Instruction: Generate impression based on findings.

Input: Male, 56 years old, with medically intractable right temporal lobe epilepsy. Functional MRI requested for language lateralization. All language paradigms produced reliable language related cortical activation. Language is left dominant. Broca's area is identified as several foci of activation in the left inferior frontal lobe, primarily pars triangularis. Wernicke's area is identified as one or two foci of activation along the posterior aspect of the superior left temporal gyrus.

Output: Successful functional MRI for language lateralization. Language is left dominant.


Instruction: Generate impression based on findings.

Input: 31-year-old female with liver lesions in the setting of NASH. Patient previously had FNH proven by biopsy, which has involuted. Other lesions are growing which was adenoma biopsy. She stopped all oral contraceptive pills. Please evaluate and characterize lesions, particularly the segment 4B lesion. Also prior history of osteosarcoma, AML, and diabetes. ABDOMEN:LIVER, BILIARY TRACT: Diffuse loss of signal intensity of the liver on out of phase imaging most suggestive of hepatic steatosis. Status post cholecystectomy.Multiple faintly T2 weighted hyperintense foci are again noted both lobes of the liver, and these lesions are stable to slightly decreased in size. Reference measurements listed below. Following contrast administration, these lesions demonstrate homogeneous enhancement on arterial phase and remain moderately hyperintense on portal venous and equilibrium phase imaging. The demonstration of avidly enhancing liver lesions against a background of hepatic steatosis may be seen in the setting of liver adenomas, particularly the inflammatory subtype. On the delayed/hepatobiliary phase, these lesions are centrally hypointense with a hyperintense peripheral rim (axial series 4 images 46, 76); FNH lesions typically demonstrate increased signal intensity in the hepatobiliary phase. The reference segment 4B lesion contains subtle focal increased T2 signal intensity, which could represent a central scar as in the case of FNH lesions.SPLEEN: No significant abnormality noted.PANCREAS: Stable small cystic lesion of the pancreatic head most compatible with a side branch IPMN (axial series 3 image 31 coronal series 6 image 26).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.INDEX LESION MEASUREMENTS (Current exam date/time: 8/29/2016 13:00:00)PERIPHERAL RIGHT HEPATIC LOBE LESION: 2.2 x 1.8 cm (Image 39, Series 10); 2.0 x 2.8 cm on prior (4/6/2016) (Image 35, Series 8).SEGMENT 4A LESION: 3.2 x 3.5 cm (Image 75, Series 10); 3.9 x 3.8 cm on prior (4/6/2016) (Image 68, Series 8).SEGMENT 2 LESION: 1.4 x 1.3 cm (Image 44, Series 10).

Output: 1. Bilobar enhancing lesions are stable to slightly decreased in size. Reference measurements listed above. Constellation of imaging characteristics are nonspecific and could represent atypical FNH lesions or atypical adenomas.2. Stable small cystic lesion of the pancreatic head most compatible with a side branch IPMN.


Instruction: Generate impression based on findings.

Input: Diagnosis: Hereditary hemorrhagic telangiectasia. Disorder of brain, unspecified. Other malformations of cerebral vesselsClinical question: 3T Scanner; please evaluate dural based lesion and likely AVM seen on May MRI/MRA for changes, growthSigns and Symptoms: Close surveillance of known lesions. HHT. MRI of the brainNo diffusion weighted abnormalities are appreciated.There is redemonstration of serpiginous flow voids extending in a linear fashion from the central sulcus just lateral to the hand motor area through along the perimedullary veins to the right lateral ventricle. There is associated enlargement of relevant cortical veins and subependymal veins.There is redemonstration of an extra-axial left parafalcine enhancing mass measuring 25x23 mm on coronal imaging and 28x25mm on axial imaging. There is associated susceptibility effect within the lesion. There is no evidence for signal change in the adjacent brain parenchyma. The adjacent superior sagittal sinus is narrowed and possibly occluded.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 left A1 segment is larger than the right A1 segment. The ACOMA is small. There is fetal origin of the left PCA with a large left p1 segment almost as large as the PCOMA. The right PCOMA is small.There is enlargement of the right posterior parietal artery, the right precentral artery and the central arteries associated with cortical and subependymal venous opacification.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.Findings are compatible with a small AVM involving the right central sulcus with both superficial and deep venous drainage. The cortical venous drainage appears to drain anterior to the meningioma. The patient will need to be recalled to include the entire brain on the MRA at no expense to the patient.2.A left parafalcine meningioma is stable in size. It appears to narrow or obstruct the superior sagittal sinus. An MRV would help distinguish between narrowing and occlusion of the superior sagittal sinus if this is clinically relevant. 3.There is not evidence for cerebral edema.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other symptoms involving nervous and musculoskeletal systems(781.99)Dysphagia, unspecified(787.20)Clinical question: alteration in mental status, aphasia, concern for ICH vs massSigns and Symptoms: AMS Since the prior exam the patient has developed additional foci of diffusion restriction. Whereas previously they were more punctate and to a large degree involved watershed zones and cerebellum and patchy foci in the occipital lobes, there is now a larger area of diffusion restriction involving left middle and inferior frontal gyri and another new focus in the medial left occipital lobe involving calcarine cortex.Associated contrast enhancement with some of the infarction has evolved along some of the prior infarctions.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam the patient has developed new foci of infarction involving the left frontal lobe and left occipital lobe as described above in addition to multiple foci of infarction as described above. Please note that some of the areas of infarction are associated with contrast enhancement which is likely related to subacute phase of infarction which is associated with breakdown of the blood brain barrier. This is supported by the evolution of contrast enhancement since the prior exam.


Instruction: Generate impression based on findings.

Input: Syncope. The left parieto-occipital region intraparenchymal hematoma from January 2016 has resolved, leaving encephalomalacia and hemosiderin staining at the site, and there is no evidence of acute infarction or mass. There is diffuse patchy cerebral and pontine white matter T2 hyperintensity and a punctate focus of encephalomalacia in the right thalamus. There is a punctate focus of susceptibility effect in the left cerebellar hemisphere, which may represent a chronic lacunar infarct. There is a small developmental venous anomaly in the right cerebellar hemisphere. There is ex vacuo dilatation of the posterior left lateral ventricle superimposed upon mild diffuse cerebral volume loss. There is no midline shift or herniation. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.

Output: 1. Chronic right thalamus lacunar infarction and what likely represents chronic small vessel white matter ischemic disease, but no evidence of acute infarct. 2. The left parieto-occipital region intraparenchymal hematoma from January 2016 has resolved, leaving encephalomalacia and hemosiderin staining at the site.


Instruction: Generate impression based on findings.

Input: 66-year-old male with weakness and elevated CK to greater than 1000. ROTATOR CUFF: There is a near full thickness bursal surface tear of the supraspinatus tendon just proximal to its insertion on the greater tuberosity without significant retraction. Some of the articular surface fibers can be traced to their insertion on the greater tuberosity. The supraspinatus muscle appears intact. There is thickening and intermediate signal intensity within the infraspinatus consistent with mild tendinosis. The infraspinatus muscle and tendon appear intact. There is thickening and intermediate signal abnormality within the subscapularis indicating mild tendinosis. The subscapularis and teres minor muscle and tendons appear intactSUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Although this examination was not protocoled for evaluation of the glenoid labrum, the labrum appears intact. There is subchondral cyst formation within the humeral head.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Near full-thickness tear of the supraspinatus tendon as described above without significant retraction.2. No fatty atrophy or increased signal abnormality is identified within the imaged musculature of the right shoulder.


Instruction: Generate impression based on findings.

Input: Female 32 years old Reason: anterior vaginal wall cyst- rule out urethral diverticulum History: no symptoms- seen on exam PELVIS:UTERUS, ADNEXA: Note is made of a bicornuate bicollis uterus. There is a 3.1 x 1.6 cm T2 hyperintensity located in the anterior vaginal wall. The epicenter of the lesion is superior to the urethra and there is no definite connection to the bladder or urethra to suggest a diverticulum. The appearance is more suggestive of a Gartner duct cyst. Additional subcentimeter cysts identified within the lower cervix are also suggestive of nabothian cysts.Multiple ovarian follicles are noted. There are cystic lesions in the right adnexa, the largest measuring 3.9 x 2.4 cm, may represent a paraovarian cysts or peritoneal inclusion cysts. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cystic lesion in the superior vagina vault which is most consistent with a Gartner duct cyst.2. Paraovarian cyst versus peritoneal inclusion cyst formation in the right adnexal area.


Instruction: Generate impression based on findings.

Input: 36-year-old female status post left THA. Evaluate for leg length discrepancy. Status post total left hip arthroplasty.Left leg:Acetabular roof to knee length: 45.0 cmKnee to talar dome length: 35.0 cmRight leg:Acetabular roof to knee length: 45.0 cmKnee to talar dome length: 35.0 cm

Output: Leg length measurements as above.


Instruction: Generate impression based on findings.

Input: Back pain For the purposes of numbering, there are 5 nonrib-bearing lumbar vertebral bodies with mild sacralization involving the right aspect of the L5 vertebra. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5 and L5 on S1 with advanced facet arthropathy evident bilaterally at these levels. CT may be helpful to assess for pars defect. Bone marrow signal is benign including T1 hyperintense lesion involving the left posterior aspect of the T12 vertebral body compatible with a hemangioma. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: Minimal disc bulge and mild facet arthropathy. No significant spinal canal or neural foraminal stenosis. L4-L5: There is grade 1 anterolisthesis with disc uncovering, minimal bulge, and mild disc height loss. There is also advanced bilateral facet arthropathy. There is mild to moderate left neural foraminal narrowing. No significant spinal canal or right neural foraminal narrowing at this level. There is however mild spinal canal stenosis just inferior to the L4-L5 disc level involving the lateral aspects of the thecal sac.L5-S1: There is grade 1 anterolisthesis with disc uncovering, dorsal annular fissure, moderate disc height loss, and there is no significant spinal canal stenosis at any level. Advanced bilateral facet arthropathy. There is no significant central canal stenosis. There is partial effacement of the lateral recesses. There is mild to moderate right and no significant left neural foraminal narrowing. Paraspinous soft tissues are unremarkable. Small perineural cysts in the sacrum are incidentally noted.

Output: Degenerative changes at the L4-L5 and L5-S1 levels including advanced bilateral facet arthropathy and grade 1 anterolisthesis at these levels. There is mild narrowing of the spinal canal just inferior to the L4-L5 disc level related to the facet arthropathy. There is also mild to moderate neural foraminal narrowing at the left L4-L5 and right L5-S1 levels. No higher grade spinal canal or neural foraminal stenosis is appreciated.


Instruction: Generate impression based on findings.

Input: 28 year old male with history of Tetrology of Fallot s/p repair and PV replacement who presents for cardiac MRI to evaluate for right and left ventricular function and size Left VentricleThe left ventricle is upper limits of normal in size with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVEDV is 193 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 106 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 80 g (normal range 164+/-36). There is global hypokinesis. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately increased in size with moderately reduced systolic function. The overall RV ejection fraction is 35%, the RV end diastolic volume index is 141 ml/m2 (normal range 82+/-16), the RVEDV is 260 ml (normal range 142+/-31), the RV end systolic volume index is 92 ml/m2 (normal range 31+/-9), and the RVESV is 168 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.The aortic valve is probably bicuspid in morphology; however, a good imaging plane was not able to be obtained when the patient was not having arrhythmia. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThere is a bioprosthetic pulmonic valve present. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a right sided aortic arch with mirror image brachiocephalic branching pattern. The aortic root is dilated in size.Sinus of Valsalva: 48 x 36 mm (5/1/2014: 47 x 35 mm)Sinotubular junction: 35 x 33 mm (5/1/2014: 36 x 33 mm)Ascending Aorta: 29 x 32 mm (5/1/2014: 30 x 29 mm)Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is dilated in size. The LPA has a sharp angulated take off and is significantly narrowed at the ostium; however, there is no evidence of flow acceleration suggesting that the narrowing is not hemodynamically significant. Main pulmonary artery: 41 x 38 mm (5/1/2014: 39 x 38 mm)Right pulmonary artery: 24 x 23 mm (5/1/2014: 20 x 22 mm)Left pulmonary artery: smaller in caliber- 13 x 15 mm (5/1/2014: 16 x 15 mm)Venous AnatomyThe SVC and IVC are normal in size and 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. The left ventricle is upper limits of normal in size with mildly reduced systolic function [LVEF 45%]2. The right ventricle is moderately increased in size with moderately reduced systolic function [35%]3. Probably bicuspid aortic valve morphology3. Aortic root dilation with no evidence of aortic coarctation. No significant change from prior study.4. Pulmonary artery dilation with ostial left pulmonary artery stenosis.5. Bioprosthetic pulmonary valve present6. In comparison to the study performed 5/1/2014, there has been no significant change. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of Chiari decompression, new symptoms, difficulty swallowing and gait changes. Again seen are postsurgical changes of Chiari decompression with occipital craniectomy and cranioplasty. Posterior C1 arch resection is also again seen. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. There is good ventral and dorsal biphasic CSF flow at the foramen magnum. Again seen is prominence of the retrocerebellar CSF space. Multiple T2 hyperintense lesions are noted in the cervical cord, relatively largest at C2 and C7 levels, with smaller lesions including right C4-C5, left C6, and bilaterally at T1. These appear similar to 1/31/2013 without new lesions identified.Mild degenerative changes are seen as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal. Minimal left greater than right foraminal narrowing. C4-5: No significant compromise to the spinal canal. Mild left foraminal narrowing related to uncovertebral hypertrophy.C5-6: Prominent disc osteophyte complex and uncovertebral hypertrophy on the left which results in moderate left-sided neural foraminal stenosis. No significant compromise to the spinal canal or right neural foramina.C6-7: Small disc osteophyte complex, eccentric to the left with minimal left neural foraminal narrowing. No significant spinal canal or right foraminal narrowing..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.

Output: 1. Postsurgical changes of Chiari decompression with preserved CSF flow ventrally and dorsally at the foramen magnum.2. Multifocal T2 hyperintense lesions throughout the cervical cord similar to prior from 1/31/2013, which are nonspecific, but most suggestive of chronic demyelinating disease. Other prior inflammatory processes may also be considered. No new lesions are demonstrated to suggest progression. MRI of the brain with contrast can be considered if there is possibility of active demounting disease in the brain.3. Degenerative changes in the cervical spine including left foraminal disc osteophyte complex at the C5-C6 level which results in moderate left-sided foraminal narrowing. No significant spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Male, 22 years old, with urinary incontinence and back pain. Evaluate for cord compression. Spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal intensity is within normal limits. The spinal cord demonstrates normal morphology and signal characteristics. No cord compression is seen. No epidural abnormalities are present. No significant disc bulge or disc herniation is seen. The spinal canal and neural foramina appear to be patent.

Output: Unremarkable evaluation with no evidence of acute cord compression.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for patellar tendon rupture, other intra-articular knee pathology History: R knee injury, inability to extend, effusion. Due to the patient's body habitus, the high-definition knee coil could not be used. An alternative coil was used resulting in suboptimal image quality.MENISCI: No fluid-filled meniscal tears are evident.ARTICULAR CARTILAGE AND BONE: Evaluation of the articular cartilage is limited. There is moderate degeneration of the articular cartilage of the medial facet of the patella with near full-thickness to full-thickness fissuring. The remainder of the articular cartilage is unremarkable, given the aforementioned limitations.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is rupture of the patellar tendon at its attachment to the patella with a small portion of the tendon remaining attached to the patella, laterally. There is thickening and increased signal intensity of the tendon likely reflecting underlying moderate to severe tendinosis. The rupture results in a gap of just under 1 cm. There is also thickening and intermediate signal intensity within the distal quadriceps tendon suggesting tendinosis. There is also disruption of the lateral retinaculum with fluid from the joint insinuating between the torn retinacular fibers. The medial retinaculum also appears abnormally thickened with linear increased signal intensity traversing its anterior fibers suggesting a tear.ADDITIONAL

Output: 1. Limited study as described above.2. Patellar tendon rupture with additional tearing of the medial and lateral retinacula and tendinosis of the quadriceps and patellar tendons.3. Degeneration of the articular cartilage of the medial facet of the patella.


Instruction: Generate impression based on findings.

Input: weakness There are multiple restricted diffusion lesions on the right right superior and middle frontal gyri indicating acute or subacute ischemic infarctions. Gyriform susceptibility artifacts on GRE within the restricted diffusion area indicate hemorrhagic conversion and corresponding enhancement on post Gad images suggest subacute ischemic infarction related blood brain barrier disruption.High signal intensity lesion on the left precentral gyrus hand motor cortex on DWI is likely to be T2 shine through. 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: Acute or subacute ischemic infarction on the right frontal lobe superior and middle frontal gyri with evidence of hemorrhagic transformation as described above.


Instruction: Generate impression based on findings.

Input: Left shoulder pain after fall ROTATOR CUFF: There is increased signal and thickening of the supraspinatus tendon reflecting moderate tendinosis. There is separation of the anterior fibers of the distal supraspinatus tendon at its insertion reflecting tear of the bursal surface fibers. The articular surface fibers may be intact. There is no evidence of retraction and the supraspinatus muscle is normal.There is mild tendinopathy of the distal infraspinatus tendon however there is no evidence of tear. The infraspinatus muscle is normal.The teres minor tendon and muscle are normal.There is mild insertional tendinosis of the subscapularis tendon without evidence of tear. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: There is severe acromioclavicular arthrosis. Fluid is noted within the subdeltoid bursa anterior to the region of the supraspinatus tear. The glenohumeral joint demonstrates mild osteoarthritic changes.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum appears normal for the patient's age. A small amount of joint fluid is present but there is no sizable effusion. Mild osteoarthritis affects the joint.BICEPS TENDON: There is mild tendinosis of the biceps tendon at the rotator interval without evidence of tear.

Output: Rotator cuff tendinosis with focal tearing of the anterior insertional fibers of the supraspinatus tendon. There is no retraction or atrophy of the supraspinatus muscle. There is no evidence of additional rotator cuff tendon tear; additional findings of the shoulder are described above.


Instruction: Generate impression based on findings.

Input: Ms. Weiner is a 46-year-old woman with a personal history of right breast IDC/DCIS status post lumpectomy in November 20, 2012. Patient received adjuvant radiation and chemotherapy. No current breast related complaints. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes are present within the right lower outer breast.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 84-year-old male with a history of hnc and CRT, compare to previous measurements.Additional history from EMR: Adenoid cystic carcinoma of the right parotid gland (T4aN0), underwent right total parotidectomy and a right selective neck dissection with a rotational skin flap closure on 2/16/12. Redemonstrated are post-operative changes of a previous right parotidectomy without evidence of recurrence. A left parotid 7 x 6 mm T2 hyperintense nonenhancing cystic lesion is again seen which is nonspecific but remains unchanged in size. Chronic denervation changes are again seen in the left masticator space. There is stable nonspecific enhancement of the left petrous apex corresponding to the location of a previous dural based enhancing mass.The ventricles and sulci are prominent but stable, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are stable scattered nonspecific punctate foci of T2/FLAIR hyperintensity which could relate to mild chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is persistent fluid signal again seen within the right mastoid air cells.

Output: 1.Stable MRI of the brain without evidence of new intracranial metastatic disease.2.Stable postoperative changes in the right parotidectomy bed without recurrence 3.Unchanged appearance of the nonspecific subcentimeter cystic lesion in the left parotid gland centrally.4.Persistent nonspecific enhancement along the left petrous apex, adjacent to area of previous dural based mass may reflect post-treatment changes.


Instruction: Generate impression based on findings.

Input: 87 year old man with elevated iron markers, referred for cardiac MRI to evaluate for cardiac iron overload. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 83 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9), the LVESV is 47 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. Based on T2 Star imaging, there is no evidence of myocardial iron overload (T2star 26 msec). There is borderline LVH with LV wall thickness of 10mm.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 62%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 127 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 79 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trace 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 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsT2star value in the liver is 11.4 msec. 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. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 69%.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%.3. There is no evidence of myocardial iron overload. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 99 years Female (DOB:2/17/1917)Reason: Stroke location History: R side weakness and aphasiaPROVIDER/ATTENDING NAME: DAVID G BEISER KOUROSH X REZANIA MRI of the brainFoci of diffusion restriction are present along the left insular cortex extending to the inferior aspect of the left precentral gyrus. Some punctate foci of diffusion restriction are present in the left centrum semiovale.. A 5 mm focus of diffusion restriction is present in the left temporal lobe.There are patchy foci of encephalomalacia present along the inferior aspects of the cerebellar hemispheres bilaterally.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Some patchy lesions which are T2 and FLAIR hyperintense are present in the brainstem. Small T2 and FLAIR hyperintense foci are present in the basal ganglia.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: Exam is degraded by patient motion artifact.Flow within the basilar artery and the distal left vertebral artery is not readily identified. The right vertebral artery and the left vertebral artery both appear relatively small. The posterior communicating arteries appear to supply the posterior cerebral arteries bilaterally.. There is opacification of the distal basilar artery including the superior cerebellar arteries.The left A1 segment is small. Findings suggest an azygos A2 segment. The left middle cerebral artery vasculature is not as readily visualized is the right middle cerebral artery vasculature. There appears to be divisional occlusion along the left middle cerebral artery territory most likely the inferior division. Is partly obscured by patient motion.

Output: 1.Occlusion of the proximal and mid portions of the basilar artery and possibly distal left vertebral artery. The distal basilar artery and the superior cerebellar arteries appear to be supplied from the anterior circulation through the circle of Willis. Please note that the MRA exam is somewhat degraded due to motion artifact. As a result details are less conspicuous. If clinically appropriate and further detail is necessary for clinical management a CT angiogram may be helpful to further evaluate this.2.Findings suggest left middle cerebral artery occlusion at the inferior division. Please note that the MRA exam is somewhat degraded due to motion artifact. As a result details are less conspicuous. If clinically appropriate and further detail is necessary for clinical management a CT angiogram may be helpful to further evaluate this.3.Findings are compatible with acute infarction involving left insular cortex and adjacent aspects of the left centrum semiovale and frontal lobe as well as a small lesion in the left temporal lobe. These are located in the left middle cerebral artery territory.4.Foci of encephalomalacia present along the inferior aspect of the cerebellar hemispheres which are most likely related to prior cerebrovascular event.5.Periventricular and subcortical white matter lesions of a mild degree as well as patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 6.The MRI of the brain exam is limited due to patient inability to cooperate. No susceptibility weighted imaging was performed. No T2 axial or imaging was performed. No axial T1 imaging was performed.


Instruction: Generate impression based on findings.

Input: 59-year-old female with cirrhosis, assess for portal vein thrombosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with nodular contour and fissural prominence. Small amount of perihepatic ascites. No significant change in eccentric filling defect in the main portal vein compatible with nonocclusive thrombus. Status post cholecystectomy.SPLEEN: Spleen is enlarged measuring 16 cm. Small perisplenic ascites.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Thickened left adrenal gland.KIDNEYS, URETERS: 2.6 cm simple cyst in the right inferior pole.RETROPERITONEUM, LYMPH NODES: Mildly prominent periportal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 1.3 cm cystic lesion in the right inferior breast.OTHER: No significant abnormality noted.

Output: 1.Nonocclusive thrombus in the main portal vein as described above is not significantly changed since the prior exam.2.Cirrhotic liver morphology is again noted without suspicious lesions.


Instruction: Generate impression based on findings.

Input: Pain in left knee. Is there a Baker's cyst or other pathology in the posterior knee? Also, what is the sclerotic focus mentioned in the April 22 knee radiograph? Exquisite tenderness and posterior knee with palpation. Evaluation the knee is limited on some sequences by motion artifactMENISCI: There is marked attenuation of the body and much of the posterior horn of the lateral meniscus, presumably reflecting extensive attritional tearing assuming there has not been a prior partial meniscectomy. The tearing also extends anteriorly to involve the inner fibers of the anterior horn of the lateral meniscus. There is also diffuse attenuation of the medial meniscus likely representing chronic attritional tearing in the absence of prior partial meniscectomy. Additionally, however, there is a complete longitudinal (vertical) tear of the posterior horn of the medial meniscus near the red-white junction.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the knee with much of the lateral tibiofemoral compartment devoid of articular cartilage, particularly posteriorly. Abnormal subchondral signal intensity in the lateral femoral condyle and tibial plateau is likely degenerative in etiology. There is also subjective thinning of the articular cartilage of the medial tibiofemoral compartment and moderate degeneration of the articular cartilage of the patellofemoral compartment with focal areas of full-thickness cartilage loss. There are tricompartmental osteophytes. There is an irregularly-marginated cortically-based focus of low signal intensity within the distal femoral metaphysis medially that corresponds to the sclerotic focus seen on recent radiographs. Small foci of high signal intensity are noted adjacent to this abnormality on the fluid sensitive sequences. I suspect that this represents the residua of an involuted benign fibroxanthoma (nonossifying fibroma).LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Severe osteoarthritis, particularly affecting the lateral tibiofemoral compartment.2.Attenuation of the menisci likely represents extensive chronic attritional tearing (assuming there has not been prior partial meniscectomy); there is also a complete longitudinal tear of the posterior horn of the medial meniscus.3.Although I see no Baker cyst, there is a joint effusion with a small amount of fluid extending posteriorly through a small rent in the posterior capsule.4.Predominantly low signal intensity focus within the distal femoral metadiaphysis corresponds to the sclerotic focus seen on radiographs. I suspect that it represents the residua of a involuted fibroxanthoma (nonossifying fibroma).


Instruction: Generate impression based on findings.

Input: Redemonstrated are postoperative changes from L2 through L5 with complete or partial laminectomy present. Two previously demonstrated spinal cord stimulators entering at T12/L1 and L1/2 are not well demonstrated with MRI technique and may has been removed. Correlation with x-ray or CT could help better define.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: Bilateral facet hypertrophy without resulting stenosis, unchanged.L1/2: Mild disc bulge, ligamentum flavum thickening, and bilateral facet hypertrophy. There are no significant stenoses. These findings are unchanged.L2/3: Diffuse disc bulge, endplate spurring, facet hypertrophy, and presumed right incorporated posterior graft material. There is marked bilateral lateral recess and severe bilateral neural foraminal stenosis, unchanged.L3/4: Diffuse disc bulge, endplate spurring, facet hypertrophy, and presumed bilateral incorporated posterior graft material. There is mild central, marked bilateral lateral recess, and severe bilateral neural foraminal stenosis, unchanged.L4/5: Diffuse disc bulge, endplate spurring, facet hypertrophy, and presumed bilateral incorporated posterior graft material. There is severe central, marked bilateral lateral recess, and severe bilateral neural foraminal stenosis. Central and right foraminal stenosis have progressed. L5/S1:Asymmetric bulge to the right, endplate spurring, facet hypertrophy, and presumed bilateral incorporated posterior graft material. There is mild central, moderate right lateral recess, marked right lateral recess, mild left neural foraminal, and moderate to severe right neural foraminal stenosis, unchanged.SI Joints: Partial fusion with osteophytic bridging, unchanged.

Output: 1.L2/3: Marked bilateral lateral recess and severe bilateral neural foraminal stenosis, unchanged.2.L3/4: Mild central, marked bilateral lateral recess, and severe bilateral neural foraminal stenosis, unchanged.3.L4/5: Severe central, marked bilateral lateral recess, and severe bilateral neural foraminal stenosis. Central and right foraminal stenosis have progressed. 4.L5/S1:Mild central, moderate right lateral recess, marked right lateral recess, mild left neural foraminal, and moderate to severe right neural foraminal stenosis, unchanged.


Instruction: Generate impression based on findings.

Input: Effusion and positive McMurray's. MENISCI: There is a complex tear with both radial and vertical components and fragmentation of the posterior horn of the medial meniscus. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is full thickness loss of articular cartilage of the weight-bearing portion of the medial femoral condyle in between the meniscal horns. There is also thinning of the articular cartilage of the weight-bearing portion of the medial tibial plateau along the medial aspect. The articular cartilage of the lateral compartment is intact. There is partial thickness heterogeneity of the lateral facet articular cartilage of the patella compatible with degeneration. The trochlear cartilage is intact. There is mild edema along the medial aspect of the medial tibial plateau.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: Increased T2 signal in the soft tissues anterior to the patellar tendon may reflect a prepatellar bursitis.ADDITIONAL

Output: 1. Complex tearing of the posterior horn of the medial meniscus.2. Chondromalacia as described above.


Instruction: Generate impression based on findings.

Input: Rule out spinal cord compression. History of subacute waxing and waning bilateral lower extremity weakness). There is mild superior endplate deformity at T12 vertebra with adjacent Schmorl's node, which is most likely related to mild chronic compression fracture. There is mild deformity also noted along the superior endplate of T4 vertebral body also likely related to mild chronic compression deformity. Remaining vertebral body and intervertebral disc heights are preserved. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.There are scattered degenerative changes throughout the spine including disc osteophyte complex at C5-C6 and C6-C7 with ligamentum flavum thickening. Small scattered disc bulges involving the lower thoracic spine is noted. The lumbar spinal canal appears developmentally narrowed. There is prominent epidural fat and disc bulges at L4-L5 and L5-S1 levels, with suspected mild to moderate spinal canal stenosis at these levels. There are focal scattered T1 hyperintense areas at multiple vertebral body levels which may represent focal fat or benign hemangiomas.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. Scattered degenerative changes throughout the cervical and thoracic spine but without high-grade spinal canal or neural foraminal narrowingDevelopmentally narrowed lower lumbar spinal canal with prominent epidural fat and disc bulge at L4-L5 and L5-S1, which results in mild to moderate narrowing of the spinal canal at these levels. Further evaluation with dedicated lumbar spine imaging can be obtained as clinically indicated.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: 26-year-old female. Hepatic mass with chronic right upper quadrant pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Patient's known mass near the caudate lobe cannot be well seen on this single phase CT but remains grossly unchanged compared to previous MRI. No evidence of a complication related to this mass such as hemorrhage.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 7 x 4.3 cm cystic mass arising from the right ovary. Further evaluation with pelvic ultrasound is recommended.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change in the patient's known, most likely benign hepatic lesion. This lesion cannot be well seen or measured on this single phase CT.Right ovarian cystic lesion. Further evaluation with pelvic ultrasound is recommended to exclude a cystic ovarian neoplasm.


Instruction: Generate impression based on findings.

Input: 29-year-old female with liver lesions in the left lobe and caudate lobe. ABDOMEN:LIVER, BILIARY TRACT: The liver is mildly prominent in size, though of normal parenchymal appearance otherwise. There is no biliary ductal dilation. Two masses are seen in the liver. A caudate lobe mass measures 3.8 x 3.1 cm. A left hepatic lobe mass measures 2.9 x 1.8 cm. The masses are homogeneously isointense to the background liver on T2 sequences and hyperintense on T1 sequences, without signal dropout on out of phase images. The masses are gently lobulated. The masses demonstrate arterial enhancement on e-THRIVE sequences, with continued enhancement on delayed images. There is a question of a focal linear T2 hyperintensity in the caudate lobe mass, which demonstrates delayed enhancement suggestive of a scar.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abdominal fluid collections are noted.

Output: Two enhancing masses seen in the liver, most likely representing focal nodular hyperplasia.


Instruction: Generate impression based on findings.

Input: Male 21 years old Reason: r/o meniscal or ligamentous tear History: pain MENISCI: There is perhaps mild fraying of the anterior edge of the posterior horn of the lateral meniscus. Otherwise no discrete meniscal tear is identified.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect in the lateral femoral condyle measuring approximately 5 mm in AP dimension, with underlying T2 hyperintense bone edema signal. There is thinning of the articular cartilage of the medial femoral condyle.LIGAMENTS: There is complete rupture of the anterior cruciate ligament. Diffuse yellow is intact. The MCL and LCL are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Complete rupture of the ACL and other findings as described above.


Instruction: Generate impression based on findings.

Input: 65-year-old female with lower back pain and history of non-Hodgkin's lymphoma. Evaluate for metastatic involvement. Multiple areas of increased signal are present on STIR sequence. On the right, there is increased signal within the right acetabulum, right femoral head and neck junction, and greater trochanter with extension into the femoral diaphysis. On the left, there is increased signal within the acetabulum, intertrochanteric region, lesser trochanter, and greater trochanter with extension into the diaphysis.There is also extensive increased signal within the sacrum. The L3, L4, and L5 vertebral bodies are also involved.There is enhancement most prominent in the sacrum and lumbar vertebral bodiesCystic foci are present in the ovaries bilaterally.

Output: Widespread metastatic disease in the lumbar spine, pelvis, and femurs as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Brain parenchymal injury/intraventricular hemorrhage. Signs and symptoms: Head trauma. Nonenhanced brain MRI:Diffusion weighted images demonstrate multiple varying size small foci of restricted diffusion involving the cortex and subcortical white matter of bilateral cerebral hemispheres.Regions of acute stroke demonstrate no evidence of hemorrhagic changes when compared with susceptibility MRI sequences. The largest finding in the right hemisphere is in the right posterior temporal cortex and measuring at approximately 6 x 12 mm in transaxial dimensions. The largest left hemispheric lesion is in the left frontal and partially involves the left insular cortex and measuring at approximately 8 x 9 mm in transaxial dimensions. These lesions are well identified as foci of T1 hyperintense and T2 hyperintense and without significant mass effect.Examination additionally demonstrate focus of acute hemorrhage hemorrhage/hematoma in the midline projecting in an AP semierect tibia at least partially within the corpus callosum and partially within the cisterna velum interpositum and with a small amount of hemorrhage in the right lateral ventricle as was noted on prior head CT.There is extra-axial subdural collection also in the right frontal and temporal convexity with subtle mass effect on the adjacent parenchyma and measuring maximum of 4 mm in thickness. Previously noted on head CT small right sided subdural hematoma along the right tentorial leaf is again noted and measures approximately 2 mm in maximum thickness.Unremarkable images through posterior fossa.Ventricular system remains within normal size and great maintained midline.The signal void of major intracranial arterial branches are identified.Images through the orbits are grossly unremarkable on this nondedicated study.There is extensive (R>L) opacification of mastoid air cells.Paranasal sinuses demonstrate mild sphenoid mucosal thickening.Nonenhanced brain MRA:Patent and unremarkable bilateral vertebral arteries, left PICA, dominant right Aica, basilar artery, superior cerebellar and posterior cerebral arteries and their branches.Patent and unremarkable right internal carotid artery, right anterior and middle cerebral arteries and their branches.Patent and unremarkable left internal carotid, left anterior and middle cerebral arteries.

Output: 1.Multiple scattered foci of restricted diffusion/acute stroke in bilateral cerebral hemispheres without evidence of hemorrhagic changes as detailed/measured above.2.Midline hemorrhage likely partially within the corpus callosum and partially within the cisternal development of positive as well as right lateral ventricle without significant change since prior head CT exam.3.Right frontal and temporal subdural measuring maximum of 4 mm in size is more conspicuous on this exam compared to prior CT.4.Subdural noted on prior head CT along the right tentorial is again identified and stable since prior exam with maximum of 2 mm in thickness.5.Opacification of bilateral mastoid air cells (R>L).6.Grossly unremarkable images through the orbits and paranasal sinuses.7.Unremarkable brain MRA.


Instruction: Generate impression based on findings.

Input: 73-year-old female patient with history of recurrent inflammatory lesions of the brain. Reevaluate inflammatory lesions. There are stable postbiopsy findings in the left cerebellum with residual susceptibility artifact in the left cerebellar hemisphere. Additionally, there is residual mild high T2 signal in the left pons and pontomedullary junction region. There is an unchanged punctate focus of enhancement within the left pons with associated susceptibility artifact. Minimal periventricular T2 hyperintensity is unchanged and may represent chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage or acute infarct. 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. There is fluid within the paranasal sinuses with air-fluid levels. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Stable postbiopsy findings in the cerebellum without evidence of new inflammatory intracranial lesions.2. An unchanged punctate left pontine lesion may represent an underlying vascular malformation, such as a telangectasia, versus sequela of a treated inflammatory lesion.3. Air-fluid levels in the paranasal sinuses is suggestive of acute sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 74 year old woman with history of CAD s/p CABG in 2013, referred for further evaluation of inducible ischemia.MEDICATIONS: ASA, Lipitor, Coreg, Enalapril, Lasix, Nifedipine First Pass PerfusionDuring hyperemia, there were perfusion defects in the apical inferior, mid anterior and anterolateral and basal inferior walls.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. Mild left ventricular hypertrophy with a sigmoid septum. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 68 ml/m2 (normal range: 65+/-11), the LVEDV is 137 ml (normal range 109+/-23), the LV end systolic volume index is 24 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 39 g/m2, and the LV mass is 78 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. Lipomatous hypertrophy of the interatrial septum. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 155 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 70 ml (normal range 35+/-13). 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 mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a pseudo-bovine brachiocephalic branching pattern. Mild atherosclerosis noted in thoracic aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThyroid enlargement is noted. Sternal wires noted. 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. During hyperemia, there were perfusion defects in the apical inferior, mid anterior and anterolateral walls, and the basal inferior walls.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 64%). Mild left ventricular hypertrophy.4. Normal RV size and systolic function (RVEF 55%).5. Mild dilation of the main pulmonary artery.6. Moderate biatrial dilation with lipomatous hypertrophy of the interatrial septum. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 77-year-old female with a left groin mass. Please evaluate. A vitamin E marker overlies the medial aspect of the left anterior thigh which presumably represents the patient's palpable area of concern. There is a lobulated mass of predominantly fluid signal intensity along the anterior aspect of the thigh within the adductor brevis muscle of the adductor musculature, which measures approximately 3.9 x 4.0 x 5.6 cm (TR x AP X CC). There are associated septations which enhance on post contrast sequences. There is an inguinal lymph node along the anterolateral margin of the mass, measuring 6 mm in the short axis, which appears to retain its normal fatty hilum/morphology on coronal images. There are no inflammatory changes in the surrounding soft tissues to suggest an infectious etiology, although this cannot be completely excluded by this examination. No bone marrow signal abnormality is identified. The imaged musculature of the left hip and thigh are otherwise normal in appearance.

Output: 5.6 cm mass along the medial aspect of the left anterior thigh, with fluid signal intensity and enhancing septations suspicious for neoplasm, most consistent with an intramuscular myxoma. A soft tissue sarcoma is considered less likely, but cannot be completely excluded.


Instruction: Generate impression based on findings.

Input: 27-year-old female with BRCA2 mutation. There is heterogeneous amount of fibroglandular tissue in both breasts, which appear symmetric. Moderate parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: NF type 2, deafness, vestibular schwannomas. There are postoperative findings related to bilateral retrosigmoid and right parietal craniotomy. Redemonstrated are numerous supratentorial and infratentorial extra-axial masses, including schwannomas and meningiomas, which are not significantly changed. In particular, the right vestibular schwannoma measures 3.7 x 2.3 x 2.2 cm, previously 3.7 x 2.2 x 2.2 cm and the left vestibular schwannoma measures 1.6 x 0.7 x 0.6 cm, previously also 1.6 x 0.7 x 0.6 cm. The brain parenchyma appears unchanged with mild areas of edema associated with some of the meningioma, particularly at the cerebral convexities. There is no evidence of acute cerebral infarction. The partially imaged intramedullary heterogeneously enhancing lesion within the upper cervical spinal cord appears grossly unchanged and is compatible with an ependymoma.

Output: 1. No significant interval change in the extensive intracranial stigmata of neurofibromatosis type 2, including bilateral vestibular schwannomas.2. Partially imaged ependymoma within the upper cervical spine.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: lung adenocarcinoma staging History: SOB There are multiple susceptibility lesions involving bilateral frontal, parietal lobes and bilateral thalami. These lesions indicate possible abdomen lordosis or petechial small chronic hemorrhages or calcifications.No evidence of acute ischemic or acute hemorrhagic lesion.Patchy periventricular white matter FLAIR/T2 high signal intensity lesions are seen indicating non specific small vessel ischemic disease.There is no abnormal enhancement.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal various sized susceptibility lesions indicating possible cerebral amyloidosis, petechial chronic hemorrhages or calcification.2. Non specific small vessel ischemic disease.3. No acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: cT2N1 nasopharyngeal squamous cell carcinoma treated with TFHx and XRT. There are post-treatment findings in the nasopharyngeal. Thre is no residual measurable right nasopharynx mass. There is also no significant upper cervical lymphadenopathy. For example, a right level 2B lymph node measures 6 x 10 mm. The skull base is intact. The submandibular glands are relatively hyperenhancing, which may be attributable to treatment effects. The parotid glands are unremarkable. There are nonspecific scattered foci of T2 hyperintensity in the imaged cerebral white matter. There is mild scattered paranasal sinus mucosal thickening. There is a small amount of fluid within the right mastoid air cells.

Output: No measurable residual treated right nasopharyngeal carcinoma and no significant upper cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Chiari malformation, headaches. The cerebellar tonsils extend up to approximately 5 mm inferior to the foramen magnum and display rounded morphologies. In addition, there is intact biphasic flow across the foramen magnum, both anteriorly and posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The pituitary gland is unchanged, measuring up to 10 mm in height, which is within normal limits. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal scattered paranasal sinus mucosal thickening.

Output: The cerebellar tonsils extend up to approximately 5 mm inferior to the foramen magnum and display rounded morphologies. In addition, there is intact biphasic flow across the foramen magnum, both anteriorly and posteriorly.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out cord compression. Signs and symptoms: Leg weakness. Nonenhanced thoracic MRI:Examination demonstrates normal signal intensity and alignment of vertebral carotid.There is normal signal intensity and caliber of thoracic cord.There is no appreciable degenerative changes of the spine, spinal canal or neural foraminal compromise at any level.There is no detectable paraspinal soft tissue abnormalities.There is no interval change since prior cord compression MRI study from 6-25-15.Nonenhanced lumbar MRI:Examination demonstrates normal signal intensity and alignment of vertebral column. Minute degenerative disease at L5-S1 is noted. No detectable spinal canal or neural foraminal compromise/stenosis at any level.Normal signal intensity and morphology of the conus and cauda equina.No detectable. Spinal soft tissue abnormalities.

Output: 1.Unremarkable nonenhanced thoracic MRI.2.Unremarkable nonenhanced lumbar MRI.


Instruction: Generate impression based on findings.

Input: Female 49 years old Reason: knee pain, eval for meniscal or chondral injury History: as above. MENISCI: There is a small defect along the undersurface of the inner fibers of the posterior horn of the medial meniscus, indicating a small undersurface tear. Mild increased signal intensity within the posterior horn and body of medial meniscus indicates intrasubstance degeneration. The anterior horn appears normal. There is mild intrasubstance signal within the body of the lateral meniscus indicating degeneration, but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: There is partial-thickness degeneration of the articular cartilage of the medial femoral condyle, above the posterior horn of the medial meniscus. There is also partial thickness degeneration of the articular cartilage of the medial femoral condyle above the anterior horn of the medial meniscus. There is minimal superficial fraying of the articular cartilage of the medial tibial plateau. Mild increased signal intensity of the articular cartilage of the lateral tibial plateau between the meniscal horns is suggestive of mild degeneration. The patellar cartilage appears normal for patient's age.LIGAMENTS: Mild edema type signal along the medial collateral ligament could represent a sprain in the correct clinical context, but the ligament itself appears normal. Lateral collateral ligament complex is intact. The cruciate ligaments are unremarkable. The femoral attachment of the medial patellofemoral ligament is indistinct, but the clinical significance of this is uncertain.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Small undersurface tear of the posterior horn of the medial meniscus.2.Foci of cartilage degeneration as described above.3.Joint effusion and Baker's cyst as described above.


Instruction: Generate impression based on findings.

Input: 50 year-old female with instability and pain ROTATOR CUFF: The muscles and tendons of the rotator cuff appear intact and normal.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is intact without evidence of tear or degeneration. The articular cartilage appears normal.BICEPS TENDON: Normally situated within the bicipital groove.ADDITIONAL

Output: Normal shoulder arthrogram without findings to explain the patient's pain.


Instruction: Generate impression based on findings.

Input: 74-year-old female with right ear pain, right neck pain, right shoulder pain, right suboccipital adenopathy, fever and chills. History of contrast allergy premedication (unreadable wording.) Enhanced CT of soft tissues of neck:Limited view of the intracranial content is essentially unremarkable for patient's stated age of 74.Images through the skull base, cavernous sinuses, paranasal sinuses and bilateral petrous bones are also normal.Very small soft tissue densities within the left external auditory canal is likely secondary to debris.The soft tissues of the suboccipital region demonstrate no evidence of lymphadenopathy as clinically indicated. No abnormality of occipital bone is detected either.Images through the neck demonstrate no evidence of a mass or pathologic adenopathy. The facia planes are well preserved. There is no evidence of any inflammatory changes of soft tissues of neck. There is no abnormal enhancement of soft tissues of neck. There is no evidence of any osseous or cartilaginous erosion. Limited images of mediastinum and upper lung fields are negative for masses or adenopathy.The aortic arch appears a slightly dilated and measures 43.5-mm in its widest visualized portion.Moderate degenerative disk disease at C5 -- C6 and C6 to C7 levels are noted. There is loss of disk height and subtle sclerotic changes of the adjacent endplates. There is a slight reversal of cervical lordosis which may be positional or secondary to degenerative spondylosis. There is partial visualization of the neural foramina in the cervical region. This demonstrate compromise the right neural foramina at C6 -- C7, C5 -- C6 bilaterally and C4 -- C5 on the right. Although this test is not appropriate for evaluation of central spinal stenosis there is no bony central canal stenosis. Considering a provided clinical date of an MRI of cervical spine might be helpful for further evaluation of patient's pain.

Output: 1.No evidence of mass or pathologic adenopathy in the neck.2.No evidence of any inflammatory/infectious process in the neck.3.No detectable suboccipital adenopathy as clinical data indicates.4.Well pneumatized paranasal sinuses, mastoid air cells and middle ear cavities.5.Degenerative disk disease throughout the cervical spine with multilevel neural foramina compromise as detailed above.6.Limited view of intracranial content is essentially unremarkable for patient's stated age.


Instruction: Generate impression based on findings.

Input: There is normal alignment of the cervical spine. The osseous marrow signal is benign. The cord signal is within normal limits. The visualized soft tissues are within normal limits. The visualized flow voids in the neck are patent.C2-3: Unremarkable.C3-4: Unremarkable.C4-5: Minimal left facet arthrosis with no disc herniation, spinal canal or neural foraminal stenosis.C5-6: Unremarkable.C6-7: Unremarkable.C7-T1: Unremarkable.

Output: Unremarkable noncontrast cervical spine with no spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Male, 22 years old, with numbness, twitching limbs, speech difficulty, and headache. A 7 mm, relatively round T2 hyperintense lesion is evident within the left frontal white matter showing no evidence of associated mass effect, restricted diffusion or susceptibility artifact. A much smaller T2 hyperintense lesion is evident within the right periatrial white matterMild CSF prominence at the level of the right choroidal fissure is seen. Brain parenchymal morphology is otherwise within normal limits. No evidence of significant edema or mass effect is detected. No restricted diffusion is seen. No evidence of intracranial hemorrhage is detected. The ventricular system is within normal limits for size.

Output: 1.Two subcentimeter white matter lesions are identified, one within the left frontal lobe and one in the right periatrial region. Although these are not adequately specific to make a definitive diagnosis, the possibility of a demyelinating process should be considered. Imaging follow-up with contrast may be considered as clinically warranted.2.Mild CSF prominence at the level of the right choroidal fissure may represent an anatomic variation or a small choroidal fissure cyst, in any case likely an incidental finding.


Instruction: Generate impression based on findings.

Input: Point tenderness. There is no evidence of cervical spine bone marrow edema of gross ligamentous disruption. The vertebral body heights are preserved. There is multilevel degenerative spondylosis with associated spinal canal and neural foraminal narrowing, particularly at C4-5, C5-6, C6-7 and C7-T1. The spinal cord signal is preserved. There is lack of the usual cervical lordosis, but no spondylolisthesis. There is a left thyroid nodule.

Output: 1. No evidence of cervical spine bone marrow edema of gross ligamentous disruption.2. Multilevel degenerative spondylosis with associated spinal canal and neural foraminal narrowing, particularly at C4-5, C5-6, C6-7 and C7-T1. 3. Left thyroid nodule.


Instruction: Generate impression based on findings.

Input: Sensorineural hearing loss and headache. (Longstanding DM with retinal hemorrhages, now blind in the right eye and decreased visual acuity in the left eye, as well as sensorineural hearing loss of unclear etiology: possible vasculitis.) There is no evidence of significant steno-occlusive lesions in the cerebral arteries. There is also no evidence of cerebral aneurysms. There is a right scleral buckle and intraocular silicone oil.

Output: No evidence of significant steno-occlusive lesions. However, MRA has limited sensitivity for small vessel vasculitis.


Instruction: Generate impression based on findings.

Input: 52-year-old female s/p OLT now with altered mental status status There is patchy restricted diffusion in the pons with questionable mildly restricted diffusion involving the caudate nuclei and bilateral thalami. Corresponding T2 hyperintensity is seen involving the caudate and putamina bilaterally and possibly the medial temporal lobes and hypothalami. The ventricles are not frankly enlarged though they do appear to be 2 to 3 mm larger in caliber when compared to previous CT. There is a thin rim of ependymal T2 hyperintensity along the lateral ventricular margins.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified.

Output: Restricted diffusion is evident in the pons, thalami and questionably the basal ganglia. Abnormal T2 signal intensity is seen in these areas, and also in the hypothalami and medial temporal lobes. Although the ventricles are not frankly dilated, they have increased in caliber by 2 to 3 mm and there is a thin rim of ependymal signal abnormality along the lateral ventricular margins. Some of the above findings could be accounted for by a metabolic derangement, perhaps osmotic demyelination related to osmotic stress, although other metabolic abnormalities are not excluded. On the basis of this examination, a nonspecific encephalitis (infectious, autoimmune or drug related) could also be considered. Findings are not typical for either an ischemic process or classic hepatic encephalopathy. Imaging follow-up with contrast enhanced MRI should be considered if symptoms fail to improve.


Instruction: Generate impression based on findings.

Input: 52 year old female with history of hypertension, coronary artery disease s/p multiple PCI, dyslipidemia and sarcoidosis presenting for cardiac evaluation. MEDICATIONS: aspirin, amlodipine, clopidogrel, rosuvastatin, hydrochlorothiazide, isosorbide mononitrate, losartan and metoprolol First Pass PerfusionDuring hyperemia, the patient has a perfusion defect involving the basal inferior wall, the mid anteroseptal, anterior, anterolateral, inferior, and inferoseptal walls, and the entire LV apex. The perfusion defect is in the usual territory of the LAD and RCA.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 59 ml/m2 (normal range: 65+/-11), the LVEDV is 100 ml (normal range 109+/-23), the LV end systolic volume index is 59 ml/m2 (normal range 18+/-5), the LVESV is 35 ml (normal range 31+/-10), the LV mass index is 40 g/m2, and the LV mass is 69 g. There are no regional wall motion abnormalities present. 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 55%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 108 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 49 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. There is communication between the left and right atria, likely consistent with patent foramen ovale. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The aortic valve is thickened and calcified with evidence of flow acceleration. Correlation with echo suggested to further quantify/ determine severity of aortic valve sclerosis/ stenosis.Mitral ValveThe mitral valve opens widely and there is at least mild, eccentric, mitral regurgitation. The anterior leaflet of the mitral valve was thickened and possibly calcified.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 large lymph node (22mm) in the left axilla. 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. Large perfusion defect/ "ischemia" noted in LAD and RCA territory.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 55%).5. Thickening/ calcification noted on aortic and mitral valves. 6. Small patent foramen ovale is note.7. Large left axillary lymph node noted.When compared to the prior study from 2/2009, there is no longer late gadolinium enhancement present.Findings conveyed to Dr. DeCara.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, 63 years old, with temporal lobe epilepsy. Scattered foci of nonspecific periventricular T2 hyperintensity are seen. No evidence of edema or mass effect is detected. No pathologic intracranial enhancement is observed. The mesial temporal lobe structures are symmetric and free of pathologic signal abnormality. There are small hippocampal sulcus remnant cysts on the left. The ventricles, sulci and convexity subarachnoid spaces are prominent compatible with generalized parenchymal volume loss. No evidence of intracranial hemorrhage or any abnormal extra-axial collection is seen.

Output: No findings are seen which would account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: Abdominal bloating after eating. History of dilated pancreatic duct on outside hospital CT. ABDOMEN:LIVER, BILIARY TRACT: Several liver cysts are noted. The liver is otherwise normal in morphology, size, signal intensity and enhancement without a focal suspicious lesion or intrahepatic biliary ductal dilatation with the common bile duct measuring up to 4 mm. The vessels are patent.Normally distended gallbladder.SPLEEN: The spleen is normal in size, morphology, signal intensity and enhancement without a focal lesion.PANCREAS: The main pancreatic duct is diffusely dilated up to 6 mm but tapers smoothly at the level of the ampulla without a discrete mass lesion or ampullary bulging. No significant pancreatic parenchymal atrophy. Normal post-contrast enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts. No suspicious lesion or hydroureteronephrosis.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: Moderate diffuse dilatation of the main pancreatic duct to the level of the ampulla without a discrete mass lesion or pancreatic atrophy. No significant biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Assess right hip avascular necrosis There is serpentine signal abnormality within the epiphysis of the right femoral head indicating avascular necrosis involving the majority of the subchondral bone. The necrotic bone is of predominantly fat signal intensity on T1-weighted images. A thin curvilinear band of subchondral intermediate signal intensity likely represents a subchondral fracture, but I see no frank articular surface collapse. There is edema of the femoral head extending into the neck and intertrochanteric region. There is a small amount of fluid in the joint, but no large effusion.Similar although slightly less extensive avascular necrosis affects the left femoral epiphysis, with edema of the left femoral head extending into the left femoral neck. There is small amount of fluid in the joint, but no large effusion. The remainder of the bone marrow signal intensity is normal. The sacroiliac joints appear normal. The musculature appears normal. This study was not protocoled for detailed evaluation of the pelvic viscera, but I see no gross abnormalities. There are nodular subcutaneous lesions in the mons pubis which may represent cysts.

Output: Avascular necrosis of the femoral heads and other findings as above.


Instruction: Generate impression based on findings.

Input: Sensory level, gait instability. There is a slight disc protrusion at C4-5, which minimally effaces the anterior thecal sac cerebrospinal fluid. There is no significant neural foraminal stenosis or cord compression at any of the cervical spine levels. There is straightening of the vertebral column is the sagittal plane, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is an incompletely imaged pituitary lesion.

Output: 1. Slight disc protrusion at C4-5, but no significant neural foraminal stenosis or cord compression at any of the cervical spine levels.2. No evidence of demyelinating lesions in the imaged portions of the spinal cord. 2. Incompletely imaged pituitary lesion. Please refer to the recent pituitary MRI report for additional details.


Instruction: Generate impression based on findings.

Input: Female, 21 years old, currently 35 weeks GA, with suspected thymic mass on ultrasound. A solid, homogeneous, relatively T2 hypointense soft tissue structure is present in the anterior mediastinum where is drapes the great vessels and heart most compatible with thymus tissue. The margins of this tissue are well defined and gently curved as would be expected for thymus. The tissue is at most mildly prominent, with a transverse diameter of 38 to 40 mm. This is reasonably close to the reported normative mean of 36 mm for a GA of 35 weeks as assessed by ultrasound (Cho et al., Ultrasound Obstet Gynecol 2007; 29:634-638). No evidence of any invasive features or cystic spaces is seen. The adjacent tissues of the upper thorax are within normal limits. The airway is visualized and is unobstructed from the level of the pharynx to the carina. No other neck masses are seen. The fetal thyroid is identified as a distinct structure and is normal.

Output: No evidence of any pathologic neck or mediastinal mass lesion is seen. The thymus is identified in its normal anterior mediastinal position. The internal consistency of the gland is unremarkable. Size of the gland is in the range of upper normal. No aggressive or concerning features are seen. These findings most likely represent a normal or at most mildly hyperplastic thymus.The adjacent mediastinal structures are unremarkable. In particular, the airway is patent from the pharynx to the carina.


Instruction: Generate impression based on findings.

Input: Cervical images are somewhat limited by patient motion. Within these limitations, post contrast images demonstrate numerous areas of abnormal enhancement, including a few foci within the right inferior cerebellum as seen on prior brain MRI. There is redemonstration of leptomeningeal enhancement along the left greater than right cerebellar sulci. In addition, there is patchy intramedullary cord enhancement most conspicuous along the right ventral C6 level, as well as areas of leptomeningeal enhancement scattered along the cord surface along its entire length. There is a small area of intrinsic T2 hyperintensity within the midline ventral cord at the mid T8 level with enhancement. There is also T2 abnormality along the left ventral aspect of the cord at the T9-T10 and mid T11 levels with enhancement. There is also similar abnormality along the left dorsal mid T12 level. Focal enhancing nodules also seen along some of the distal cauda equina nerve roots caudal to the L3-L4 level. There is focal 5 x 4 mm nodular enhancement in the right lateral thecal sac L1-L2 level presumably associated with a nerve root.The spine is in normal alignment. There is mild disk narrowing at L5-S1 with mild scattered lumbar disk desiccation. The vertebral body and disk heights are otherwise well-maintained. There is a mildly heterogeneous appearance of the marrow signal especially in the cervical and thoracic spine which is nonspecific. The spinal cord is of normal caliber. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L2 level.Throughout the cervical spine, there are mild disk bulges with rightward predominance. There is minimal ligamentum flavum thickening at C5-C6 and C6-C7. There is mild central spinal canal stenosis at C5-C6. There is mild right foraminal narrowing at C3-C4 and C4-C5, as well as bilaterally at C5-C6.There is a trace disk bulge at L2-L3 with left paramedian annular fissure and shallow left foraminal disk protrusion. There is resultant mild/moderate left foraminal narrowing. Additional trace disk bulges noted at L4-L5 with small left distal foraminal/fat lateral annular fissures. Small central annular fissure is also present at L5-S1 with shallow right paracentral disk protrusion which abuts the descending right S1 nerve root.There is moderate fluid opacification of bilateral mastoid air cells.

Output: 1. Diffuse leptomeningeal disease within the spinal canal, with scattered early areas of intramedullary metastatic disease identified along cervical and lower thoracic spine which may in part relate to direct extension from areas of leptomeningeal tumor.2. Redemonstration of known leptomeningeal and parenchymal metastatic disease in the posterior fossa.3. Nonspecific heterogeneous appearance of the marrow signal.4. Mild scattered cervical and lumbar spondylotic changes as detailed above.


Instruction: Generate impression based on findings.

Input: Bilateral forearm pain and upper extremity numbness. There is right C4-5 uncovertebral hypertrophy with moderate neural foraminal stenosis. There is a small posterior disc-osteophyte complex at C6-7 and facet hypertrophy with perhaps mild right neural foraminal stenosis, but no significant spinal canal or left neural foramen stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Right C4-5 uncovertebral hypertrophy with moderate neural foraminal stenosis. 2. Small posterior disc-osteophyte complex at C6-7 and facet hypertrophy with perhaps mild right neural foraminal stenosis, but no significant spinal canal or left neural foramen stenosis.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with weakness. Possible TIA. MRI brain:No convincing restricted diffusion is seen. Numerous scattered periventricular and subcortical foci of T2 hyperintensity are evident within the cerebral hemispheres and brainstem. No evidence of significant edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.MRA brain:No high-grade intracranial stenosis or vascular occlusion is seen. There is mild irregularity of the cavernous ICAs. The ACOM artery is small and unremarkable. Prominent bilateral PCOM arteries are seen. No aneurysm or vascular malformation is suspected.MRA neck:Conventional aortic branching is seen. The origins of the great vessels are not well seen due to technical artifact. The carotid vessels of the neck are free of significant vascular stenosis by NASCET criteria. The origin of the right vertebral artery is not well seen. Otherwise, the vertebral arteries are free of significant vascular stenosis or occlusion.

Output: 1.No acute ischemia or other definite acute intracranial abnormality is seen. Findings compatible with chronic microvascular ischemic disease are evident.2.No significant vascular stenosis or occlusion is detected in the head or neck.


Instruction: Generate impression based on findings.

Input: Syncope and collapse: concern for seizures. There is no evidence of hippocampal sclerosis, heterotopia, intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, brainstem, and cerebellum 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is an area with fat signal characteristics in the right clivus that measures up to 20 mm.

Output: 1. No evidence of potential seizure foci.2. An area with fat signal characteristics in the right clivus likely represents arrested pneumatization of the sphenoid, which is an anatomic variant. Further evaluation via dedicated skull base imaging may nevertheless be useful.


Instruction: Generate impression based on findings.

Input: Hodgkin's lymphoma with left buttock pain, post bone marrow biopsy in February. Now with numbness of left leg. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is some loss of normal lumbar lordosis. Alignment is otherwise within normal limits. The conus medullaris is normal in position. There are multiple small T1 hypointense, T2 hyperintense, and enhancing lesions throughout the lumbar spine and partially visualized lower thoracic spine.Multilevel 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: There is left paracentral disk protrusion with effacement of the left lateral recess which may be impinging on the traversing left L5 nerve root. No central spinal canal or neural foraminal stenosis. Mild facet hypertrophy.L5-S1: There is disk desiccation and small central disk protrusion. No significant spinal canal or neural foramina stenosis. Mild facet hypertrophy.Atrophic native kidneys and right renal transplant partially visualized. Paraspinous soft tissues are unremarkable.

Output: 1. Multiple small osseous lesions throughout the lumbar and visualized lower thoracic spine compatible with known lymphoma. No prior MRI lumbar spine is available for comparison. No pathologic fractures or evidence of epidural tumor. 2. Degenerative changes at the L4-L5 and L5-S1 levels as detailed above. There is left paracentral disk protrusion at L4-L5 which may be impinging on the traversing left L5 nerve root in the lateral recess.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow-up S1 lesion, status post SCT. Signs and symptoms: Left S1 radiculopathy. Pre and post enhanced lumbar MRI:Lower most visualized thoracic spine from T9 inferiorly demonstrate extensive postoperative changes including posterior bilateral transpedicular screw placement at T9, T10, T12 and L1 levels. Extensive artifacts from metallic hardware precludes precise assessment for pathology in this region. There is mild kyphotic deformity centered at L1 vertebrae which appears to be less than compressed. Mild central spinal stenosis at T10 and T11 level is suspected.T12-L1 demonstrate mild disc disease with loss of disc height, mild chronic compression deformity of the superior endplate and unremarkable exam otherwise.L1-L2 demonstrate mild disc disease and loss of disc height, mild chronic compression deformity of superior endplate and a Schmorl's node along the superior endplate. No spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy with resultant mild central spinal stenosis and no neural foraminal compromise.L3-L4 demonstrate mild disc degeneration and loss of disc height, moderate ligamentum flavum and mild bilateral facet hypertrophy. Mild central spinal stenosis without neural foraminal compromise is noted.L4-L5 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum and to a lesser degree facet hypertrophy changes are present. No spinal stenosis however moderate right neural foraminal compromise is identified.L5-S1 demonstrates advanced disc disease and loss of disc height, mild grade 1 retrolisthesis, mild bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis however moderate left and mild right neural foraminal compromise is present.There is a large metal demarcated focus of T1 hypointense and T2/T2 STIR hyperintense signal intensity in the left posterior body of S1 and left pedicle and sacral ala measuring at approximately 25 x 32 mm in transaxial dimensions. The findings demonstrate enhancement and highly suspected of a focus of multiple myeloma considering patient's history. The finding abuts the left S2 nerve root canal however without evidence of extension into the neural foraminal or mass effect on the nerve root. No fracture and no evidence of extraosseous soft tissue enhancement.

Output: 1.Well-demarcated focus of T1 hypointense, T2/T2 Stir hyperintense enhancing mass in the left posterior S1 vertebral body, pedicle and sacral ala suggestive of a metastatic multiple myeloma. No extraosseous spread of tumor.2.Mild central spinal stenosis secondary to degenerative disease at L2-L3 and L3-L4 levels.3.Neural foraminal compromise as detailed per level above.4.Extensive postoperative changes of posterior fusion extending from T9 through L1 with extensive metallic hardware artifact which precludes precise assessment. Within this limitation however mild central spinal stenosis at T10 and T11 is suspected.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with sharp shooting pains and paresthesias. Brain:At most, there may be trace nonspecific T2 hyperintense signal along the left frontal horn. No other focal signal abnormality is detected. No edema or mass effect is observed. Diffusion-weighted images are within normal limits. No findings are seen to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.C-spine:Alinement is anatomic. Vertebral body heights are preserved. No concerning areas of marrow replacement or marrow edema are seen.The visualized spinal cord shows normal signal characteristics throughout. No focal lesions are seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Moderate right and mild left foraminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Severe left and moderate right foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate right foraminal narrowing. C6-7: Loss of disc height with mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.No specific findings are seen in the brain or cervical spine to account for the patient's symptoms.2.Relatively mild multilevel cervical spondylosis is evident but without high-grade spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Symptoms of vague numbness and burning pain involving the arms in recent months. The spinal cord displays normal signal and morphology. The tip of the conus medullaris is located at the L1 level and shifts appropriately between the prone and supine positions. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are no gross dysraphic defects. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. The cerebellar tonsils are mildly low-lying on the limited localizer images that include the cervical spine.

Output: No evidence of syringohydromyelia in the imaged portions of the spinal cord. The conus medullaris is not low-lying and shifts appropriately between the prone and supine positions.


Instruction: Generate impression based on findings.

Input: Female, 77 years old, with lightheadedness multiple falls. Multiple scattered small foci of FLAIR hyperintensity are seen within the cerebral hemispheres. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: 1.Numerous scattered foci of FLAIR hyperintensity are seen which most likely represent chronic microvascular ischemia.2.No definite acute lesions are seen.3.No specific findings are detected to account for the patient's symptoms.