Instruction: Generate impression based on findings.

Input: Chiari I malformation, worsening headaches Brain:Again seen is cerebellar tonsillar ectopia with approximately 6 mm of inferior herniation of the left cerebellar tonsil through the foramen magnum and mild effacement of the dorsal subarachnoid space at this level. CSF flow sequence demonstrates patent biphasic flow ventrally and diminished posteriorly at the foramen magnum, similar to prior.Again seen are several scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes. No evidence of acute infarct or intracranial hemorrhage. Again seen is a small CSF intensity lesion measuring 16 x 11 mm in the right cerebellopontine angle compatible with an arachnoid cyst and unchanged. There is minimal if any local mass effect associated with this lesion. No other intracranial mass or mass effect. No hydrocephalus. Brain parenchyma is otherwise unremarkable. No abnormal parenchymal or meningeal enhancement. Paranasal sinuses and mastoid air cells are clear. Calvarium and remainder of the extracranial soft tissue structures are unremarkable.Cervical Spine:No abnormal signal in the cervical cord. No abnormal enhancement. Vertebral body heights are maintained. Mild straightening of the cervical spine and mild retrolisthesis of C5 on C6 remain unchanged. Bone marrow signal is benign. Degenerative changes are seen in the cervical spine as described below:C2/3: No significant spinal canal stenosis or neuroforaminal compromise, unchanged.C3/4: No significant spinal canal stenosis or neuroforaminal compromise, unchanged.C4/5: No significant spinal canal stenosis or neuroforaminal compromise, unchanged.C5/6: There is a disc osteophyte complex, mild ligamentum flavum thickening, and bilateral uncovertebral hypertrophy resulting in mild spinal canal stenosis which is stable to minimally worse since prior along for differences in technique and neck position. There is moderate bilateral neural foraminal narrowing which also appears minimally worse since prior.C6/7: Again seen is small disc osteophyte complex, mild uncovertebral hypertrophy, and ligamentum flavum thickening with minimal narrowing of the spinal canal. There is mild right and minimal left neural foraminal stenosis which is not significant changed.C7/T1: No significant spinal canal stenosis or neuroforaminal compromise, unchanged.

Output: 1. Compared to 10/28/2013 and 12/28/2012, there is no significant change in ectopia of the cerebellar tonsils with the left cerebellar tonsil measuring up to 6 mm below the foramen magnum. There is is mildly diminished CSF space and CSF flow involving the posterior aspect of the foramen magnum similar to prior.2. Unchanged small right cerebellopontine angle arachnoid cyst with minimal, if any, local mass effect.3. Mild chronic small vessel ischemic changes.4. No cord signal abnormality or evidence of syrinx in the cervical cord. 5. Degenerative changes in the cervical spine at C5-C6 and C6-C7 which are minimally worse since 10/28/2013. Please see details above.


Instruction: Generate impression based on findings.

Input: Metastatic disease: seizures. There is a 7 mm diameter right occipital lobe peripherally enhancing lesion with susceptibility effect and surrounding vasogenic edema. There is an enhancing dural based lesion that measures up to 5 mm along the inferior surface of the left tentorium, near the apex. There are punctate foci of susceptibility effect without associated enhancement in the right cerebellum, left frontal lobe periventricular white matter, and medial right occipital lobe. There is no evidence of acute infarct. There are scattered foci of cerebral white matter T2 hyperintensity without associated enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. The skull and scalp soft tissues are grossly unremarkable. There is fluid in the left maxillary and right sphenoid sinuses and scattered paranasal sinus mucosal thickening. There is also fluid within the bilateral mastoid air cells.

Output: 1. A 7 mm diameter right occipital lobe peripherally enhancing lesion with susceptibility effect and surrounding vasogenic edema is compatible with metastatic disease. 2. An enhancing dural based lesion that measures up to 5 mm along the inferior surface of the left tentorium may represent a meningioma or metastasis.3. Punctate foci of susceptibility effect without associated enhancement in the right cerebellum, left frontal lobe periventricular white matter, and medial right occipital lobe are nonspecific and may represent chronic microhemorrhages, perhaps related to amyloid angiopathy.4. Findings suggestive of acute sinusitis and mastoiditis.


Instruction: Generate impression based on findings.

Input: Male 61 years old; Reason: RUQ with mildly dilated pancreatic and CBD ABDOMEN:Suboptimal study secondary to patient motion artifact.LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Diffuse hepatic steatosis. Mild intrahepatic biliary duct dilatation and CBD measures up to approximately 10 mm. However duct demonstrates smooth circumferential tapering distally, distal portion measuring up to 15 mm, see image 19 series 6. No evidence of obstructing stone or lesion. SPLEEN: No significant abnormality noted.PANCREAS: Intrinsic T1 signal of pancreas preserved. Mildly dilated pancreatic duct measuring up to 4 mm, smooth circumferential tapering seen in distalmost portion of level of pancreatic head (measures 15 mm), see image 19 series 6. No definite pancreas divisum seen. No obstructing masslesion seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered colon diverticula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Very extensive patient motion artifact makes evaluation suboptimal.Mild pancreatic ductal dilatation and CBD and intrahepatic biliary duct dilatation visualized, appearance suggestive of underlying benign ampullary stenosis. No obstructing lesion or stone visualized. Relatively smooth circumferential tapering of distal portions of both main pancreatic duct and CBD as above.


Instruction: Generate impression based on findings.

Input: Neoplasm of uncertain behavior of brain, unspecified [D43.2], Reason for Study: ^Reason: Post op R crani for tumor resection History: lethargy Post-resection status of the right globus pallidus mass lesion with right frontal approach ventriculostomy tube insertion status.There are susceptibility artifacts within the resection cavity, surrounding bran parenchyme as well as intraventricular space especially on the left lateral ventricle occipital horn indicating operation related blood products.On Gad enhanced scan, there is minimal enhancements especially on the posterolateral aspect of the original mass which may indicate residual tumor. Comparing to pre-operative scan, the degree of midline shift has been significantly improved.And ventricle size also has been decreased likely due to ventriculostomy tube insertion.The extent of surrounding edema on the right frontal lobe appears to be slightly decreased, but grossly no change since prior scan.Other enhancing intra axial lesion on the left temporal lobe does not show any interval change since prior scan in terms of size, enhancement pattern and the extent of surrounding edema,There is no evidence of new acute ischemic or hemorrhagic lesion on this scan.There is about 10.1mm (RL) x 18.1mm (AP) x 20.8mm (CC) sized peripherally enhancing lesion with some central stippled enhancement within the left temporalis muscle associated with temporalis fascial enhancement indicating most likely inflammatory lesion, clinical correlation and follow up scan can be considered.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post resection status of the right globus pallidus lesion with right frontal approach ventriculostomy insertion status.2. Blood products within the resection cavity, surrounding brain parenchyme and left lateral ventricle indicate postoperative changes.3. Interval improvement of midline shift, interval decrease of ventricle size and slightly decreased the extent of surrounding edema of the right globus pallidus lesion.4. No change of the left temporal intra axial enhancing lesion.5. No evidence of new acute ischemic or hemorrhagic lesion.6. Left temporal extracranial enhancing soft tissue lesion involving both temporalis muscle and overlying fascia suggesting inflammatory in nature. Clinical correlation and follow up imaging may need to be considered.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, history of metastatic melanoma with brain metastases, now with recent seizure and left-sided weakness. Assess for new brain metastases. Two new rim-enhancing lesions are evident within the right post-central gyrus, each containing blood fluid levels, measuring 13 and 10 mm in diameter. These lesions induce moderate local edema which tracks into the underlying white matter.A lesion within the left inferior parietal lobule has significantly increased in size now measuring up to 17 mm, previously 4 mm. A lesion along the left superior frontal sulcus has increased in size now measuring 7 mm, previously punctate. A new 10 mm lesion is evident within the paramedian right occipital lobe, and a new 16 mm lesion is evident more laterally in the right occipital lobe. The above lesions induce mild local edema. A 2 mm focus of enhancement is new within the left inferior frontal lobe.A lesion in the paramedian right parietal lobe is unchanged. The right frontal lobe resection cavity has collapsed with no significant change in the amount of enhancement and decreasing edema. The left superior frontal resection cavity is stable and free of enhancement.

Output: Multiple new and/or growing lesions compatible with progression of metastatic disease.


Instruction: Generate impression based on findings.

Input: Male 34 years old s/p arrest, remains comatose, evaluate for extent of brain injury, unresponsive off sedation >24 hrs Focus increased diffusion and mildly decreased ADC signal in the posterior right temporo-occipital lobe (401/271) and left inferior cerebellar vermis (401/264) with associated FLAIR abnormality suspicious for subacute infarctions. Mild susceptibility artifact within the right temporo-occipital lobe suggestive of hemorrhagic conversion. Encephalomalacia with surrounding FLAIR abnormality noted within the left inferior parietal lobe involving the supramarginal and angular gyrus suggestive of remote infarct. There is no evidence of intracranial mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Subacute infarcts within the right temporo-occipital lobe, which demonstrates hemorrhagic conversion, as well as the left inferior cerebellar vermis. 2. Chronic left parietal infarct involving the supramarginal and angular gyrus.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, status post craniotomy. A small left convexity craniotomy is seen through which the previously demonstrated enhancing mass in the left posterior frontal lobe has been resected. The surgical cavity contains fluid and a small heme level. Thin diffusion restriction around the cavity margins is compatible with procedural cytotoxic edema. No evidence of residual tumor is seen. Vasogenic edema surrounding the operative bed is similar to that seen preoperatively.Elsewhere, no additional pathologic enhancement or suspicious signal abnormality is seen. Scattered foci of T2 hyperintensity within the white matter are unchanged and nonspecific. Ventricular size and morphology are within normal limits. Partial opacification the right mastoid air cells is seen.

Output: Expected findings are seen status post resection of a tumor from the high left posterior frontal lobe. No residual tumor is identified.


Instruction: Generate impression based on findings.

Input: Subdural hemorrhage [432.1], Reason for Study: ^Reason: bilateral hygromas - assess any change in size or rehemorrhage History: headache There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Redemonstration of bihemispheric subdural fluid collections (maximum diameter on coronal scan is about 10mm on the right and about 8mm on the left), no change since prior scan. There is no evidence of internal hemorrhage or enhancement.There are also subdural fluid collections on posterior fossa around cerebellar hemispheres, again no change since prior scan.There is no evidence abnormal enhancement or mass lesion.Ventricular system appears to be normal.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. There are minimal to mild mucosal thickening on bilateral (left more than right) maxillary sinuses. Interval development of the right mastoid air cell opacifications.

Output: 1. No change of bihemispheric and posterior fossa subdural prominent fluid collections since prior scan.2. No evidence of air acute ischemic or hemorrhagic lesion on the scan.3. No evidence of abnormal enhancement. No mass lesion.


Instruction: Generate impression based on findings.

Input: A 56 year old male with suspected hypertrophic cardiomyopathy by echocardiography. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size and systolic function. There is mid to apical chamber obliteration at end systole. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 54 ml/m2 (normal range: 74+/-15), the LVEDV is 114 ml (normal range 142+/-34), the LV end systolic volume index is 21 ml/m2 (normal range 25+/-9), the LVESV is 43 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 110 g (normal range 164+/-36). Hypertrophy was noted diffusely at the basal and mid segments reaching a maximum of 16 mm at the basal antero-septum. There are no regional wall motion abnormalities present. There is are punctate foci of high signal within the interventricular septum, at the insertion of the right ventricular free wall, most notable at the mid chamber level. No other enhancement is identified.No cardiac iron overload noted.No findings compatible with amyloid.On the 3 chamber view during systole, there is an intracavitary jet which is suggestive of a mild resting gradient within the chamber in the subvalvular LVOT (at site of maximal wall thickness).No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 129 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 54 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is a hockey-stick configuration to the anterior leaflet which may be the result of prior rheumatic disease. There is mild to moderate systolic anterior motion of the anterior leaflet of the mitral valve. There is transient non coaptation as a result, at early diastole. No significant mitral regurgitation is identified; dedicated 3 plane imaging was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. Near concentric basal hypertrophy with additional thickening of the interventricular septum. The maximal thickness is 16 mm at end diastole. Mid to apical chamber obliteration at end systole. Left ventricular ejection fraction equals 62%. Punctate foci of intermediate high signal noted at the interventricular septum at the insertion of the right ventricular free wall. Mitral SAM is present. The consolation of findings are suggestive of hypertrophic cardiomyopathy.2. Right ventricular wall thickness is normal with well-preserved systolic function. The right ventricular ejection fraction equals 58%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 23 years old. Assess fracture and proximal femur lesion. ACETABULAR LABRUM: The labrum is grossly intact within the limits of a nonarthrographic study.ARTICULAR CARTILAGE AND BONE: The lesion in the left femur involves the subarticular femoral head (within 1 cm of the cartilage), the greater and lesser trochanters, as well as the proximal femoral diaphysis. The lesion is expansile and shows diffuse T1 hypointensity and heterogeneously increased T2 signal, with thinning of the overlying cortex. There is a minimally displaced fracture through the this lesion in the intertrochanteric region. There is a moderate effusion. The right hip and other visualized bones of the pelvis are normal.SOFT TISSUES: There is edema and fluid in the soft tissues surrounding the fracture. ADDITIONAL

Output: 1.Expansile lesion in the left proximal femur may reflect a unicameral bone cyst versus possibly fibrous dysplasia or giant cell tumor.2.Pathologic fracture through this lesion in the intertrochanteric region.


Instruction: Generate impression based on findings.

Input: 28 year-old female with newly diagnosed left breast inflammatory cancer presents for MRI guided biopsy of the non mass enhancement in the right breast lower inner quadrant. On subtraction images, linear nonmass enhancement were identified in the lower inner quadrant of the posterior right breast. This was chosen as the target.PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 12 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show no significant hematoma at the biopsy site. An ATEC clip was placed into the center of the target.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent ultrasound-guided biopsy of right axillary lymph node which will be dictated in a separate report. After this MRI guided procedure and a ultrasound-guided right axillary lymph node biopsy, a right unilateral mammogram to locate the percutaneously placed clip was performed. The clip is placed at 4 o'clock position with no evidence of any complications due to the procedure. The ultrasound clip is seen in the axilla as well. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Wang under direct supervision of Dr. Schacht who was present throughout the procedure.

Output: Successful MR guided core needle biopsy of the right breast 4 o'clock enhancing lesion. Successful clip placement. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Female 68 years old. Reason: Left shoulder pain, possible RC tear. History: shoulder pain s/p fall on 4/2/15 ROTATOR CUFF: The infraspinatus is edematous with evidence of atrophy. There is a complete tear of the infraspinatus. The supraspinatus and subscapularis appear unremarkableSUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint is unremarkable. The labrum is grossly normal.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Complete tear of the infraspinatus.


Instruction: Generate impression based on findings.

Input: Low back and leg pain. There are postoperative findings related to prior right hemilaminectomy at L3-4 and interval right L4-5 laminotomy with medial facetectomy and decompression, with mild edema in the paraspinal muscles along the surgical approach. There is multilevel degenerative spondylosis. At L1/2, there is a disc bulge with mild bilateral neural foraminal narrowing, but no evidence of spinal canal. At L2/3, there is a disc bulge with a left lateral disc protrusion, facet hypertrophy, and ligament flavum thickening that result in severe left neural foraminal narrowing. There is also mild right neural foraminal and mild spinal canal narrowing. At L3/4, there is a disc bulge with superimposed central protrusion, facet hypertrophy with effusions and left synovial cyst formation, and ligament flavum thickening that result in severe left lateral recess and neural foraminal narrowing and mild to moderate right neural foraminal narrowing. There is mild anterior subluxation of L3 on L4. At L4/5, there is left facet and ligamentum flavum hypertrophy and a prominent disc bulge that result in moderate to severe right and severe left neural foraminal narrowing, as well as mild spinal canal stenosis. There is also mild anterior subluxation of L4-L5 and irregularity of the superiroL5 endplate. At L5/S1, there is prominent bilateral facet hypertrophy with impingement upon the neural foraminal nerve roots, but no significant spinal canal stenosis. The imaged portions of the spinal cord are unremarkable.

Output: Postoperative findings in the lumbar spine and extensive multilevel degenerative spondylosis with impingement upon neural foraminal nerve roots at the left L2/3, left L3/4, bilateral L4/5, and bilateral L5/S1 levels.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 58 years old. Right shoulder pain ROTATOR CUFF: Metallic suture material in the humeral head causes artifact, somewhat limiting evaluation. The supraspinatus, infraspinatus, and teres minor tendons and muscles are intact. There is mild to moderate tendinopathy of the subscapularis tendon, without discrete tear identified. There is minimal fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: There is trace fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly intact within the limits of a nonarthrographic study.BICEPS TENDON: The tendon of the long head biceps is not well visualized due to metallic artifact.ADDITIONAL

Output: Postoperative changes with mild rotator cuff tendinopathy as above. No discrete rotator cuff tear identified.


Instruction: Generate impression based on findings.

Input: Unspecified sequelae of cerebral infarction [I69.30], Reason for Study: ^Reason: r/o stroke and reperfusion injury History: neurological deficit after CEA There interval development of new restricted diffusion lesions on the left parietal lobe inferior parietal lobule indicating acute ischemic infarction.Previously seen left hemispheric ischemic infarction lesions on the left parietal lobe inferior parietal lobule and left frontal lobe show decreased extent of restricted diffusion areas but some still show diffusion restriction. In addition, there are small scattered susceptibility lesions on the left inferior parietal lobule indicating petechial hemorrhages which are more conspicuous on today's scan. However, the extent of susceptibility lesions are unchanged and there is no associated surrounding edema.There are cortical linear T1 high signal intensity lesions on the left frontal and parietal lobes indicating chronic ischemic lesions with laminar necrosis. Scattered right hemispheric chronic ischemic infarctions are seen, unchanged.Right cavernous sinus enhancing lesions indicating meningioma is again seen, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval development of new scattered restricted diffusion lesions involving left parietal lobe (series 202, images 144, 136).2. Evolving acute/subacute ischemic lesions on the left frontal and parietal lobes. Petechial hemorrhagic transformation are suggested but grossly unchanged since prior scan.3. Unchanged right hemispheric chronic ischemic lesions.4. Unchanged right cavernous sinus enhancing mass, meningioma, since prior scan.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. There is 4-mm retrolisthesis of L5 on S1. There is no osseous marrow edema. The conus terminates at L1.T12-L1: No spinal stenosis or disk herniation.L1-2: No disk herniation or spinal stenosis.L2-3: Mild disk bulge and facet arthropathy with no spinal stenosis.L3-4: Disk desiccation with moderate loss of disk height, and mild disk bulge with no significant spinal stenosis.L4-5: Disk desiccation with moderate loss of disk height, moderate bilateral facet arthropathy causing mild bilateral neural foraminal stenosis and no significant spinal canal stenosis.L5-S1: Disk desiccation with severe loss of disk height, type II endplate degenerative changes, retrolisthesis of L5 on S1 causing no significant spinal canal stenosis and mild bilateral neural foraminal stenosis.There is a right renal cyst incompletely imaged measuring up to 18 mm.

Output: 1.Multilevel lumbar spondylosis with mild bilateral neural foraminal stenoses at L4-5 and L5-S1.2.Incompletely imaged right renal cyst measuring up to 18 mm.


Instruction: Generate impression based on findings.

Input: CERVICAL: The vertebral body alignment, heights and marrow signal are normal. The spinal cord signal is within normal limits. Minimal degenerative changes are seen at C4-C5, C5-C6 without significant spinal canal or neural foraminal stenosis.THORACIC: There are postoperative findings related to prior right T1-2 intradural-extramedullary mass resection with right laminectomy at T1 and T2. Previously seen fluid collection in the posterior soft tissue operative bed is nearly resolved. Lack of intravenous contrast somewhat limits evaluation however, there is no evidence of residual or recurrent tumor. Again seen is mild rotation of the upper thoracic cord likely related to scarring/thecal sac adhesions. Minimal T2 hyperintense signal in the upper thoracic cord is again seen. The vertebral body alignment, heights and marrow signal are normal. There is no significant spinal canal or neural foraminal stenosis.

Output: 1. No evidence of recurrent tumor within the limitations of noncontrast MRI. 2. Please see note in technique section. Patient will return for postgadolinium sequences at a later time.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate grade 3 oligodendroglioma status post RT and TMZ. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination redemonstrates extensive postoperative changes of right anterior temporal lobectomy since prior study. There is stable FLAIR and T2 hyperintensity of the right temporal lobe immediately posterior to the surgical resection site which extends into the left basal ganglia consistent with encephalomalacia/gliosis and postoperative changes. There is no detectable focus of abnormal enhancement at the surgical site or remote to the surgical site. This is a similar observation is prior exam.Moderate to be enlarged supratentorial ventricular system with maintained midline remain similar to prior study.Focus of encephalomalacia in the left anterior frontal lobe without abnormal enhancement or interval change since prior study.Scattered periventricular and subcortical FLAIR and T2 hyperintensity foci suggestive of chronic small vessel ischemic strokes are again noted without interval change. Possibility of overlapping post treatment/radiation changes cannot be excluded. Correlate with clinical history.Diffusely prominent cortical sulci and CSF spaces also remains identical to prior exam.

Output: 1.No evidence of an acute or definitive new finding since prior exam.2.Stable postoperative/therapy changes of the right anterior temporal lobectomy without abnormal enhancement to suggest recurrence of tumor.3.Stable scattered foci of FLAIR hyperintensity in the subcortical and periventricular white matter and a focus of encephalomalacia in the left anterior and inferior frontal lobe similar to prior exam.4.Stable scattered foci of FLAIR hyperintensity and localized focus of encephalomalacia in the left frontal lobe since prior study.5.Stable moderately enlarged supratentorial ventricular system and generalized prominence of cerebral cortical sulci likely representing ex vacuo dilatation.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with bilateral uveitis, headache, blurry vision, possible TB versus GCA versus other. The dura overlying the bilateral frontal and anterior temporal lobes remains smoothly thickened and enhancing. More posteriorly, these findings diminish and the dura is becomes relatively unremarkable. In the areas where dural thickening is most pronounced, thin bilateral subdural collections are redemonstrated measuring up to 5 mm in thickness, previously 6 mm. The collections overlie the lateral aspects of the frontal lobes and do not extend more superiorly or posteriorly. No enhancement is seen along the inner margins of these collections and there is no convincing associated susceptibility effect.No evidence of any pathologic leptomeningeal or parenchymal enhancement is seen. No acute intracranial hemorrhage is detected. Diffusion-weighted images are within normal limits. Scattered foci of periventricular and subcortical FLAIR hyperintensity are redemonstrated, similar to prior. Ventricular size morphology are within normal limits.

Output: Smooth dural thickening and enhancement persists, similar to the prior examination, predominantly affecting the frontal and anterior temporal regions. Small subdural collections along the lateral aspects of the frontal lobes are slightly reduced in size. Scattered parenchymal foci of signal abnormality are unchanged and nonspecific.The etiology of the above findings remains uncertain. The differential diagnosis would include changes in intracranial pressure which could account for both the dural thickening and the small bilateral subdural collections. Alternately, the dural thickening may be reactive to the collections. The collections themselves do not demonstrate typical features of empyema, though an atypical infectious etiology could certainly be considered. Finally, noninfectious inflammatory, granulomatous and/or autoimmune conditions remain in the differential.


Instruction: Generate impression based on findings.

Input: Evaluate for osteochondroma. A broadbase osteochondroma arising from the posterolateral distal tibial diaphysis has a three cm base and protrudes two cm towards the anteromedial aspect of the fibula. The osteochondroma abuts the fibula and causes chronic pressure effect with resultant concavity of the fibular surface and narrowing of the fibular diameter. The osteochondroma has a thin cartilaginous cap measuring eight mm in thickness and which demonstrates minimal enhancement on post-contrast images. The cortex of both the tibia and fibula is intact. No fracture is evident. No evidence of abnormal enhancement within the soft tissues of the right leg.

Output: Broadbase osteochondroma minimally larger when compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Right thigh mass post incisional biopsy 9/2/2015. Evaluate remaining mass. BONE MARROW: No significant abnormality noted.SOFT TISSUES: There is a T2 hyperintense linear area of enhancement measuring 1.7 x 0.6 x 2.7 cm within the lateral right upper thigh subcutaneous tissue extending to the skin surface (series 1201, image 43). JOINTS: No significant abnormality noted.ADDITIONAL

Output: T2 hyperintense linear focus within the lateral aspect of the right upper thigh subcutaneous tissue, may be secondary to recent excisional biopsy. Unable to exclude residual lesion.


Instruction: Generate impression based on findings.

Input: 49-year-old female with left knee pain, medial joint line tenderness, no improvement with injections or conservative treatment MENISCI: Globular intermediate signal within the outer third of the anterior horn of the lateral meniscus extending to the femoral articular surface consistent with degenerative fraying. Blunting of the free edge of the posterior horn of the lateral meniscus compatible with a tear.The medial meniscus is within normal limits.ARTICULAR CARTILAGE AND BONE: A focal chondral defect is noted in the lateral tibial articular cartilage measuring up to 4 mm in AP dimension, directly beneath the aforementioned meniscal tear. Grade 1-2 chondromalacia medial tibiofemoral compartment. There is severe thinning of the lateral patellar facet articular cartilage. Subchondral cysts are noted in the lateral tibial plateau/spine. Otherwise, there is no abnormal marrow signal. Mild tricompartmental osteophytosis is noted.LIGAMENTS: Cruciate ligaments are intact. Collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Blunting of the free edge of the posterior horn of the lateral meniscus compatible with a tear. Underlying focal chondral defect is also noted in the lateral tibial articular cartilage measuring up to 4 mm in AP dimension2.Globular intermediate signal within the outer third of the anterior horn of the lateral meniscus extending to the femoral articular surface consistent with degenerative fraying. 3.Focal 4 mm loose body is also noted in the pocket of fluid posterior to the femoral metaphysis.4.Mild to moderate osteoarthritis affects the left knee.


Instruction: Generate impression based on findings.

Input: Right thumb pain LIGAMENTS: No significant abnormality noted. Specifically, the ulnar and radial collateral ligaments of the thumb appear intact.TENDONS: No significant abnormality noted. BONES: There is a cortical defect of the dorsal aspect of the base of the proximal phalanx of the thumb likely reflecting a subacute or chronic avulsion fracture. There is no significant surrounding marrow edema to suggest this is acute in nature. There is a slight volar tilt of the proximal phalanx in relation to the metacarpal but otherwise alignment of the thumb is relatively anatomic.ADDITIONAL

Output: Avulsion fracture at the base of the proximal phalanx of the thumb. Given the lack of surrounding marrow edema, this is most likely subacute or chronic in nature. There is no evidence of collateral ligament tear and aside from mild volar tilt of the proximal phalanx, the thumb is otherwise in anatomic alignment.


Instruction: Generate impression based on findings.

Input: Abnormal uterine bleeding with clinical picture suggestive of adenomyosis. Pelvic ultrasound with possible endometrial polyps. PELVIS:UTERUS, ADNEXA: The uterus is anteverted in position and measures 4.9 x 8.0 x 6.9 cm. The endometrial stripe is normal in appearance measuring up to 7 mm in thickness. The junctional zone is mildly thickened measuring up to 15 mm anteriorly. A few subcentimeter foci of decreased signal within the anterior myometrium may reflect subcentimeter fibroids. The ovaries are unremarkable in appearance and contain normal-appearing follicles measuring up to 2.2 cm. No adnexal masses are identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings compatible with uterine adenomyosis.


Instruction: Generate impression based on findings.

Input: 51-year-old woman with history of Crohn's disease status post total proctocolectomy on Azathioprine. Patient now has right upper quadrant pain. ABDOMEN:LIVER, BILIARY TRACT: Decreased signal on out of phase imaging suggests diffuse hepatic steatosis with small areas of sparing. No focal hepatic lesion identified. Cholelithiasis without evidence of acute cholecystitis.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: A subcentimeter cyst is seen in the right upper pole. The left kidney is normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy is identified.BOWEL, MESENTERY: The patient is status post proctocolectomy and a right lower quadrant ostomy is identified. No focal bowel wall thickening or abnormal enhancement is identified. There is no evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality is identified.OTHER: No significant abnormality noted.PELVIS:UTERUS/ADNEXA: Nabothian cyst formation noted. BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: Very mild left-sided perineal subcutaneous soft tissue stranding is seen, however previously seen T2 hyperintense fistulous tract appears to have resolved.OTHER: A very small amount of loculated pelvic fluid is seen, predominantly on the right.

Output: No evidence of active Crohn's disease.


Instruction: Generate impression based on findings.

Input: History of tuberous sclerosis, evaluate for angiomyolipoma. ABDOMEN:LIVER, BILIARY TRACT: Liver demonstrates normal parenchymal signal intensity without focal lesions. No biliary ductal dilatation.SPLEEN: The spleen is normal in size without focal lesions.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys demonstrate normal parenchymal enhancement without focal lesions. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy is identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The bones appear normal.OTHER: No significant abnormality noted.

Output: Normal examination without renal lesions.


Instruction: Generate impression based on findings.

Input: Knee pain, loss of range of motion, difficulty with stairs, joint instability, abnormal knee exam. History of meniscal tear age 12, status post surgery. Assess for meniscal tear. The patient's knee would not fit into the high-definition coil and, therefore, an alternative coil was used resulting in suboptimal image quality.MENISCI: There is extensive deformity of the lateral meniscus with moderate attenuation of the posterior horn and marked attenuation of the body as well as displacement of meniscal tissue into the intercondylar notch indicating a bucket handle tear. Furthermore, there is extensive mucoid degeneration of the anterior horn with formation of intrameniscal cyst that extends anteriorly as a parameniscal cyst is noted. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is heterogeneity of the articular cartilage of the lateral compartment indicating degeneration with near full thickness to full-thickness loss of cartilage above the posterior horn of the lateral meniscus. There there are small subchondral foci of signal abnormality in the lateral femoral condyle presumably degenerative in etiology, as well as a cyst in the lateral tibial spine, which is also presumably degenerative in etiology.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Deformity and degeneration of the lateral meniscus including a bucket handle tear as described above.2. Degeneration of the cartilage of the lateral femoral compartment.


Instruction: Generate impression based on findings.

Input: 52 year old with a biopsy proven DCIS in the right breast presents for MRI evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a unifocal non-mass enhancement at posterior upper outer quadrant in the right breast (10:00 position), measuring 20 x 11 x 33 mm (AP x LR x CC) showing rapid uptake. Elsewhere, no abnormal enhancing lesion in the right breast.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal right breast lesion at posterior 10:00 position, consistent with biopsy proven DCIS.2. No MRI evidence for malignancy in the left breast. 3. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: metastatic RCC with new brain mets now s/p radiosurgery; please evaluate response History: brain metastases. Previously seen right posterior temporal lesion is not significantly changed in size measuring 20 x 20 x 19 mm, previously 19 x 18 x 19 mm but demonstrates slight interval increase in intrinsic T1 hyperintensity and slight decrease in enhancement. Interval increase in susceptibility effect is also noted within this lesion consistent with increased blood products.Left posterior frontal lobe lesion demonstrates interval increase in intrinsic T1 hyperintensity and susceptibility consistent with blood products. There is slight decrease in associated enhancement. This lesion measures 20 x 21 x 20 , previously 19 x 20 x 18 mm.No new mass or focus of enhancement is seen to suggest progression of metastatic disease. No new edema, mass effect, midline shift or herniation. No hydrocephalus.There are a few punctate foci of increased T2 signal scattered throughout the cerebral white matter without enhancement or mass effect and are nonspecific. The major cerebral flow voids are intact. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: 1.No significant change in size of the left posterior frontal lobe and right posterior temporal lesions. There is however interval increase in blood products within the lesions and mild decrease in enhancement, findings compatible with treatment-related change. No new lesions or findings to suggest progression of metastatic disease.2.No significant edema or mass effect.


Instruction: Generate impression based on findings.

Input: 47-year-old male with Sjogren's and left orbital mass. Please evaluate interval change. Also has history of sinus disease, frontal sinus retention cyst. Stable postsurgical changes are seen in the left frontal sinus. Stable soft tissue density in the left frontal sinus which again most likely represents a mucous retention cyst versus a polyp. There is increased mucoperiosteal thickening in the ethmoid air cells. Significant mucoperiosteal thickening and retention cyst or polyp formation within the left maxillary sinus. The right exercise also contains a retention cyst or polyp. Ostiomeatal units appear occluded bilaterally. Stable mild nasal septal deviation towards the right. Bilateral orbits are within normal limits. Specifically, no evidence of orbital masses. The left lacrimal gland appears minimally enlarged compared to the right. MRI of the orbits could be obtained if concern for orbital pathology remains.

Output: Increased ethmoid sinus disease with occluded ostiomeatal units bilaterally. No evidence of orbital mass.


Instruction: Generate impression based on findings.

Input: Brain mapping for a stereotactic biopsy. Enhanced head CT:80 cc of Omnipaque 350 is administered for this exam.Stealth infused head CT with 1 mm slice thickness is obtained. Reformatted images are also acquired. This exam is performed with patient with stereotactic frame on head.Examination again demonstrates a large area of CSF collection in the right posterior frontal -- parietal region (likely result of prior partial lobectomy) with suggestion of subtle enhancing mass along its anterior edge similar to prior MRI exam from 4 -- 29 -- 2011. Extensive vasogenic edema in the left posterior frontal -- parietal is also again noted. There is an internal focus of enhancement measuring 14.9 x 19.5-mm in size.No evidence of an additional focus of enhancement.Stable size of ventricular system and no midline shift.

Output: Stereotactic Stealth pulse infused T2 of the brain demonstrate two foci of enhancement one along the anterior aspect of right posterior temporal -- parietal lobectomy and a second one in the right posterior parietal similar to prior MRI exam.


Instruction: Generate impression based on findings.

Input: 61-year-old female with metastatic breast cancer and known brain metastases with new onset atrial fibrillation. Now with mental status change. Evaluate for acute CVA or hemorrhage. Multiple low attenuation areas correspond to vasogenic edema secondary to known metastatic foci are seen involving both cerebral hemispheres. Some of these lesions correspond to those on MRI from 3 months prior, however all cannot be appreciated on this exam. No definite new lesions identified. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Multiple low attenuation areas correspond to vasogenic edema from known brain metastases are seen. MRI is suggested for further evaluation if clinical concern remains for acute CVA.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: Eval GBM. This will be 3 mo post RT. History: GBM on TMZ There is no evidence of acute ischemic or hemorrhagic lesion.There is evidence of left parieto-occipital craniotomy with left occipital tissue defect associated with nodular wall enhancements. The tissue defect size is measured about 30.3mm (AP) x 28.3mm (RL) and 25.1mm (CC). In addition, there are scattered susceptibility artifacts on the peripheral aspect of the cavity and overlying brain surface indicating operation related blood products. At least 3 discrete nodular enhancing lesions are seen on the margin of the resection cavity which are measured about 7-8mm in longest diameter.In particular, there is a focal nodular enhancing lesion at the junction of the resection cavity and left lateral ventricle occipital horn. However, there is no evidence of associated adjacent ependymal enhancement. On FLAIR images, those enhancing lesions are associated with surrounding edema indicating possible residual or recurrent tumors. In particular, there is brain edema on the left corpus callosum splenium. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post resection and post radiation status of the left occipital GBM with at least 3 discrete enhancing nodular lesions on the resection margin as described above.2. Enhancing lesions on the resection margin could represent residual or recurrent tumor.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, inability to access the joint, and failure of medication to relieve pain) 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 left shoulder was localized fluoroscopically, and a spot radiograph was obtained. 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 22-gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 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 saline, 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 the 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: 39 seconds

Output: Successful fluoroscopically guided left shoulder arthrogram and injection of dilute gadolinium. Please see subsequent MRI report for further details.


Instruction: Generate impression based on findings.

Input: 81-year-old male with renal mass. Exam limitations are related to respiratory motion artifacts.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small T1 hypointense and T2 hypointense focus of the upper splenic pole correlates with large calcified granuloma on the 2013 CT exam.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple cysts in the bilateral kidneys. There are multiple bilateral small T2 hyperintense foci that are too small to characterize.In the right kidney, a lower pole exophytic 1.1 cm T1 hyperintense and T2 hypointense lesion demonstrates no contrast enhancement and is favored to be benign. Other: The hyperintense lesions of the right kidney also demonstrate T2 hyperintensity and are felt related to proteinaceous cyst. No hydronephrosis.In the interpolar region of the left kidney, there is a 5 x 4.3 cm lobulated mass that is hypointense on T2, heterogenous on T1, demonstrates contrast enhancement and is concerning for a renal cell carcinoma. No renal vein invasion or left sided retroperitoneal lymphadenopathy is seen.The left kidney also demonstrates multiple T2 hyperintense simple cysts, and a few demonstrate T1 hyperintense signal compatible with proteinaceous material. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: In the anterior aortocaval region, there is a 1.3 x 1.6 cm soft tissue lesion that demonstrates T1 hypointense, T2 hyperintense (axial series 701 image 8), and post contrast enhancement (axial series 1/3/2003 image 68). This lesion is stable in size since the 2013 CT exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large T2 hyperintense and enhancing lesion of the left kidney measuring 5 x 4.3 cm is consistent with a renal cell carcinoma. No renal vein invasion. No regional lymphadenopathy.2.An aortocaval soft tissue lesion measuring 1.3 x 1.6 cm is stable in size since the 1/7/2013 CT exam. Given the stability and imaging features described above a benign etiology such as an extra-adrenal pheochromocytoma or benign nerve sheath tumor is favored.


Instruction: Generate impression based on findings.

Input: Female; 40 years old. Reason: 40 yo F no symptoms with newly Dx chronic pancreatitis by EUS r/o ductal or parenchymal changes of CP History: 40 yo F no symptoms with newly Dx chronic pancreatitis by EUS r/o ductal or parenchymal changes of CP ABDOMEN:LIVER, BILIARY TRACT: Scattered small hepatic cysts. No biliary ductal dilation.SPLEEN: Small splenule inferior to the spleen.PANCREAS: Normal volume and T1 signal of the pancreas. Normal homogeneous enhancement. No pancreatic ductal dilation. Normal physiologic response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral breast implants, partially visualized.

Output: No specific evidence of chronic pancreatitis, as clinically questioned.


Instruction: Generate impression based on findings.

Input: 51 years Female (DOB:1/13/1965)Reason: lateral recess syndrome at L5/S1 1012 ct recommended: HNP History: left and right sciaticaPROVIDER/ATTENDING NAME: JAMES J. CURRAN JAMES J. CURRAN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There are only minor degenerative changes present lumbar spine.


Instruction: Generate impression based on findings.

Input: Clinical question: Repeat study, given motion artifact with prior study, persistent altered mental status for unknown reasons. Signs and symptoms: As above. Nonenhanced brain MRI:Diffusion-weighted images demonstrate a tiny focus of restricted diffusion in the left centrum semiovale measuring approximately 5 mm sized. There is no evidence of hemorrhage in this finding. This finding was also utilized flair sequence as a small focus of hyperintensity.Examination condition demonstrate minimal periventricular white matter flair hyperintensity and a tiny focus of similar signal change in the left external capsule which are suspicious for minute chronic non-hemorrhagic small vessel ischemic strokes.The anatomical morphology as well as the signal intensity of brain parenchyma otherwise remains within normal all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits and paranasal sinuses.

Output: 1.5-mm focus of restricted diffusion in the left centrum semiovale noted on diffusion-weighted images.2.Minute chronic nonhemorrhagic small vessel ischemic strokes as detailed.3.Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Female, 24 years old, with neurofibromatosis type I, hydrocephalus, aqueduct stenosis. Evaluate for changes, tumors, CSF flow through 3rd VC. A right frontal approach ventriculostomy catheter appears to be in stable position. Ventricular size and morphology are stable and within normal limits. Evidence of third ventriculocisternostomy is again seen with CSF flow demonstrated across the defect.An oval, T2 hyperintense, nonenhancing lesion within the left splenium of the corpus callosum has increased in size now measuring 21 x 13 mm, previously 11 x 6 mm. Several additional small T2 hyperintense lesions are also redemonstrated without evidence of progression. In fact, a lesion in the right cerebral peduncle may even be somewhat smaller. As before, some of these lesions enhance, including those within the left temporal lobe, at the left foramen of Monro, and in the tectum. The tectal lesion causes narrowing of the cerebral aqueduct. A nonenhancing potentially cystic focus is redemonstrated in the pineal gland without significant interval change.No significant generalized parenchymal mass effect is seen. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Diffusion-weighted images are within normal limits.

Output: 1.Interval increase in size of the lesion within the left aspect of the splenium of the corpus callosum.2.Multiple additional stigmata of neurofibromatosis including scattered enhancing and nonenhancing lesions are otherwise unchanged, with one lesion perhaps slightly smaller.3.Stable positioning of the right frontal ventricular catheter. Stable ventricular size and morphology. The third ventriculocisternostomy remains patent.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with gait problems and history of obstructive hydrocephalus. No restricted diffusion is seen. Subacute infarction within the left precentral gyrus noted on the prior examination has evolved and now demonstrates chronic appearing T2/FLAIR hyperintensity.Multiple additional foci of periventricular T2/FLAIR hyperintensity are seen with ill-defined hyperintensity is also noted in the pons. These findings have not significantly changed from prior. No pathologic parenchymal or extra-axial enhancement is observed. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. A few scattered foci of susceptibility are seen in association with the left precentral stroke compatible with chronic microhemorrhage.The lateral and third ventricles remain disproportionately enlarged relative to the caliber of the sulci. No interval change is seen in the caliber of the ventricular system. On thin section sagittal imaging, there is no obstruction of the cerebral aqueduct. On CSF flow imaging, robust flow is evident through the cerebral aqueduct, fourth ventricle and foramen of Magendie. A mild blush of flow related signal is also seen adjacent to the foramen of Monro. Robust biphasic CSF flow is seen in the basal cisterns surrounding the brainstem.

Output: 1.Previously seen left precentral infarct has evolved and now appears chronic.2.Evidence of fairly extensive additional microvascular ischemic disease is seen.3.The lateral and third ventricles remain enlarged relative to the fourth ventricle and the sulci which is concerning for normal pressure hydrocephalus. However, no obvious obstructive lesion is seen.


Instruction: Generate impression based on findings.

Input: Clinical history rectovaginal fistula. Flatus with greenish discharge per vagina. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: The soft tissue interface between the rectum and vagina is unremarkable. The distal most aspect of the rectum/anus is not well visualized due to the inherent lack of spatial resolution of MR. No fistulous tract is evident.

Output: No rectovaginal fistula is evident. Complementary fluoroscopic evaluation is also recommended to exclude rectovaginal fistula if clinical suspicion persists.


Instruction: Generate impression based on findings.

Input: 20-year-old female with history of Chiari malformation experiencing chronic headaches and vision changes Brain MRI:Limited diffusion weighted images are negative. Sagittal T1 weighted images demonstrate stable postoperative changes of suboccipital midline craniectomy and removal of posterior arch of C1 for decompression of the foramina magnum. There is expected expansion of thecal sac and no detectable deformity of the cerebellar tonsils. This finding is similar to prior examination. CSF flow demonstrates biphasic flow posteriorly at the level of the foramen magnum and cerebellar tonsils.The signal intensity and morphology of the brain is within normal limits. There is no evidence of hydrocephalus.Metallic artifact overlapping the left occipital bone producing significant amount of ferromagnetic artifact which obscures adjacent brain parenchyma and calvarium. Overall exam demonstrates no interval change since prior study.Cervical spine MRI: Examination redemonstrates expected postoperative changes of suboccipital midline craniectomy and removal of posterior arch of C1 and resultant expansion of thecal sac.The signal intensity and caliber of the cord remains within normal limits with no evidence of syrinx. There are no significant degenerative changes or stenoses.

Output: 1.Stable postoperative changes of suboccipital craniectomy, unremarkable, and stable since prior study.2.MRI examination of cervical spine demonstrates no evidence of syrinx or stenoses.


Instruction: Generate impression based on findings.

Input: Female, 35 years old. Reason: R/O TFCC tear History: pain and loss supination LIGAMENTS: Given the limitations of a non-arthrogram study, the scapholunate and lunotriquetral ligaments appear intact.TRIANGULAR FIBROCARTILAGE COMPLEX: Although we see no fluid signal intensity completely traversing the articular disc of the triangular fibrocartilage, there is increased signal intensity within the articular disc near its attachment to the ulnar styloid that may reflect degeneration or a tear. There is edema within the soft tissues both volar and dorsal to the ulnar styloid and triangular fibrocartilage that may represent recent injury. There is also a small amount of fluid within the distal radioulnar joint with a small focus of intermediate signal intensity volarly within the joint that may represent a small cartilaginous fragment. There is also mild edema within the fovea of the distal ulna. There is slight dorsal translation of the ulna relative to the sigmoid notch of the radius, and we cannot entirely exclude the possibility of a partial thickness tear of the volar radioulnar ligament at its ulnar attachment, although its radial attachment appears intact. The volar ulnotriquetral ligament appears intact. The volar ulnolunate ligament is not clearly seen, but the significance of this is uncertain.TENDONS: The extensor carpi ulnaris tendon is appropriately positioned within its groove. Distal to the ulnar styloid the tendon appears slightly thickened with mild increased intrasubstance signal which may reflect a mild tendinosis, but we see no discrete tear of the tendon. The remaining tendons of the wrist are unremarkable. BONES: A side from the aforementioned mild signal abnormality within the distal ulna, the bones appear normal.ADDITIONAL

Output: Increased signal intensity within the ulnar fibers of the articular disc of the triangular fibrocartilage with edema in the adjacent soft tissues and bone, suggestive of a tear. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Left posterior oral tongue cancer T4a treated with CRT and 2nd primary T1 excised in 2014. Now with thickening and pain. There are post-treatment findings in the left oral cavity region. There is decreased conspicuity of patchy areas of T2 hyperintensity in the left oral tongue. Otherwise, there is no evidence of measurable oropharyngeal mass lesions or cervical lymphadenopathy. There is an unchanged well-defined T2 hyperintense lesion in the left shoulder region, without convincing enhancement. The thyroid gland and remaining salivary glands are unremarkable. There is minimal fluid within the left mastoid air cells. The orbits and imaged intracranial structures are unremarkable.

Output: 1. Post-treatment findings in the left oral cavity region with decreased conspicuity of nonspecific patchy areas of T2 hyperintensity in the left oral tongue. Otherwise, no evidence of measurable oropharyngeal mass lesions or cervical lymphadenopathy. 2. Unchanged well-defined cystic lesion in the left shoulder region.


Instruction: Generate impression based on findings.

Input: GBM on Avastin. There are postsurgical changes of right craniotomy for tumor resection including mild dural thickening and enhancement. The bulk of the heterogeneously enhancing right cerebral hemisphere mass, centered in the deep grey matter nuclei and frontal lobe, appears to have increased in size, with scattered areas of restricted diffusion and susceptibility effect. However, the more peripheral necrotic portions and the surrounding high T2 signal that likely represents at least to some extent vasogenic edema have diminished. The right lateral ventricle and perhaps the third ventricle have increased in size, but the left lateral ventricle remains distended. There is persistent leftward midline shift of approximately 14 mm and right uncal herniation. There is no evidence of acute territorial infarction or hemorrhage. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: The bulk of the enhancing portions of the large right cerebral hemisphere glioblastoma appears to have increased in size, which may be due to tumor progression, but the necrotic components and associated vasogenic edema has diminished, which may be attributable to Avastin.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 64 year old man with history of AL type amyloidosis who has been treated with chemotherapy with previous MRI suggestive of early cardiac involvement. He was referred for repeat cardiac MRI to evaluate for possible progression. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 71 ml/m2 (normal range: 74+/-15), the LVEDV is 151 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 84 ml (normal range 47+/-19), the LV mass index is 59 g/m2 (normal range 85+/-15), and the LV mass is 124 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a focal area of late gadolinium enhancement in the basal inferior subendocardium, which was not seen previously, and the basal inferolateral wall. On the previous study this region was thought to represent fat, but review of images today is consistent with true late gadolinium enhancement. Left AtriumThe left atrium is moderately dilated. There is thickening of the interatrial septum. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 135 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 55 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a right upper lobe nodule which was seen on the previous study; it measures 14mm x 13mm today which is grossly stable compared to last MRI scan. No significant pleural effusion. Small focal inferior splenic hyperintense lesion is also unchanged compared to previous MRI scan, which is reassuring. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF = 55%). There is mild left ventricular hypertrophy (posterior wall thickness 12mm) and septal hypertrophy (11mm) which is stable from previous. There is a focal area of late gadolinium enhancement in the basal inferior and inferolateral wall (present on previous study but thought to represent artifact), suspicious for an infiltrative process in this patient with amyloidosis history.2. Normal RV size and systolic function (RVEF = 59%). 3. Moderate biatrial dilatation with interatrial septal thickening. 4. At least mild mitral regurgitation. 5. Stable appearing right upper lobe nodule and stable splenic hyperintense focus.


Instruction: Generate impression based on findings.

Input: Reason: Septated Renal Cyst Bosniak IIF History: Flank Pain ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion is identified. No evidence of intrahepatic or extrahepatic biliary ductal dilatation. No gallbladder wall thickening or pericholecystic fluid collection.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, largest measuring 2.0 x 1.2 x 2.1-cm in the mid left kidney. There may be fine septation of the largest cyst, which is not visualized very well. There is no contrast enhancement. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral multiple cystic lesions, likely simple cyst. Largest left cyst with possible fine septation but without contrast enhancement, of benign appearance.


Instruction: Generate impression based on findings.

Input: Reason: new onset of pain, difficulty ambulating, Multiple myeloma on active chemotherapy. MENISCI: There is an oblique tear through the posterior body and horn of the medial meniscus which contacts the inferior articular surface. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild grade 1/2 chondral thinning in the medial and lateral tibiofemoral compartments. The articular cartilage in the patellofemoral compartment is intact.There are multiple T2 hyperintense and T1/PD hypointense lesions in the proximal tibia, including in the medial and lateral tibial plateau, which are nonspecific, but given history, are concerning for myeloma lesions, which did not appear to be present on the previous PET/CT. The lesion in the lateral tibial plateau causes overlying cortical destruction of the articular surface (series 7, image 20).LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The medial and lateral collateral ligament complex is normal.EXTENSOR MECHANISM: There is mild abnormal T1 and T2 signal hyperintensity at the insertion of the quadriceps tendon, which may reflect mild tendinopathy.ADDITIONAL

Output: 1.Multiple abnormal focal lesions in the proximal tibia which are concerning for myelomatous involvement, including an area of cortical disruption of the articular surface in the lateral tibial plateau.2.Oblique tear of the posterior horn of the medial meniscus.3.Diffuse muscular edema within the quadriceps and hamstring muscles which is nonspecific, but may reflect denervation injury.4.Mild diffuse interfascial and intramuscular edema surrounding the knee.


Instruction: Generate impression based on findings.

Input: 39-year-old male with seizure status post a partial suprasellar mass resection. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. Right frontoparietal craniectomy with overlying skin staples and surgical drain with adjacent frontal and left temporal pneumocephalus consistent with postsurgical procedure. A small amount of hemorrhage is present in the subarachnoid space and overlying the left cerebellar hemisphere. This examination is nondiagnostic for evaluation of the pituitary sella; for evaluation of residual disease, MRI of the pituitary may be considered.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Postsurgical changes as described above without acute abnormality.2. For evaluation of residual disease MRI of the pituitary may be considered.


Instruction: Generate impression based on findings.

Input: 44 year old male with right ankle pain and knee pain has been unable to bear weight for several days. Evaluate for fracture. TENDONS: The Achilles tendon is unremarkable. The medial tendons of the ankle are unremarkable. The peroneus brevis appears normal. The peroneus longus tendon is markedly attenuated as it courses along the lateral margin of the anterior calcaneus compatible with a near full thickness tear. We see no fluid immediately adjacent to this portion of the tendon and therefore suspect this to be a chronic process. The anterior portion of the tendons appear normal.LIGAMENTS: The ATFL appears irregular, likely representing prior injury. The calcaneal fibular ligament appears intact although intermediate signal within the ligament may represent prior injury. The PTFL is unremarkable. The distal tibiofibular syndesmotic complex appears normal. The deltoid ligament is grossly intact.ARTICULAR SURFACES AND BONE: We see no fracture line. There is mild edema within the talar dome medially with focal loss overlying the cartilage. This could represent a small post traumatic osteochondral defect or simply a manifestation of long standing osteoarthritis. There is slight prominence of the "posterior malleolus" of the distal tibia which may reflect old trauma. There is associated mild subchondral signal abnormality that we suspect is degenerative. There is a small amount of fluid in the tibiotalar joint but no large effusion. There is an os trigonum posterior to the talus with a small cyst anteriorly. ADDITIONAL

Output: 1. Soft tissue swelling that is nonspecific.2. Mild osteoarthritis affects the tibiotalar joint as described above.3. Marked attenuation of the peroneus longus tendon suggesting a near full thickness tear that we suspect is chronic.3. No fracture line is evident.


Instruction: Generate impression based on findings.

Input: 43-year-old female with dyspnea on exertion, obstructive and restrictive pattern on pulmonary function testing, normal ejection fraction. Referred for cardiac MRI to rule out cardiac sarcoidosis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%. The LVEDV is 131 ml (normal range 109+/-23), LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), LVESV is 52 ml (normal range 31+/-10), and LV end systolic volume index is 31 ml/m2 (normal range 18+/-5). The LV mass is 70 g (normal range 114+/-24) and the LV mass index is 41 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native T1 myocardial relaxation time is <1050 which is within normal limits..There is no myocardial iron overload. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RVEDV is 158 ml (normal range 110+/-24), the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVESV is 67 ml (normal range 35+/-13), and the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.Normal sized left ventricle with normal systolic function (LVEF 60%)2.Normal sized right ventricle with normal systolic function (RVEF 58%)3.No late gadolinium enhancement. No evidence of inflammatory or infiltrative disease of the myocardium.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 22 years, Female, Reason: R/O cholangiocarcinoma History: PSC. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Minimally irregularity of the proximal common bile duct is unchanged. Multiple intrahepatic strictures and dilatations are not significantly changed from the prior exam. No suspicious hepatic lesions.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious hepatic lesions.2.Multifocal areas of intrahepatic stricturing and dilatation are not significantly changed from the prior exam and consistent with patient's known history of primary sclerosing cholangitis.


Instruction: Generate impression based on findings.

Input: Other musculoskeletal symptoms referable to limbs(729.89) [729.89] / Dysphagia, unspecified(787.20) [787.20], Reason for Study: ^Reason: see MRA/MRI History: as above There is evidence of restricted diffusion on the left middle cerebral peduncle and anterior inferior aspect of the left cerebellar hemisphere indicating left AICA territorial ischemic infarct. There is no evidence of hemorrhagic transformation.Scattered high signal intensities on periventricular white matter on FLAIR imaging indicating nonspecific small vessel ischemic disease, minimal degree.The ventricles, sulci and cisterns are symmetric and unremarkable.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate tight stenosis on the proximal basilar artery where the right AICA arises but the left AICA is not seen. The distal right vertebral artery completes with the right PICA. Left PICA is not seen. Bilateral intracranial internal carotid arteries shows tortuosity but without significant (more than 50%) luminal stenosis. No definite evidence of intracranial arterial aneurysm was seen.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate slightly smaller left internal carotid artery comparing to that of right with a subtle linear low intensity across the carotid bulb. Therefore, the diagnostic possibilities of relatively smaller size of the left internal carotid artery include normal variation, and secondary changes due to proximal extracranial cervical segment vascular web. If clinically indicated, CT angiography of the neck could be considered. Right common carotid and extracranial internal carotid as well as bilateral vertebral arteries appear to be normal.

Output: 1. Acute ischemic infarct on the left ACA territory without evidence of hemorrhagic conversion. 2. Tight stenosis of proximal basal artery on the origin of the right AICA, the left ACA is not seen. 3. Atherosclerotic changes of intracranial arterial system.4. Relatively smaller luminal diameter of the left extracranial internal carotid artery, diagnostic possibilities include normal variation and proximal arterial web related secondary changes.


Instruction: Generate impression based on findings.

Input: 62-year-old female with history of rectal cancer status post resection on 10/23/2015. Patient presents for restaging. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Again redemonstrated is presacral thickening which was noted on the previous CT examination with evidence of diffusion restriction; this area does not demonstrate enhancement on subtraction images. Right lower quadrant ostomy noted.OTHER: No significant abnormality noted.

Output: 1.Stable presacral thickening as above without evidence of enhancement. This likely represents posttreatment changes.2.No definite evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: Female, 37 years old, with past medical history of cerebral venous thrombosis, originally diagnosed in 2000, not currently on anticoagulation, presenting with progressive headache. No evidence of restricted diffusion is seen. No significant parenchymal edema or mass effect is detected. Mild asymmetric T2 hyperintensity within the left ventral pons was present on the prior examination from 2011 and shows no significant interval change.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular system is normal in size and morphology. Cerebellar tonsillar ectopia is noted, a stable finding.On dedicated MRV imaging, the superior sagittal sinus is of small caliber and not well visualized at its anterior-most extent. The left transverse sinus is not well visualized, and the right shows at least one area of focal caliber change. Collateral venous vessels are evident along both transverse sinuses. The deep cerebral venous system, feeding into the vein of Galen and straight sinus, is prominent. Accounting for differences in scan technique, and for differences between MRV and CTV, no significant or convincing interval change is observed.

Output: 1.No acute intracranial abnormality is suspected.2.MRV imaging demonstrates chronic narrowing of the superior sagittal sinus and transverse sinuses, left more than right, with compensatory engorgement of the deep venous system. This could very well represent the chronic sequelae of prior venous sinus thrombosis or stenosis, but no convincing or significant interval change is appreciated when compared to multiple prior exams.


Instruction: Generate impression based on findings.

Input: Crohn's disease of small intestine with distal obstruction, underweight Crohn's disease a Significantly limited examination due to artifacts on the MR enterography scan.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: Subcentimeter left renal cysts noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ne0 cecum and ileocecal junction is visualized in the right lower quadrant and demonstrates normal caliber. No definite area of wall thickening or abnormal enhancement identified within the large or small bowel loops. The previously described enhancement involving the rectum has significantly reduced.No free fluid or loculated fluid collection. No evidence of bowel obstruction.No evidence of a sinus tract/fistula formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites

Output: Suboptimal interpretation due to artifacts during MR enterography scans.Given these limitations the neo- cecum and ileocecal valve appear unremarkable with normal caliber. No evidence of bowel obstruction. No evidence of abnormal wall thickening or enhancement within the larger small bowel loops.