormal parenchymal, leptomeningeal or calvarial enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses, mastoid air cells and bilateral middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Negative diffusion weighted images.2.Mild prominence of supratentorial ventricular system for age with a surrounding nonspecific thin band of flair hyperintensity without enhancement. Finding could represent post treatment change.3.Unremarkable pre-and post enhanced brain MRI otherwise.4.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.5.No appreciable interval change since prior brain MRI exams from Michigan state University dated 12 -- 10 -- 14


Instruction: Generate impression based on findings.

Input: New right pronator drift. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are are a few unchanged scattered foci of T2 hyperintensity and susceptibility effect in the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are retention cysts in the right sphenoid and left ethmoid sinuses, as well as in the nasopharynx.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. A few unchanged scattered foci of T2 hyperintensity and susceptibility effect in the cerebral white matter may represent chronic small vessel ischemic disease and chronic microhemorrhages, respectively.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 13 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of Marcaine, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 0:39 minutes

Output: Successful fluoroscopically guided contrast injection of the right hip with MRI to follow.


Instruction: Generate impression based on findings.

Input: right hip septic arthritis status post surgical drainage and IV antibiotics. There is a small amount of fluid signal intensity anterior to the right femoral head and deep to the the tensor fascia lata and iliopsoas muscles which demonstrates enhancement on postcontrast images which is compatible with postsurgical change. The right hip joint effusion seen on the previous study has resolved but there is persistent enhancement of the synovium which is not unexpected. There is high T2 and low T1 signal within the posterior acetabulum on the right which has not progressed in size since the previous exam, this area has abnormal enhancement on postcontrast images. Mild enhancement is also seen along the medial aspect of the right acetabulum and the lateral aspect of the obturator internus muscle although this has improved markedly compared to the prior exam.The remaining osseous structures are within normal limits for the patient's age.There is no pelvic free fluid. No evidence of bowel obstruction.

Output: 1.Resolution of the right hip effusion status post surgical drainage. There is persistent synovial enhancement which is not unexpected given the history of septic joint and surgical intervention.2.Osteomyelitis of the posterior right acetabulum appears similar to the previous exam, clinical correlation is needed as imaging finding may lag behind clinical response. 3.Edema and subperiosteal fluid medial to the acetabulum on the right have improved.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 4 y/o ex-26 week M with no significant PMH who presents with new onset seizure without any inciting factors on history and without concern on physical examination. Please evaluate for structural brain abnormality, mass, or evidence of prior insult History: first time seizure lasting 8 minutes per parental report, sounds generalized tonic clonic per history. Brain parenchyma appears within normal limits. There is mild prominence of the perivascular spaces in the periatrial region which is a normal variation. There is minimal nonspecific FLAIR hyperintensity in the adjacent posterior periventricular white matter. There is no significant parenchymal signal abnormality. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There is moderate opacification throughout the paranasal sinuses. There is also diffuse right mastoid opacification. Bone marrow signal and extracranial soft tissues are otherwise within normal limits.

Output: 1. Brain parenchyma appears within normal limits. Specifically, no findings to suggest seizure focus are appreciated.2. Diffuse opacification of the paranasal sinuses as well as the right-sided mastoid air cells, which can be correlated with clinical findings.


Instruction: Generate impression based on findings.

Input: Disorientation, unspecified [R41.0], Reason for Study: ^Reason: R/O CNS lymphoma History: HIV patient with AMS Especially post contrast scans' image quality are significantly degraded due to motion artifact. No evidence of acute ischemic or hemorrhagic lesion.Minimal high signal intensities on bihemispheric periventricular white matter and minimal brain atrophy are seen which are non specific. The FLAIR/T2 high signal intensity lesions are not confluent nor mainly located on deep white matter. Comparing to prior scan, there is no significant interval change. 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 mastoid air cells are clear.Sphenoid sinus shows mucosal thickening.

Output: Unchanged non specific periventricular white matter FLAIR high signal intensity with minimal to mild diffuse brain atrophy since prior scan.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: Spasticity. Signs and symptoms: Spasticity. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrate normal signal intensity of brain parenchyma on all MRI sequences. Post enhanced images demonstrate no detectable abnormal enhancement of brain parenchyma or the leptomeninges.There is uniform slight prominence of cortical sulci for patient's stated age which could be within upper limits of normal. Unremarkable ventricular system, CSF spaces and brain myelination otherwise.There is normal visualization of signal void of major intracranial arterial branches.The signal intensity of intracranial venous sinuses is within normal and the normal pattern of enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium, soft tissues of the scalp and without abnormal enhancement.Moderate size retention cyst in the right maxillary sinus and minute ethmoid sinus disease is noted.Pre- and post enhanced cervical MRI:Examination demonstrates unremarkable signal intensity of vertebral column and within normal anatomical alignment.There is mild degenerative disc disease throughout the cervical spine however without evidence of central spinal stenosis at any level.Degenerative changes however results in mild left neural foraminal compromise at C3-C4, moderate neural foraminal compromise on the right at C4-C5 moderate right and mild left neural foraminal compromise at C5-C6, mild neural foraminal compromise on the left at C6-C7.On post enhanced images there is no detectable abnormal enhancement of the cord, leptomeninges or the vertebral column.Pre- and post enhanced thoracic MRI:There is unremarkable signal intensity of vertebral column and within normal anatomical alignment.There is normal signal intensity and caliber of the thoracic cord.There is no evidence of spinal stenosis or definitive evidence of neural foraminal compromise at any level.There is no detectable abnormal enhancement of the vertebral column, thoracic cord or the leptomeninges.There is exaggerated left ligamentum flavum hypertrophy at T3 level with partial effacement of the dorsal subarachnoid space however without mass effect on the cord or central spinal stenosis.

Output: 1.Pre- and post enhanced brain MRI is unremarkable. Please see above comments.2.Pre-and post enhanced cervical MRI demonstrate mild degenerative changes without spinal stenosis however with neural foraminal compromise as detailed per level above. Normal signal intensity and caliber of cervical cord. No detectable abnormal enhancement of vertebral column, cord or the leptomeninges.3.Pre and post enhanced thoracic MRI demonstrate normal signal intensity and caliber of thoracic cord without abnormal enhancement. Mild degenerative changes without spinal stenosis or neural foraminal compromise at any level. No detectable abnormal enhancement of the vertebral column.


Instruction: Generate impression based on findings.

Input: 61 years, Female, history of ALL undergoing clinical trial with new complaints of headaches Compared to prior examination from 14/2016, there has been interval development of leptomeningeal enhancement involving the sulci of the left occipital and temporal lobes. There is also dural thickening and enhancement along the left temporal and occipital convexities. There is corresponding diffusion hyperintensity. There is abnormal T2/FLAIR hyperintensity involving the adjacent cortex as well as nonsuppression of CSF on the FLAIR sequences. There is no intracranial mass effect, midline shift, or herniation. Ventricles are not significantly changed in size since prior. There is patchy FLAIR hyperintensity involving the bilateral frontoparietal white matter which has mildly increased when compared to the prior available FLAIR sequence from 1/13/2016 and likely represents treatment-related change. No evidence of acute ischemia or hemorrhage. There is heterogeneity of the bone marrow which is nonspecific and may be related to known leukemia. No destructive calvarial lesions are appreciated. There is moderate mucosal thickening involving the right maxillary sinus with fluid levels and frothy secretions which may represent acute sinusitis in the appropriate clinical setting. There is minimal mucosal thickening elsewhere in the paranasal sinuses.

Output: 1. Compared to prior exam from 1/14/2016, there has been interval development of abnormal leptomeningeal as well as dural enhancement in the left temporal and occipital lobes. Finding is favored to represent neoplastic meningeal infiltration, presumably from known leukemia. Inflammatory/infectious process seems less likely but can be correlated with CSF analysis.2. Slight increase in FLAIR hyperintensity involving the frontoparietal white matter likely representing posttreatment change.3. Moderate mucosal thickening involving the right maxillary sinus with fluid levels and frothy secretions, which may represent acute sinusitis in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: History of portal vein thrombosis. Interval follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma has normal signal. No evidence of hepatic steatosis. There is abnormal morphology with hypertrophy of the right hepatic lobe, possibly related to chronic portal vein thrombosis. No focal suspicious parenchymal lesion.Similar to prior, the main portal vein is thrombosed. There are small intrahepatic portal vein branches indicating some residual flow through collateralization/cavernous transformation.No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Marked splenomegaly with the spleen measuring 17.8 cm in length.PANCREAS: The pancreas is mildly atrophic, but maintains normal signal. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. No focal mass lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are multiple prominent gastroesophageal varices as well as splenorenal shunt collaterals.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: 1.Findings compatible with thrombosis of the main portal vein with cavernous transformation appearing similar to prior.2.Sequela of portal hypertension including marked splenomegaly, gastroesophageal varices formation, and prominent splenorenal shunt collateral veins.


Instruction: Generate impression based on findings.

Input: 3 week old with hematoma and subdural bleed after birth. There is no evidence of residual intracranial hemorrhage. There is no evidence of intracranial mass or acute infarct. The brain parenchyma, brainstem, cerebellum, and pituitary gland appear unremarkable. There is a normal degree of myelination. 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. However, there is bilateral tympanomastoid fluid.

Output: 1. No evidence of residual intracranial hemorrhage.2. Nonspecific bilateral otomastoid effusions.


Instruction: Generate impression based on findings.

Input: There is an approximately 1.5 cm area of abnormal signal within the left precentral gyrus which exhibits increased signal on DWI images, isointense signal on ADC images, and increased signal on T2 images in pattern consistent with subacute infarction. There are additional punctate foci of increased DWI signal and decreased ADC signal compatible with acute microinfarctions within the superior paramedian pons, left middle cerebellar peduncle, left cerebellar hemisphere, and right ventral medulla. There is a small focus of chronic infarction within the right head of the caudate and anterior limb of the internal capsule with associated susceptibility artifact likely reflecting a small amount of mineralization and/or chronic blood products. There is additional confluent increased T2 signal within the bilateral periventricular and subcortical white matter compatible with moderate chronic small vessel ischemic changes. There is mild prominence of the ventricles including mild ex vacuo dilatation of the right lateral ventricle as well as prominence of the cortical sulci compatible with mild cerebral volume loss. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The vertebral artery flow voids appears slightly diminutive which may reflect atherosclerotic disease. Incidental note is made of a partially empty sella. Incidental note is made of hyperostosis frontalis interna. There is an approximately 1.6 x 1.0 cm lesion within the left frontal skull which displays decreased T1 signal, decreased T2 signal, and enhancement. There is a subcentimeter round lesion along the right anterior aspect of the falx without associated significant mass effect which demonstrates intrinsic T1 hyperintensity, possible mild enhancement, and susceptibility artifact which may be related to dural calcification or tiny meningioma.There is abnormally increased T2/FLAIR signal within the left globe, a fluid level within the posterior aspect of the left globe indicative of an effusion, and susceptibility artifact within the left globe reflecting mineralization or prior blood products. These findings may all be related to chronic retinal detachment.

Output: 1.Multifocal infarcts of different ages including acute, subacute, and chronic, as described above, including subacute infarct involving the left precentral gyrus and more acute microinfarcts within the superior paramedian pons, left middle cerebellar peduncle, left cerebellar hemisphere, and right ventral medulla. 2.Slightly diminutive flow voids within the intracranial vertebral arteries which may be related to atherosclerotic disease and could be further assessed with MRA or CTA if clinically indicated.3.Nonspecific 1.6 x 1.0 cm enhancing left frontal skull lesion. Comparison with prior outside examinations may be helpful.4.Incidental note of subcentimeter nodule in right parafalcine region which lacks mass effect and which may represent dural calcification or a tiny meningioma.Discussed with BURNS, MATTHEW at 11:50 a.m. on 9/11/2015.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: AMS; eval for leptomeningeal spread; NSCLC w mets to brain s/p recent stereotactic brain XRT History: see above There are a couple of focal enhancing lesion on the left posterior temporal lobe which are new lesions not seen on Apr 5 2016.Right frontal white matter lesion (series 12, image 9), right middle frontal gyrus (series 12, 7) image are seen, unchanged since prior scan.The right occipital intraaxial mass which abuts dura shows interval decrease in size since prior scan.  Patchy FLAIR high signal intensities on periventricular white matter indicating non specific small vessel ischemic lesions are seen, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval development of new nodular enhancing lesions on the left posterior temporal lobe.2. Interval decrease in size of the right occipital lobe lesion since prior scan.3. Small nodular enhancing lesions at the right frontal lobe do not show any significant interval change.


Instruction: Generate impression based on findings.

Input: 84-year-old male with bilateral neuropathy, primarily RLE weakness and R foot drop. Also fatigue. History of lymphoma with RChop therapy in 2013. No radiation. History of RA. Evaluate for lumbosacral plexopathy, with particular interest of the right, although there is bilateral neuropathy on the EMG. The exam is significantly limited by motion artifact. Please refer to the recent previous dedicated lumbar spine MRI for characterization of the lower lumbar spine levels. The right L4 nerve root is again seen and somewhat thickened and ill-defined compared to the left side which is unchanged. The configuration of the right sacral foramina and bony central spinal canal involving the upper to mid L4 level is similar prior exams, with slight expansion on the right, likely developmental. There is no definite abnormal enhancement or mass involving the lumbosacral plexus.

Output: No abnormal enhancement or mass involving the lumbosacral plexus. Please refer to the recent previous lumbar spine MRI performed on 8/16/2016 for level by level characterization of the lower lumbar spine.


Instruction: Generate impression based on findings.

Input: There is an unchanged expanded-empty sella without evidence of mass lesions. The pituitary gland is markedly flattened along the superior aspect of the sella. The pituitary stalk lies in the midline. The optic apparatus and cavernous sinuses are intact. There are prominent arachnoid granulations in the left middle cranial fossa, into which the inferior temporal lobe slightly protrudes. There is a subcentimeter cystic lesion in the posterior nasopharynx, which may represent a retention cyst or Thornwaldt cyst.

Output: Unchanged enlarged partially-empty sella and prominent left middle cranial fossa arachnoid granulations, into which the left inferior temporal lobe slightly protrudes, may be manifestation of pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Male, 57 years old. Right shoulder pain. Evaluate for proximal biceps pathology. ROTATOR CUFF: There is a focus of increased signal in the supraspinatus muscle likely representing a intramuscular ganglion or sentinel cyst. This likely represents a laminar tear without evidence of retraction. There is intermediate signal within the supraspinatus tendon which likely represents tendinosis. There is no evidence of a full thickness tear. The remainder of the rotator cuff appears intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears grossly normal. The glenohumeral joint alignment is within normal limits.BICEPS TENDON: The biceps tendon is unremarkable. ADDITIONAL

Output: Laminar tear of the supraspinatus with an intramuscular ganglion or a sentinel cyst. No evidence of retraction or full-thickness tear of the rotator cuff.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with epidural abscess status post debridement. Thoracic:Evidence of laminectomy is seen on one side or the other at most levels in the thoracic spine. The posterior operative soft tissues are edematous and tracking fluid is evident through the subcutaneous surgical plane most notably in the lower cervical and upper thoracic regions.On comparison with the preoperative examination, the extensive ventral epidural collection has significantly decreased in size. In most areas the collection has completely or nearly completely resolved. There is no longer any significant thecal sac encroachment or displacement of the spinal cord. No cord signal abnormality is detected.A deep concavity of the T12 superior endplate is unchanged. Vertebral body heights are otherwise preserved. Spinal alignment is anatomic. No evidence of marrow replacement or marrow edema is seen. No significant compromise of the spinal canal or neural foramina is noted. Scattered mild areas of disc degeneration are seen.Lumbar:The previously seen posterior fusion instruments at L4-5 have been removed, though the intervertebral device remains in place at this level. The large left paraspinal fluid collection that had previously encompassed the fusion instruments has nearly completely resolved. There remains a very small collection of fluid spanning the left L4-5 laminectomy bed which measures approximately 3 cm in length and approximately 1 cm in width when measured in the axial plane. This collection does extend into the lateral and ventral epidural space at L4-5 where it continues to narrow the thecal sac, but the degree of narrowing has improved.Evidence of laminectomy is seen on the left at L2 and on the right at L1. The epidural collection seen previously throughout the lumbar spine has improved though a predominately ventral collection does persist from L1 down to L3 measuring up to 9 mm in thickness. The thecal sac is narrowed but to a much lesser degree than on the prior examination.Spinal alignment is anatomic. Vertebral body heights are preserved. Endplate signal changes at L4-5 are again seen which may be postoperative in nature. No significant disc degeneration is detected. Apart from narrowing caused by epidural fluid, there is no additional superimposed spinal canal or foraminal stenosis.

Output: Postoperative findings are seen compatible with removal of posterior fixation instruments at L4-5 and multilevel laminectomy for debridement of a large epidural abscess involving a majority of the spine. In the thoracic region, this epidural collection has completely or nearly completely resolved. In the lumbar spine, some residual epidural fluid persists, for example ventrally from L1 through L3. In addition, there remains a small fluid collection within the left laminectomy defect at L4-5 which extends into the lateral and ventral epidural space causing encroachment on the thecal sac. Both these areas of epidural fluid in the lumbar spine have significantly improved when compared to the preoperative examination.


Instruction: Generate impression based on findings.

Input: Male, 60 years old. Pain. ROTATOR CUFF: There is mild to moderate tendinopathy of the supraspinatus tendon without discrete tear identified. The infraspinatus and teres minor tendons and muscles are intact. Mild tendinopathy affects the subscapularis tendon. The subscapularis muscle is intact. There are small subchondral cysts at the humeral head.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is marked small subchondral cysts within the inferior aspect of the glenoid both anteriorly and posteriorly. Internal signal involving the inferior labrum is consistent with degeneration.BICEPS TENDON: The tendon of the long head of the biceps is visualized within the bicipital groove, but it is not visualized in the rotator interval, compatible with a tear. ADDITIONAL

Output: 1.Nonvisualization of the long head biceps in the rotator interval, compatible with a tear.2.Rotator cuff tendinopathy particularly involving the supraspinatus and subscapularis tendons, without discrete tear identified.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other disorders of orbitClinical question: New headaches and outside CT scan suggests mass at right posterior orbit and other calcified dural lesionsSigns and Symptoms: headache MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is redemonstration of a 3 mm extra-axial lesion at the right tentorial leaf which is bright on T1 and suppresses on the fat suppressed imaging. It is stable compared to the prior examNormal 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 small mucous retention cysts. The visualized portions of the mastoid air cells are clear. MRI orbits:There is an 18 x 14 mm axial dimension right intraconal space mass present which previously measured similar dimensions. It is located between the right lateral rectus muscle and the optic nerve and splays the 2 apart. It enhances homogeneously. It has similar signal characteristics to the extraocular muscles on T1. On the prior exam it had a fluid fluid level in it. This is also present on the prior exam and is more subtle.The eyeballs are intact. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: 1.There is redemonstration of an intraconal space mass on the right side which displaces adjacent structures (right optic nerve and right lateral rectus muscle). Its signal characteristics suggest that this may represent a venolymphatic lesion. It is stable when compared to the prior exam2.A tiny lesion along the right tentorial leaf is present which could represent a lipoma, a lipomatous meningioma or a dermoid. It is also stable compared to the previous exam.


Instruction: Generate impression based on findings.

Input: 64 years Male (DOB:11/21/1951)Reason: evaluate for diffuse axonal injury vs. focal abnormality History: post-concussive symptoms 9 months after mTBIPROVIDER/ATTENDING NAME: NAOUM P ISSA NAOUM P ISSA The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several subcortical punctate-sized white matter lesions identified on FLAIR MRI and T2 MRI which were also present prior exam and have not changed. There is a one in particular in the left parietal lobe which was not clearly present on the prior exam but may have been obscured due to volume averaging because it appears to have been present on the prior coronal FLAIR MRI.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.No significant microhemorrhages are appreciated intracranially.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.The current exam appears be stable compared to the 2010 exam


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: right temporal lesion crani planned for same day History: right temporal lesion Multiple fiducial markers attached on scalp during the scanning.There is a large intra-axial ring-enhancing mass on the right medial and posterior temporal lobe extended toward right side midbrain [34.8mm (RL) x 41.7mm(AP) x 39mm (CC)] , unchanged.Multiple satellite enhancing nodules were again seen, unchanged.Midline shift at the level of the foramen of Monro measured on axial scan is about 8mm, grossly unchanged. There is no evidence of trapped ventricle system or ventriculomegaly.The paranasal sinuses and mastoid air cells are clear.

Output: Large peripherally enhancing high-grade intra-axial mass at the right posterior mesial temporal lobe with the multiple satellite lesions, and midline shift toward left side, unchanged since prior scan..


Instruction: Generate impression based on findings.

Input: Intra-articular contrast is identified within the radiocarpal joint extending through the expected location of the scapholunate ligament. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 22 seconds

Output: Successful fluoroscopic guided injection of dilute gadolinium into the midcarpal joint for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: pre op planningSigns and Symptoms: tumor resection planning There is redemonstration of status post left-sided craniotomy for removal of a mass centered in the left inferior parietal lobule. There is T2 and FLAIR signal hyperintense lesion at the tumor bed. There is a masslike lesion measuring 18 x 15 mm axial dimensions along the posterior, medial and superior margins of the surgical site.An extra-axial lesion is present adjacent to the left temporal lobe which measures 11 mm on the current exam and 9 mm on the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings raise the question of local recurrence at the left parietal surgical site.2.An extra-axial mass adjacent to the left temporal lobe is slightly larger on the current exam when compared to the prior exam.3.Examination is limited and was performed for the purpose of the treatment planning.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal T2/FLAIR hyperintensities scattered in the subcortical frontal white matter which is nonspecific. The brain parenchyma and pituitary gland otherwise appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is complete opacification of the right maxillary sinus which is underdeveloped.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms. The posterior communicating arteries are not well visualized.MRA Neck: There is a common origin of the left common carotid artery and brachiocephalic artery, with a separate origin of the left subclavian artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. However, the mid to distal right V2 segment appears irregular, although evaluation is limited due to surrounding venous structures. Similarly, the course of the proximal right V3 segment appears unusual with difficulty following the vertebral artery at this level, again with evaluation limited due to surrounding venous structures and possible collateral vessels. There is no evidence of definite flow-limiting stenosis or occlusion.

Output: 1.No evidence of intracranial abnormality. 2.Incomplete evaluation of the mid to distal cervical right vertebral artery, with evaluation somewhat limited due to surrounding venous contamination, although there is also concern for slight aberrant course of the distal right vertebral artery and possible collaterals. CTA neck recommended for further evaluation, to exclude possibility of previous dissection.3.Unremarkable MRA of the brain.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 45-year-old female patient with elevated LFTs. History of polycystic kidney disease. ABDOMEN:LIVER, BILIARY TRACT: Innumerable nonenhancing T2 hyperintense lesions throughout the liver are compatible with cysts with the suggestion of concomitant peribiliary cysts. No suspicious hepatic lesion is identified. There is no intrahepatic biliary duct dilatation. The proximal common bile duct is prominent in size measuring up to 7 mm in diameter, but smoothly tapers distally without evidence of an obstructing lesion. Trace dark signal within the mid-common bile duct may represent artifact or a small amount of pneumobilia.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Innumerable T2 hyperintense lesions throughout both kidneys without suspicious enhancement features are compatible with cysts. There is no hydronephrosis. Additional subcentimeter T2 hyperintense lesions are too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific findings to account for the patient's symptoms. 2.Prominent proximal common bile duct without distal obstructing lesion. Trace dark signal within mid-common bile duct may represent artifact or trace pneumobilia; correlate with recent intervention. 3.Hepatic and renal cysts compatible with patient's diagnosis of polycystic kidney disease.


Instruction: Generate impression based on findings.

Input: 13-year-old female with right knee pain for 5 months. MENISCI: The lateral and medial menisci are intact and normal in appearance.ARTICULAR CARTILAGE AND BONE: There is a small focus of bone marrow edema affecting the medial intercondylar tubercle of the tibia. Otherwise, bone marrow signal intensity is normal. The articular cartilage is intact. No fracture.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. Medial collateral ligament and lateral collateral complex are intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: Contusion of the medial intercondylar tubercle of the tibia.


Instruction: Generate impression based on findings.

Input: Synovial sarcoma. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a persistent effusion within the left mastoid air cells and a small amount of fluid in the right mastoid air cells.Spine: There are postoperative findings related to C2-T2 laminoplasty and tumor debulking. There is perhaps slight interval increase in size and enhancement of the left paraspinal tumor with erosions of the vertebral bodies, encasement of the left vertebral artery at these levels, invasion of the corresponding neural foramina, and extension into the intraspinal epidural space, measuring up to 23 mm in width at the C3-4 level, previously 20 mm. There new and enlarging scattered enhancing bone marrow lesions in the cervical and upper thoracic spine and upper thoracic spine, but the vertebral body heights are preserved. There is a kyphotic curvature in the cervico-thoracic region, but no spondylolisthesis. The spinal canal is narrowed from C4 to T1, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. There is associated spinal cord flattening in this region, without spinal cord signal abnormality. There are partly imaged, but extensive mediastinal tumors. There are multiple nodules within the partially imaged right lung. There is a small right apical pneumothorax.

Output: 1. Postoperative findings related to C2-T2 laminoplasty and tumor debulking with apparent mild interval increase in size of the residual tumor in the treatment bed on the left side with associated vertebral body erosions, left vertebral artery encasement, and mild encroachment upon the spinal epidural space through the neural foramina. 2. New and enlarging scattered bone marrow lesions in the cervical and upper thoracic spine and upper thoracic spine, which may represent metastases. 3. The spinal canal is narrowed from C3-C7 with associated compression of the lower cervical and upper thoracic spinal cord, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. 4. No evidence of intracranial metastases.5. Partially imaged mediastinal tumors, pulmonary metastases, and bilateral small pleural effusions. Please refer to the separate chest CT report for additional details.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with worsening altered mental status, hepC cirrhosis with history of hepatic encephalopathy, hyponatremia, head CT today with new hyperattenuation in the pons. An area of susceptibility is seen within the central pons with surrounding T2 hyperintensity which fans up into the cerebral peduncles. A separate smaller focus of susceptibility with no associated T2 hyperintensity is seen within the posterior right frontal lobe.On T1 weighted images, the basal ganglia show mild symmetric intrinsic hyperintensity. No restricted diffusion is seen. Scattered small foci of T2 hyperintensity are present within the subcortical white matter of the cerebral hemispheres but without associated mass effect. Also noted, however, is asymmetric ependymal T2 hyperintensity along the right occipital horn.No pathologic extra-axial fluid collections are detected. Ventricular size is within normal limits.

Output: 1. A small pontine hemorrhage is detected, correlating with an abnormality noted on prior CT. This may simply reflect a coagulopathic hemorrhage without any additional underlying process. T2 hyperintensity within the pons may therefore simply reflect edema. However, in the context of rapidly corrected hyponatremia, the possibility of coexisting osmotic demyelination may also be considered.2. A smaller focus of chronic hemorrhage is seen within the right posterior frontal lobe.3. Scattered foci of subcortical T2 hyperintensity are nonspecific.4. Asymmetric ependymal signal abnormality along the right occipital horn could be a variation of normal, though the possibility of an underlying inflammatory or infectious process is not excluded.5. Intrinsic T1 hyperintensity within the basal ganglia is compatible with chronic hepatic encephalopathy. Typical findings for acute hepatic encephalopathy are not clearly present on this examination. Continued follow-up is advised.


Instruction: Generate impression based on findings.

Input: 39 year old female with neurosarcoidosis. Interval change of the fourth ventricle. Shunt placement left frontal. Rest of provided clinical data is not legible. Transient alteration of awareness. Nonenhanced CT of brain:Images through posterior fossa demonstrate an enlarged fourth ventricle and no appreciable interval change since prior MRI exam.Images through supratentorial space demonstrate collapsed left lateral ventricle. This is similar to what was noted on prior MRI exam. Normal appearing right lateral ventricle and similar in size to prior MRI study.Third ventricle is small and in midline and with no interval change. Left-sided ventricular catheter traverses the left frontal lobe, enters the left frontal horn, traverses the midline and with the tip at the level of foramina of Monroe on the right. Small area of encephalomalacia in bilateral frontal lobes (right greater than left) shows no interval change since prior MRI. There is no evidence of hemorrhage, edema mass-effect or midline shift.

Output: 1.No evidence of new findings since prior MRI examination of brain.2.Dilated fourth ventricle and a small supratentorial ventricular system remains stable since prior study.


Instruction: Generate impression based on findings.

Input: Male 27 years old Reason: please evaluate for disease activity and peri-anal disease History: abdominal pain, weight loss, diarrhea ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multifocal areas of abnormality throughout the colon and rectum. There is a 4.0-cm segment of wall thickening, edema, mural hyper enhancement and luminal narrowing in the distal transverse colon (series 501, image 15). There is marked dilatation of the proximal transverse colon measuring up to 11.1 cm. There is a second more distal segment of severe luminal narrowing involving the descending colon which measures at least 17cm which persists throughout the study. There is mild associated mural edema and hyperenhancement. The proximal transverse colon measures 9.3 cm in dimension. The rectum is markedly abnormal with significant mural thickening, stratification and edema. There is mild engorgement of the adjacent vasa recta as well as fibrofatty proliferation. The 3 above described segments demonstrate diffusion restriction. The findings are consistent with stenotic disease with associated inflammatory changes which are most marked in the rectum.Evaluation of the terminal ileum is limited on postcontrast images however there is no significant hyperenhancement.Above average stool burden in the ascending colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild upper abdominal ascites.

Output: 1.Multifocal stenotic disease of the transverse, descending colon and the rectum with superimposed inflammatory changes which are most marked in the rectum. There is marked colonic dilatation proximal to the stenotic segments.2.Abdominopelvic ascites and diffuse anasarca.3. Evaluation for perianal disease as clinically queried is limited on this study. This would be better characterized with a dedicated pelvic MRI if clinically indicated.Findings discussed with Dr. Yarur at time of dictation 10:00 a.m. 03/30/15.


Instruction: Generate impression based on findings.

Input: Clinical question: New tiny a lesion on MRI. Concern for arteriovenous malformation. Evaluate for arteriovenous malformation. Signs and symptoms: Neck pain/stiffness/headaches. Non-enhanced CT of brain:Examination demonstrate no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. Previously noted mildly enhancing cranial mass is not identified on this exam. There was no evidence of arteriovenous malformation malformation on prior MRI exam or the current CT.Calvarium is intact.Mastoid air cells, middle ear cavities and limited view of the paranasal sinuses are within normal.CTA of intracranial circulation:Right internal carotid is well visualized across the skull base and through the cavernous sinus with no abnormality. Supraclinoid right internal carotid artery, right posterior communicating artery, right anterior and middle cerebral arteries and their branches are within normal limits.Left internal carotid is well visualized and unremarkable in its cavernous and supraclinoid portion. There is normal visualization of a small posterior communicating artery. The anterior and middle cerebral arteries are within normal limits. There is anatomical variation of hypoplastic left A1. There is no evidence of arteriovenous malformation.Vertebral basilar system, there is normal visualization of bilateral intracranial vertebral arteries. Normal appearing right pica is identified. There is no visualization of the left pica. Basilar artery, superior cerebellar arteries and posterior cerebral arteries are well visualized and within normal limits. There is no detectable arteriovenous malformation as clinically questioned. The findings in the pineal region noted on prior MRI is not consistent with an arteriovenous malformation and it represents a mass.65 cc of Omnipaque 350 is administered for above study.

Output: 1.Negative non-enhanced CT of brain. 2.Previously noted less than one CM mass in the pineal region is not identified on this non-infused head CT.3.No evidence of arteriovenous malformation on this CTA or prior MRI exam.4.Negative CTA of intracranial circulation.


Instruction: Generate impression based on findings.

Input: 66 year old male with history of heart transplant in 9/2015 presenting for evaluation for function and evidence of rejection. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 198 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 98 ml (normal range 47+/-19), the LV mass index is 45 g/m2 (normal range 85+/-15), and the LV mass is 89 g (normal range 164+/-36). There are no regional wall motion abnormalities. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. However, native myocardial T1 and myocardial ECV fraction are both elevated suggesting underlying inflammation, fibrosis, or infiltration.Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 94 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The anastomosis of transplant and native aorta is well seen without any significant stenosis. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trivial pericardial effusion. Extracardiac FindingsSternal wires are present. Right renal cyst. Can not rule out left renal mass, correlation with other imaging suggested. 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.Post transplant protocol values: Global relative enhancement 1.4 (normal < 4)T2 STIR Edema ratio 1.99 (normal < 2)Native T1 time: 1183 ms (normal < 1050ms)Extracellular volume fraction 33% (normal 20-30%)

Output: 1. The left ventricle is normal in size and low normal systolic function. The overall LV ejection fraction is 50%. There are no regional wall motion abnormalities. There is no LGE and normal myocardial global relative enhancement and T2 ratio; however, native myocardial T1 and ECV fraction are both elevated suggesting underlying myocardial fibrosis, inflammation, or infiltration. 2. The right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%.3. Mild mitral regurgitation.4. Extracardiac findings as above. Findings conveyed to referring team.


Instruction: Generate impression based on findings.

Input: 45 years, Female, trigeminal neuralgia, rule out brainstem lesion. Brain parenchyma appears within normal limits. Specifically no lesions within the brainstem are appreciated. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is moderate mucosal thickening involving the left sphenoid sinus. Bone marrow signal and extracranial soft tissues are within normal limits. Noted is an enhancing, likely small venous structure, coursing along the superior aspect of the cisternal segment of the right trigeminal nerve as well as along the medial aspect of the trigeminal nerve as it enters the Meckel's cave.

Output: 1. No brain parenchymal signal abnormalities or intracranial mass.2. There is an enhancing, likely small venous structure, coursing along the superior aspect of the cisternal segment of the right trigeminal nerve as well as along the medial aspect of the right trigeminal nerve as it enters the Meckel's cave. Finding is of uncertain significance and can be correlated with symptomatology (per EMR, patient's symptoms are left sided). Also note examination was performed per routine brain MRI protocol and additional high-resolution sequences of the trigeminal nerve including its extracranial course can be obtained if clinically warranted.


Instruction: Generate impression based on findings.

Input: Patient fell while skiing, pain medially but now more lateral. MENISCI: The medial meniscus is intact, however the lateral meniscus demonstrates a more complex tear within the body extending into the anterior horn with extension to both the superior and inferior articular surfaces (image 9 series 5). Additionally and more posteriorly is a second discrete abnormality involving the apical aspect of the posterior lateral meniscus. No distinct communication is seen with the anterior lesion and specifically this posterior horn abnormality involves the superior articular surface. Both menisci are properly anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Minimal edema observed in the medial femoral condyle and tibial plateau, suggesting mild contusion. The remaining marrow signal and cartilage are otherwise unremarkableLIGAMENTS: Thickening with increased internal signal in the medial collateral ligament proximally suggests a moderate strain. Fibers however appear intact. The LCL, ACL and PCL are all otherwise unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Acute lateral meniscal tears as described involving both the posterior and anterior horns.


Instruction: Generate impression based on findings.

Input: 45 years, Female, Reason: Pt with intermittent vertigo, HA, diplopia, incoordination; rule out cerebellar abnormality, MS, or lesions. Also hyperreflexia and neck pain. Brain: No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few foci of T2/FLAIR hyperintensity are seen in the frontal subcortical white matter, which are nonspecific. There is a punctate focus of susceptibility in the left posterior temporal lobe subcortical white matter consistent with chronic microhemorrhage or calcification. Brain parenchyma is otherwise unremarkable for age. Developmental venous anomaly in the left cerebellar hemisphere is incidentally noted. No suspicious parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is a tiny mucous retention cyst in the left maxillary sinus. There is nonspecific prominence of the nasopharyngeal lymphoid tissue. Paranasal sinuses and mastoid cells are clear. Calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from mild reversal of cervical lordosis which may be in part positional. Bone marrow signal is benign including T1 hyperintense lesions involving the T1 and T2 vertebrae compatible with hemangiomas or foci of fat. The cervical spinal cord has normal signal characteristics.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Tiny central disc protrusion which contacts the ventral cord. No significant compromise to the spinal canal or neural foramina.C4-5: Disc osteophyte complex with effacement of the ventral thecal sac and overall very mild spinal canal stenosis. There is also mild right neural foraminal stenosis. Left neural foramen is patent.C5-6: Disc osteophyte complex and uncovertebral hypertrophy with mild to moderate spinal canal stenosis. There is also mild to moderate right and mild left neural foraminal stenosis.C6-7: There are edematous endplate marrow signal changes and small Schmorl's node involving the superior C7 endplate. There is disc osteophyte complex and ligamentum flavum thickening. There is moderate degree of spinal canal stenosis at this level with mild cord contour deformity but without cord signal abnormality. There is moderate right and mild to moderate left neural foraminal stenosis. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.There is a partially imaged enlarged left thyroid nodule measuring at least 4 cm in the transverse dimension and 5.2 cm in the craniocaudal dimension.

Output: 1. Brain parenchyma is essentially unremarkable. No intracranial mass or mass effect. There are minimal foci of T2/FLAIR hyperintensity in the bifrontal subcortical white matter which are nonspecific and not particularly suggestive of demyelinating disease. There is also a single punctate focus of susceptibility, which may represent a chronic microhemorrhage or focus of punctate calcification, in the left posterior temporal lobe.2. No signal abnormality or abnormal enhancement in the cervical cord. There are multilevel degenerative changes with moderate spinal canal stenosis at the C6-C7 level and to a slightly lesser degree at the C5-C6 level. Additional levels as above.3. Large left thyroid nodule which can be further assessed with ultrasound as clinically warranted.


Instruction: Generate impression based on findings.

Input: 36-year-old male. Cirrhosis status post OLT 4/90. Evaluate for lesions, assess hepatic vessel patency. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with no suspicious focal lesions. Diffuse low T2 signal liver consistent with iron deposition, unchanged. Mild lacelike T2 hyperintensity that shows mild delayed enhancement in the right hepatic lobe consistent with confluent fibrosis, unchanged. Two small hepatic cysts. Portal vein and hepatic veins are patent. TIPS in expected position and with internal enhancement indicating patency.Gallbladder is not visualized, presumably resected. Multiple splenic and gastrohepatic varices are present, unchanged.Central intrahepatic biliary ductal dilatation, unchanged.SPLEEN: Stable moderate splenomegaly. Markedly enlarged splenic artery and vein, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral small renal cysts.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: Cirrhotic liver morphology with diffuse iron deposition without suspicious focal mass.


Instruction: Generate impression based on findings.

Input: Ms. Lange is a 47-year-old female with BRCA1 mutation presenting for high-risk breast cancer screening. She has a personal history of right lumpectomy for IDC with medullary features in 2003. She is status post radiation and chemotherapy. She has a family history of breast cancer in her sister diagnosed at age of 28 and ovarian cancer in a paternal aunt. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the right upper outer breast and right axillary region. There is no abnormal enhancement seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: any change in plexiform mass History: plexiform, NF type 1, pt complaining of daily pain. Again seen is a trans-spatial plexiform mass centered in the left retropharyngeal soft tissues that spans from the level of the nasopharynx into the mediastinum, with extension and left carotid space with associated partial encasement of the great vessels, and into the left visceral space with associated distortion of the thyroid gland. The mass measures up to 4.6 x 3.8 cm in the AP and transverse dimensions, axial series 701 image 11, and is not significantly changed. More superiorly at the level of the oropharynx mass measures 2.0 cm in the short axis, series 701 image 29, which is also not significantly changed. Craniocaudal extension approximately 14 cm is also not significantly changed.Again seen is narrowing of the oropharyngeal airway as well as rightward deviation of the trachea. Partially imaged brain demonstrates multiple T2 hyperintense lesions in the cerebellum, brainstem, and middle cerebellar peduncles, similar to prior. Cervical and upper thoracic spinal canal remains patent.

Output: 1. Compared to 8/25/2015 and 3/23/2015, there is no significant change in size of the plexiform neurofibroma centered in the left retropharyngeal soft tissues with extension into the mediastinum. Mass effect on the oropharyngeal airway, rightward tracheal deviation, and partial encasement of the left carotid vasculature again seen. 2. Partially-imaged intracranial stigmata of neurofibromatosis type 1.


Instruction: Generate impression based on findings.

Input: Numbness/pain and tingling of left arm. The examination is limited due to extensive motion artifact.CERVICAL SPINE: The cervical lordosis is preserved, but there is mild retrolisthesis of C3 over C4, C5 over C6, and C6 over C7. There is congenital narrowing of the spinal canal. The spinal cord demonstrates grossly normal caliber and signal intensity. There is mild heterogeneity of the bone marrow signal. The paravertebral soft tissues are unremarkable.Additional findings by level:C2-3: There is no significant disc herniation, neural foraminal stenosis, or spinal stenosis.C3-4: There is a posterior disc osteophyte complex and hypertrophy of the ligamentum flavum resulting in mild spinal cord impingement and probable mild bilateral neural foraminal stenosis.C4-5: There is a posterior disc osteophyte complex and hypertrophy of the ligamentum flavum resulting in mild spinal cord impingement without significant neural foraminal stenosis.C5-6: There is a posterior disc osteophyte complex and hypertrophy of the ligamentum flavum resulting in mild spinal cord impingement and at least mild bilateral neural foraminal stenosis.C6-7: There is a posterior disc osteophyte complex and hypertrophy of the ligamentum flavum resulting in mild to moderate spinal stenosis without significant neural foraminal stenosis.C7-T1: There is no significant disc herniation or neural foraminal stenosis.THORACIC SPINE: The thoracic kyphosis is preserved. The vertebral body heights are maintained. There is heterogeneous bone marrow signal, with multiple T1 and T2 hyperintense lesions. The largest lesion is in the T5 vertebral body, measuring up to 2 cm. There are additional lesions in the T2, T7, T8, T10, and T12 vertebral bodies. There is no evidence for pathologic fracture. There is no evidence for tumor within the thoracic spine. The thoracic spinal cord demonstrates normal signal intensity and morphology. There are scattered intravertebral disc herniations. There is no significant disc herniation, spinal stenosis, or neural foraminal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Limited examination without intravenous contrast demonstrates multifocal T1 and T2 hyperintense lesions throughout the thoracic spine, but no compression fractures. These likely represent atypical hemangiomas, but the possibility of metastatic disease is also a consideration.2. No evidence for tumor within the spinal canal although assessment is limited by the lack of contrast and extensive motion artifact.3. Degenerative spondylosis of the cervical spine superimposed upon congenital spinal canal narrowing with multilevel impingement upon the spinal cord.4. No significant thoracic spinal canal narrowing.


Instruction: Generate impression based on findings.

Input: History of NASH cirrhosis and hepatocellular carcinoma status post ablation. Interval follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology liver with nodular surface contour and widened fissures. There is redemonstration of a segment 8 ablation cavity. There is no adjacent early arterial enhancement to indicate recurrent disease. No suspicious arterial enhancing lesions elsewhere in the liver.The portal vein is borderline enlarged measuring 13 mm in diameter. The portal veins are patent. The hepatic veins and hepatic arteries are also widely patent. There is recanalization of the umbilical vein as well as multiple prominent splenorenal collaterals measuring up to 9 mm.Cholelithiasis with chronic gallbladder wall thickening. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Prominent splenomegaly with the spleen measuring 17.7 cm in length.PANCREAS: The pancreas has normal signal and morphology. The duct is within normal limits for size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts. No focal mass lesion. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Note is made of abdominal wall venous collaterals.OTHER: Trace perihepatic ascites.

Output: 1.Hepatic cirrhosis. Unchanged ablation cavity in segment 8. No suspicious arterial enhancing lesions to indicate new or recurrent disease.2.Findings of portal hypertension including splenomegaly, perihepatic ascites, and splenorenal shunt formation.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified dementia without behavioral disturbanceClinical question: cognitive declineSigns and Symptoms: memory loss, language problems, some behavior The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a cystic type lesion present along the right cerebellar medullary angle cistern which measures 22 x 18 mm in axial dimensions. It follows spinal fluid on all pulse sequences fairly closely. The adjacent nerve roots, right anterior inferior cerebellar artery and right vertebral artery drape around this cyst its superior extent is at the right cerebellopontine angle cistern where it abuts the right nerves VII and VIII.There is partial empty sella present.There is a T2 hyperintense and FLAIR hypointense lesion present in the left basal ganglia associated with some exact effect on the left lateral ventricle suspected represent an old lacunar infarct associated with some susceptibility effect around it.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are compatible with an arachnoid cyst at the right cerebellar medullary angle cistern displacing the adjacent nerve roots and mildly impressing on the brainstem.2.No evidence for acute ischemic cerebral infarction.3.Findings are compatible with an old lacunar infarct involving left basal ganglia and centrum semiovale.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.