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Melanoma with new brain metastases on CT scan. There is a medial left cerebellar enhancing lesion that measures up to 18 mm, a left lateral cerebellar enhancing lesion that measures up to 10 mm, a left middle frontal gyrus enhancing lesion that measures up to 9 mm, a left superior frontal gyrus lesion that measures up to 6 mm, a left hippocampal tail enhancing lesion that measures up to 4 mm, and a right medial cerebellum enhancing lesion that measures up to 4 mm. There is confluent T2 hyperintensity surrounding the lesions. There is no evidence of intracranial hemorrhage or acute infarct. There is partial effacement of the fourth ventricle. The third and lateral ventricles are not particularly enlarged. There is no midline shift or herniation. There is mild scattered subcortical and confluent periventricular white matter T2 hyperintensity without associated enhancement. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a subcentimeter exophytic cystic lesion in the skin along the left lateral eyelid region, which may represent a hidrocystoma. There is an apical scalp lipoma that measures 7 mm in thickness. There are small bilateral maxillary sinus retention cysts.

Multiple supratentorial and infratentorial metastases with vasogenic edema, but no midline shift or herniation.

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60 years, Female, Reason: eval biliary system, abnormal ERCP at OSH unable to see biliary drainage History: abd pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Common bile duct appears normal. No obstructing lesions or stones. Cholecystectomy clips.SPLEEN: No significant abnormality noted.PANCREAS: No evidence of pancreatic divisum. No ductal dilatation. Normal enhancement of the parenchyma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Normal MRCP status post cholecystectomy.

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60-year-old male patient with probable metastatic disease in the liver on prior CT. Note that examination is limited by technical malfunction during postcontrast imaging. Examination is also limited by patient motion.ABDOMEN:LIVER, BILIARY TRACT: There are numerous increased T2 and DWI signal lesions throughout the liver parenchyma. A reference left lobe lesion measures 1.9 x 1.3 cm (series 601 image 19). Probable focal biliary ductal dilatation in the left lobe of the liver is noted with associated perfusion anomaly, however, this is incompletely evaluated due to contrast timing.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral probable renal cysts.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1.Limited examination due to technical malfunction during postcontrast imaging. Patient should return for postcontrast imaging free of charge. An addendum will be made to the report at that time.2.Numerous lesions within the liver parenchyma with increased T2 and DWI signal raise question of metastases, but are incompletely characterized.3.Probable focal biliary ductal dilatation in the left lobe of the liver is noted with associated perfusion anomaly, however, this is incompletely evaluated due to contrast timing.

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5 years Male (DOB:12/14/2010)Reason: recurrent fevers and back pain, concern for spinal abscess History: recurrent fevers and back painPROVIDER/ATTENDING NAME: HILARY R JERICHO TIFFANY J PATTON Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

1.No compromise to lumbar spinal canal or neural foramina.2.There is no evidence for discitis or osteomyelitis.

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Male, 56 years old, with back pain and left leg pain. Spinal alignment is anatomic. Vertebral body morphology is normal. No concerning marrow replacement or evidence of marrow edema is detected.The visualized spinal cord, conus and cauda equina are unremarkable.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Loss of disc height and disc bulging. Very mild spinal canal narrowing. Severe left and moderate right foraminal narrowing. L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant spinal canal stenosis. Severe right and moderate left foraminal narrowing. L5-S1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.

1.Disc degeneration and posterior element hypertrophy at L3-4 resulting in a mild spinal canal stenosis, severe left and moderate right foraminal narrowing.2.Degenerative findings at L4-5 without significant spinal canal stenosis, but with severe right and moderate left foraminal narrowing.

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Reason: sp tumor resection and sp SRS, yearly surveillance History: sp tumor resection and sp SRS, yearly surveillance BRAINThere is a redemonstration of a mass at the left cerebellopontine angle cistern also identified on the preoperative exam. It is identified on the diffusion weighted images as well as T1 weighted images. It currently measures 21x11mm sagittal dimensions and 13x19 mm axial dimensions. It previously measured 11x16 mm axial dimensions and has been enlarging over the past few years.The patient is status post left suboccipital craniotomy and left cerebellar hemisphere surgery. There is a fluid collection present at the surgical site within the muscle tissues and which is extracranial and measures 50 x 30 mm axial dimensions and 65 x 29 mm, coronal dimensions and 59 x 29 mm, sagittal dimensions. It is stable. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a redemonstration of encephalomalacia involving the left cerebellar hemisphere, as well as some shift of the brainstem and cerebellum towards the right side. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable since the prior exam. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.Incidental note is made of partial empty sella.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.IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea within the IAC. The left sided facial and cochlear nerves and the left-sided trigeminal nerves are not readily identified in the posterior fossa but may be retracted due to scarring. The vestibular nerves are not clearly identified.There is redemonstration of a denervation atrophy of the left masticator space musculature.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.

1.The patient is status post surgery for removal of a left cerebellar medullary angle cistern and cerebellar pontine angle cistern lesion. There are attendant post surgical changes with an extracranial fluid collection at the craniotomy site.2.There is a small mass present at the left cerebellopontine angle cistern, which continues to enlarge and could represent an epidermoid3.The left vestibular nerves and left trigeminal are not identified. The left facial and cochlear nerves are suspected to be retracted at the left cerebellomedullary angle cistern due to scar tissue along the dura. Denervation atrophy of left masticator space musculature.

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Patient with newly diagnosed metastatic breast cancer, evaluate for brain metastasis. There is no evidence of intracranial hemorrhage, suspicious mass, or acute infarct. No abnormal enhancement is noted intracranially. Subcentimeter left frontal lobe cystic lesion is noted, demonstrating suppression on FLAIR sequence with no associated enhancement or mass effect. Differential includes enlarged perivascular space, sequela of prior injury, or other benign cystic lesions. 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. Nonspecific low T1 marrow signal of the calvarium with mild associated enhancement is noted, which can be seen with marrow conversion due to conditions such as chronic anemia. No destructive focal calvarial lesions are noted.There is a T1 hypointense lesion involving the posterior aspect of the C3 vertebral body, which may represent metastasis.

1.No evidence of intracranial metastatic disease.2.T1 hypointense lesion involving the posterior aspect of the C3 vertebral body is suspicious for osseous metastasis. Suggest correlation with bone scan or PET/CT. Dedicated spine MRI may be considered as clinically warranted.3.Diffuse low signal involving the calvarium with mild enhancement. This may be related to marrow conversion such as secondary to chronic anemia; however, this is nonspecific and may also be correlated with bone scan/PET. No focal destructive osseous calvarial lesions are appreciated.

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Preoperative planing for WHO II meningioma. There are postoperative findings related to prior biparietal craniotomy. There are tumors in the treatment bed, which demonstrate decreased enhancement, but have not significantly changed in size. There is persistent extensive vasogenic edema in the adjacent bilateral cerebral hemispheres. There is regional mass effect and mild midline shift to the right. There may also be enhancement in the brain parenchyma along the surgical margins, although this is incompletely characterized given the lack of precontrast images. There is obliteration of the posterior superior sagittal sinus. Skin fiducial markers are present.

Postoperative findings related to prior biparietal craniotomy for prior partial resection of meningioma. There are residual tumors in the treatment bed, which demonstrate decreased enhancement, likely due to recent embolization. Nevertheless, there is persistent extensive vasogenic edema in the adjacent bilateral cerebral hemispheres.

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59 year-old female history of abdominal pain and mass seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: There is no intra or extrahepatic biliary ductal dilatation. Common bile duct measures 5 mm. There is smooth narrowing noted at the pancreatic head, however the distal duct appears normal..The main portal vein, SMV, and splenic vein are thrombosed, likely chronic, with cavernous transformation of the portal vein. There is also extensive increased T2 signal abnormality within the porta hepatis and near the head of the pancreas with delayed enhancement and restricted diffusion. No discrete masses identified.Moderate gallbladder wall thickening, edema, and small amount of pericholecystic fluid.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct measures 3 mm. Abrupt cutoff is noted in the pancreatic head, however the distal duct reconstitutes near the ampulla . No discrete mass or filling defect.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing left renal cyst.RETROPERITONEUM, LYMPH NODES: Prominent para-aortic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1.Chronic thrombosis of the portal, superior mesenteric, and splenic veins with cavernous transformation of the main portal vein. Soft tissue thickening and extensive surrounding signal abnormality including delayed enhancement most likely secondary to combination of scarring/fibrosis and cavernous transformation and less likely due to extrahepatic cholangiocarcinoma given the lack of corresponding significant biliary ductal dilation.2.Gallbladder wall thickening and edema with pericholecystic fluid can be seen in acute cholecystitis, however this appears similar to the prior study, and probably chronic due to the aforementioned fibrosis.

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54 year old woman with AL amyloid who presents for cardiac MRI to evaluate for cardiac involvement. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 133 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 53 g/m2 (normal range 67+/-11), and the LV mass is 110 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Measured T1 value of myocardium 1150msLeft AtriumThe left atrium is mildly dilated. There is lipomatous hypertrophy of the interatrial septumRight VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 42 ml/m2 (normal range 69+/-14), the RVEDV is 124 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 43 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.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.

1. The left ventricle is normal in size with normal systolic function[LVEF 61%]2. Measured T1 value of myocardium 1150ms3. The right ventricle is normal in size and systolic function [RVEF 67%]4. Mild biatrial enlargement5. Lipomatous hypertrophy of interatrial septumI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.

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Reason: leukemia. HA. New binocular History: diplopia. The CSF spaces are appropriate for the patient's stated age with no midline shift. Multiple punctate foci of susceptibility are scattered in the genu, body and splenium of the corpus callosum as well as the periventricular white matter.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Susceptibility artifact partially obscures the eyes.In general the marrow signal is relatively low, however, this is not too unusual in a younger age.

1.Multiple microhemorrhages are present in the genu, body and splenium of the corpus callosum as well as the periventricular white matter. This pattern is rather unusual but has been seen with a prior history of high altitude cerebral edema. Please correlate with clinical history2.No brain stem lesions are appreciated specifically to explain the patient's diplopia.3.Low marrow signal the calvarium is a nonspecific finding and can be seen at younger age but also with myeloproliferative disorders.

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There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are patchy foci of T2 hyperintensity within the supratentorial white matter and brainstem most compatible with chronic small vessel ischemic disease. There are a few punctate foci of susceptibility effect within the supratentorial white matter, including the subcortical white matter and the thalami. 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is a chronic deformity of the left medial orbital wall.

1.No evidence of acute infarct.2.Moderate supratentorial and infratentorial chronic small vessel ischemic disease.3.A few scattered chronic microhemorrhages within the subcortical white matter and deep gray nuclei.

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Low back pain worse with erect spine and generalized leg weakness with walking Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is trace anterolisthesis of L5 on S1. Alignment is otherwise within normal limits. There is mild nonspecific heterogeneity of the bone marrow without destructive lesions. The conus medullaris is normal in position.Multilevel degenerative changes are seen. There is disc height loss at all levels, relatively worse at the L5-S1 level where there is also vacuum phenomena. Small Schmorl's nodes are also evident involving the endplates. Edematous marrow signal changes are noted at the inferior endplate of L4 level. Individual levels as below:L1-L2: No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: Mild disc bulge and endplate osteophytes. Mild facet arthropathy. No spinal canal stenosis. Mild left neural foraminal narrowing. Minimal right neural foraminal narrowing.L3-L4: Mild disc bulge and endplate osteophytes. Mild facet arthropathy. There is no spinal canal stenosis. Minimal left neural foraminal narrowing. No right neural foraminal stenosis.L4-L5: Minimal disc bulge. Bilateral facet arthropathy. No spinal canal stenosis. Minimal narrowing of the neural foramina. L5-S1: Mild retrolisthesis and disc bulge. There is no spinal canal stenosis. Mild facet arthropathy. There is mild narrowing of the bilateral neural foramina. Paraspinous soft tissues are within normal limits.

Degenerative changes throughout the lumbar spine without spinal canal stenosis at any level. There is fairly mild narrowing of the neural foramina at multiple levels as described above. There is generalized facet arthropathy throughout the lumbar spine which may be contributing to patient's back pain.

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Status post right knee arthroscopy microfracture of the medial compartment and patellofemoral joint. Evaluate for healing. MENISCI: There is blunting of the body of the medial meniscus likely reflecting post-surgical changes. Within this remnant, there is new horizontal signal abnormality which may represent a superimposed tear. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is redemonstration of delamination of the articular cartilage of the weight-bearing portion of the medial femoral condyle. Within this area of delamination, there is a new full thickness cartilage defect measuring approximately 1 cm in the AP dimension. There is chondral softening of lateral femoral condyle articular cartilage without full thickness defect. There is mild focal degeneration of the articular cartilage of the lateral tibial plateau along the lateral aspect of the tibial spine. There is significant thinning of the articular cartilage of the medial patellar facet, as well as focal near full-thickness degeneration of the articular cartilage of the lateral patellar facet. There is also full-thickness degeneration of the articular cartilage of the femoral trochlear centrally, with near full-thickness degeneration along the medial and lateral facets.There is interval decrease in bone marrow edema within the medial femoral condyle. LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

1. New full thickness chondral defect within a region of delamination of the medial femoral condyle articular cartilage. 2. New superimposed horizontal tear of the remnant of the body of the medial meniscus.3. Improved medial femoral condyle bone edema.

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46 year old man with a family history of sudden cardiac death referred to rule out hypertrophic cardiomyopathy. Left VentricleThe left ventricle is normal in size with normal systolic function. There is asymmetric thickening of the left ventricular wall. The basal anteroseptum is mildly hypertrophied (IVSd=12mm). The remainder of the myocardium is normal wall thickness (PWd=6mm). The overall LV ejection fraction is 55%, the LV end diastolic volume index is 103 ml/m2 (normal range: 74+/-15), the LVEDV is 217 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 97 ml (normal range 47+/-19), the LV mass index is 87 g/m2 (normal range 85+/-15), and the LV mass is 183 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is epicardial late gadolinium enhancement involving the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. 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 63%, the RV end diastolic volume index is 93 ml/m2 (normal range 82+/-16), the RVEDV is 195 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is norma in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a mild hiatal hernia. 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.

1. Normal left ventricular size and systolic function (LVEF 55%). There is asymmetric thickening of the left ventricular wall; however, strict criteria for the diagnosis of hypertrophic cardiomyopathy are not met. 2. There is a small amount of epicardial late gadolinium enhancement involving the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. 3. Normal right ventricular size and systolic function (RVEF 63%).

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Right shoulder pain and limited mobility ROTATOR CUFF: There is mildly increased signal intensity of the distal fibers of the supraspinatus suggesting tendinosis with perhaps mild bursal surface tearing but we see no fluid-filled full-thickness tear. The supraspinatus muscle is normal. The infraspinatus and teres minor tendons and muscles are normal. There is thinning of the distal subscapularis tendon with probable undersurface tearing. The subscapularis muscle is normal. A cystic focus within the humeral head appears unchanged, of doubtful significance. SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a trace amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Again seen is abnormal signal intensity within the superior labrum indicating a SLAP tear with adjacent small paralabral cyst formation. This appears similar to the prior examination. The inferior labrum is intact. There is a trace amount of fluid within the joint but no joint effusion. Alignment of the glenohumeral joint is normal.BICEPS TENDON: The biceps tendon appears slightly perched upon the lesser tuberosity which may be the result of tearing of the overlying subscapularis tendon. The biceps tendon otherwise appears intact.ADDITIONAL

AC joint osteoarthritis, rotator cuff tendinopathy, and superior labral tearing as described above with no evidence of mass.

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15-year-old male status post blunt head trauma with loss of consciousness. Evaluate for intracranial hemorrhage. Preseptal and periorbital soft tissue swelling on the left. Minimal fat stranding of the retro-orbital fat on the left appear stable. If further evaluation is clinically warranted, an MRI is suggested. The globe appears normal in morphology and density in the anterior and posterior chambers. Extraocular muscles appear intact. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.There is soft tissue swelling overlying the left orbit. There is minimal opacification of bilateral maxillary sinuses. The calvaria and skull base are radiographically normal. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Preseptal and periorbital soft tissue edema on the left with minimal fat stranding a left retro-orbital fat unchanged from prior exam. If further evaluation is clinically warranted, an MRI may be obtained.

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62-year-old female with chronic lateral plantar heel callus. Evaluate lateral plantar heel callus for foreign body. A vitamin E capsule overlies plantar soft tissues underlying the calcaneus presumably representing the site of the patient's palpable abnormality. There is skin thickening in the area underlying the aforementioned marker. There is irregularity of the pad fat of the heel which extends to the superficial fascial plane. There is also a punctate focus of decreased signal abnormality within the skin surface about the superior aspect of the aforementioned marker. These findings are equivocal for a small foreign body. No large foreign body is identified. If further evaluation is clinically warranted, ultrasound examination could be considered. There is no focal fluid collection to suggest abscess formation. There is no susceptibility artifact to suggest a metallic foreign body. There are no inflammatory changed identified in the surrounding area. The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged portions of the deltoid ligament appear intact. There is increased signal abnormality fourth tarsometatarsal joint, likely degenerative in etiology. There is associated subchondral cyst formation. There is a small amount of fluid within the tibiotalar joint without evidence of a large effusion. There is mild increased signal abnormality within the medial aspect of the talar dome, likely degenerative in etiology. No osteochondral defect is identified. There is a trace amount of fluid within the retrocalcaneal bursa.

Equivocal tiny foreign body within the superficial soft tissues of the heel as described above. If there is strong clinical concern for a retained foreign body, further evaluation with a dedicated ultrasound examination could be considered.

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Brain lesions concerning for pancreatic cancer metastasis: work finding difficulties. There is a heterogeneously enhancing mass in the posterior left inferior frontal gyrus that measures up to 35 mm. There is a small amount of susceptibility effect within the tumor, which may represent blood products. There is extensive surrounding vasogenic edema with partial effacement of the left posterior lateral ventricle. However, there is minimal midline shift and no herniation. There is a lobulated lesion in the right parietal white matter that measures up to 12 mm with circumferential susceptibility effect and an associated developmental venous anomaly. There is also a punctate focus of susceptibility effect in the right pons, with corresponding calcification on the prior CT. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

1. A lesion in the left inferior frontal gyrus that measures up to 35 mm likely represents a metastasis.2. A lesion in the right parietal white matter that measures up to 12 mm with circumferential susceptibility effect and an associated developmental venous anomaly likely represents a cavernous malformation.3. A punctate focus of susceptibility effect in the right pons may also represent a cavernous malformation.

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Male 16 years old; Reason: Right knee injury November 2014, patient jumped for a block during basketball, knee buckled, came down and fell, evaluate for ligament injury vs meniscus injury Due to the patient's body habitus, the high-definition MRI coil could not be used. An alternative coil was used, which slightly limits image quality and evaluation. MENISCI: There is a complex tear of the lateral meniscus, with attenuation of the posterior horn and displacement of meniscal tissue into the intracondylar notch. An additional vertical tear is present in the body of the lateral meniscus. There is a complete longitudinal tear of the posterior horn of the medial meniscus, which is seen on 6 consecutive sagittal slices. The body and anterior horn of the medial meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Edema within the lateral tibial plateau likely represents bone contusion. A small subchondral cyst in the posterior aspect of the lateral tibial plateau with minimal depression of the overlying bone plate may represent additional sequelae of prior injury. Mild edema is present in the lateral femoral condyle and medial tibial plateau. Slight depression of the articular surface of the lateral femoral condyle above the free edge of the anterior horn of the lateral meniscus likely represents impaction deformity sustained at the time of injury. Evaluation of the cartilage is limited, but no focal fluid-filled cartilage defect is seen.LIGAMENTS: There is a complete tear of the anterior cruciate ligament. The posterior cruciate ligament is intact. The medial and lateral collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

1. Medial and lateral meniscal tears as described above, with displacement of the lateral meniscus into the intercondylar notch.2. Complete tear of the anterior cruciate ligament.3. Other findings as described above.

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History of renal cancer. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology without focal suspicious lesion. Cholelithiasis within a normally distended gallbladder. No biliary ductal dilatation. Segment VI septated 1 cm cyst.SPLEEN: No significant abnormality noted.PANCREAS: Mild fatty atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Postsurgical changes of a partial left nephrectomy of the lateral interpolar region. No evidence of tumor recurrence in the surgery. No regional lymphadenopathy. Several simple left renal cysts are present, unchanged.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.

Postsurgical changes without evidence of metastases or suspicious lesions.

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9-year-old male with optic nerve glioma, treatment with chemotherapy Orbit MRI: There has been no significant interval change in the minimally enhancing right orbital segment optic nerve glioma with a central cystic component, which again measures up to 7 mm in diameter. The other orbital contents are otherwise unremarkable. Brain MRI: There has been no significant interval change in a non-enhancing T2 hyperintense lesion centered within the left optic chiasm and hypothalamus that again measures up to 10 mm. Additional nonenhancing T2 hyperintense foci that localize to the more posterior portions of the bilateral optic tracks as well as a right periorbital gyrus are also unchanged. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There is mild scattered paranasal sinus mucosal thickening. Mastoid air cells are clear. Expected vascular flow voids are demonstrated.

Unchanged bilateral optic pathway gliomas.

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65-year-old man with history of orthotopic liver transplant, evaluate for HCC. Please note that this study is markedly limited due to susceptibility artifact from the IVC/porta hepatis.ABDOMEN:LIVER, BILIARY TRACT: The partially visualized liver has nodular contour and widened fissures suggestive of cirrhosis. There is a geographic area of increased T2 signal in the right hepatic lobe along with delayed enhancement of this region. There is an approximately 16 x 14 mm round focus of arterial enhancement with washout on delayed phase images (series 103, image 51) in segment 6 of the liver. Restricted diffusion suggested by this focus. Additionally, there is a 10 x 10 mm focus of arterial enhancement with washout on delayed phase images (series 13, image 23) in the dome of the liver.SPLEEN: The spleen appears normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The left adrenal gland appears normal. The right adrenal gland is not visualized.KIDNEYS, URETERS: The left kidney has uniformly increased T2 signal and diffusion restriction. There is no hydronephrosis. The right kidney appears normal. The kidneys enhance symmetrically with normal nephrograms bilaterally.RETROPERITONEUM, LYMPH NODES: There are two large para-aortic masses which are heterogeneous in appearance but predominantly isointense to liver on T1 and T2 sequences. The left-sided mesenteric mass (series 4, image 27) measures 102 x 94 mm. This mass appears nodular, has small areas of high T1 signal suggesting hemorrhage, nonenhancing areas suggestive of necrosis, and peripheral enhancement. The right-sided mesenteric mass (series 4, image 27) measures 117 by 102 mm. This mass also appears nodular with nonenhancing areas suggestive of necrosis and demonstrates peripheral enhancement.The superiormost intrahepatic IVC and the intrahepatic IVC are not visualized.BOWEL, MESENTERY: Loops of small bowel are displaced by the retroperitoneal masses, otherwise the partially visualized small bowel and colon appear normal. The SMV courses anterior to the right retroperitoneal mass and is attenuated in caliber.BONES, SOFT TISSUES: There are multiple small ventral hernias, most of which contain fat, although one of which contains a portion of the transverse colon without evidence of obstruction. The patient is status post median sternotomy.OTHER: Right lung base pleural nodule (series 3, image 6) measures 12 x 11 mm.

1.Examination markedly limited by susceptibility artifact as described above, patient motion artifact noted on several sequences as well. Given the findings below, a contrast-enhanced liver protocol CT should be considered.2.Cirrhotic morphology of the liver with geographic increased T2 signal and delayed enhancement of the right lobe which may represent fibrosis or may be perfusional.3.Foci of enhancement in segments 6 and 8 of the liver as described suspicious for HCC.4.Large retroperitoneal masses which may represent necrotic nodal metastatic disease or PTLD or lymphoma (however these latter conditions considered less likely given the heterogeneous appearance).5.Abnormal signal of the left kidney nonspecific but may be related to an early obstructive process. No hydronephrosis.6.Nonspecific right pleural based lung nodule.

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Low back pain, history of herniated disk and lumbar radiculopathy. There is an eccentric left disc protrusion at L5-S1 that results in mild-to-moderate left neural foraminal stenosis, but no significant right neural foraminal or spinal canal stenosis. There is slight disc bulge at L4-5 with minimal left neural foraminal stenosis. There are fatty and edematous degenerative endplate signal alterations at L4-5 and L5-S1 with loss of fluid signal and loss of height of the discs. There is no significant degenerative spondylosis at the other lumbar spine levels. The vertebral column alignment is within normal limits. The vertebral body are preserved. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable, aside from mild dependent edema in the posterior subcutaneous tissues.

Mild-to-moderate left L5-S1 neural foraminal stenosis related to a disc protrusion.

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Clinical question: Chronic headache, history of left mastoidectomy. Signs and symptoms: Chronic headaches. Pre-and post-enhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates a normal anatomical development/morphology brain parenchyma. There is normal signal intensity brain parenchyma on all MRI sequences. Unremarkable cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Post enhanced images are negative for any abnormal parenchymal, leptomeningeal or calvarial enhancement. There is however a visualization of enhancement of the right frontal small developmental venous anomaly without interval change since prior exam.There is interval significant improvement of post operative changes are left-sided mastoidectomy.Normal signal intensity of all paranasal sinuses, right mastoid air cells and bilateral middle ear cavities. Pre-and post enhanced MRV:The examination demonstrates normal intracranial venous sinuses without evidence of abnormal caliber or in the regions of concern. Bilateral internal cerebral veins, vein of Galen, bilateral veins of Labbe and overall the entire superficial cortical veins remain within normal.

1.Pre-and post enhanced brain MRI demonstrate no evidence of any acute or new finding since prior exam. Unremarkable exam and with revisualization of a small right frontal mental venous anomaly. Interval improvement of post operative changes left mastoidectomy.2.Negative for pre-and post enhanced MRV.

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Ms. Kerulis is a 37 year old female with biopsy proven malignancy of the left breast and metastatic left axillary lymph node. She is currently on the I-SPY 2 research protocol. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left upper outer breast, there is an irregular enhancing mass identified measuring approximately 7.4 x 3.9 x 6.0 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within the central aspect of this lesion, compatible with biopsy-proven malignancy. There is no additional abnormal enhancement identified in the left breast.At least 4 abnormal lymph nodes are identified in the left axilla, the largest of which measures approximately 3.6 cm. Susceptibility artifact from biopsy marker clip is seen within the peripheral aspect of this lymph node, compatible with biopsy-proven metastatic left axillary lymph node.RIGHT BREAST: In the right lower inner breast, there is an oval subcentimeter enhancing mass with internal fat signal intensity identified. This corresponds to the mammographically seen benign morphology mass, and is compatible with a benign intramammary lymph node. No abnormal enhancement is seen in the right breast.No abnormal axillary lymph nodes are identified in the right axillary region.

(1) Biopsy proven malignancy of the left breast with metastatic left axillary lymph node.(2) No MRI evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.

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The floor of the sella is asymmetric, again downsloping towards the right. The rounded area of T2 hyperintensity along the lowered right side of the sella floor measures minimally larger. On the coronal T2-weighted images, the abnormality measures 9 mm in width, compared to 7 mm previously. The significance of this minimal change in size is doubtful given the different angulation between the two examinations resulting in slice selection mismatch. The focal abnormality is still associated with thin, partial rim enhancement and no central enhancement. There is also a contiguous line of ossification separating the lesion from the adjacent sphenoidal body marrow. It is difficult to determine whether this lesion arises from or is external to the pituitary gland. The pituitary gland otherwise continues to show normal, homogeneous enhancement. The pituitary stalk is not deviated. There is no suprasellar mass. There is no mass effect on the optic chiasm.The 5-mm cystic lesion with rim enhancement in the pineal gland is unchanged, most probably representing an incidental pineal cyst.Included brain is unremarkable. An unchanged small contrast enhancing focus involving the frontal bone along the left superior orbital rim is unchanged and probably reflects a small venous lake.

1.The tiny focal signal abnormality along the right side of the floor of the sella is stable to very minimally larger, allowing for differences in technique. While it is still difficult to determine whether this lesion arises from the pituitary gland or is external to it, the lack of significant size change over the one-year interval favors a benign etiology, with unchanged differential. Underlying chronic developmental asymmetry of the sellar floor remains possible.2.Unchanged small incidental pineal cyst.

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49-year-old male with history of bladder cancer, status post partial cystectomy. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Contour deformity from prior partial cystectomy. No focal wall thickening.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Interval resolution of the previously described nonenhancing fluid collection of the right inguinal region.

1.No evidence of metastatic disease.2.Interval resolution of the previously described right inguinal fluid collection.

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MRI Brain:Susceptibility artifact overlying the left anterior frontal lobe slightly limits evaluation for acute ischemia and hemorrhage in this region. There is however no diffusion restriction to suggest acute ischemia. There is also no evidence of acute intracranial hemorrhage or intracranial mass. There is punctate focus of susceptibility consistent with chronic microhemorrhage involving the left inferior lateral cerebellar hemisphere and unchanged. Again seen are postsurgical changes of a left parietal craniectomy. Again demonstrated is extensive encephalomalacia involving the left MCA territory particularly the left lateral frontal, parietal and temporal lobes as well as the insula with associated ex vacuo dilatation of the left lateral ventricle. There is additional underlying mild periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific unchanged and likely related to mild chronic small vessel ischemic disease. Previously seen diffusion abnormality related to subacute infarct at the right temporal occipital junction has normalized consistent with evolution. No hydrocephalus. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. There is attenuation of the distal left MCA branches coursing near the infarcted territory which may reflect decreased demand. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. Left posterior communicating artery is small. The right posterior communicating artery is not definitively visualized. MRA Neck: There is origin of the left common carotid artery from the brachiocephalic artery which is a normal variant. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. There is suggestion of a small atherosclerotic plaque at the left internal carotid artery origin without significant stenosis. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.

1.No evidence of an acute infarct, hemorrhage, or mass effect. 2.Encephalomalacia in the left MCA territory compatible with a chronic infarct again seen. There has been evolution of a small right temporal-occipital infarct which was subacute on prior study from 9/20/2016.3.Diminutive distal left MCA branches in the infarcted territory which may reflect decreased demand. Otherwise, no flow-limiting stenosis involving the intracranial vasculature or the major arteries of the neck.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.

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Male, 38 years old. Neck pain The cranial-cervical junction is normal. There is mild loss of the normal cervical lordosis, but the cervical spine alignment is otherwise anatomic. Vertebral body and disc space heights are preserved. There is endplate marrow edema at C6-7, likely degenerative in etiology. Otherwise, the bone marrow and end plates demonstrate normal MR signal. The signal of the visualized cord is normal, without evidence of cord compression or mass. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: C2-C3: There is no significant neuroforaminal narrowing or spinal stenosis. C3-C4: There is bilateral uncovertebral joint hypertrophy and posterior osteophyte disc complex formation with flattening of the left hemicord without intrinsic cord abnormality there is moderate left foraminal narrowing.C4-C5: There is bilateral uncovertebral joint hypertrophy, posterior osteophyte disc complex formation, and minimal ligamentum flavum thickening with moderate bilateral neural foraminal narrowing and mild spinal canal stenosis.C5-C6: There is left greater than right uncovertebral joint hypertrophy, posterior osteophyte disc complex formation, and minimal ligamentum flavum thickening with moderate to severe left neuroforaminal narrowing, mild to moderate right neural foraminal narrowing, and mild to moderate spinal canal stenosis.C6-C7: There is posterior osteophyte disc complex formation and uncovertebral joint hypertrophy with moderate left and mild right foraminal narrowing and minimal spinal canal stenosis.C7-T1: There is no significant neuroforaminal narrowing or spinal stenosis.

Multilevel degenerative changes involving the cervical spine as detailed above with up to mild-to-moderate spinal canal narrowing at C5-6, up to moderate-to-severe left neural foraminal narrowing at C5-6, and up to moderate right neural foraminal narrowing at C4-5.

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Clinical question: Possible stroke. Signs and symptoms: Left upper and/or extremity weakness. Nonenhanced head CT:Examination demonstrates a large area of vasogenic edema in the right frontal lobe there there is an isodense mass measuring 14 times 17-mm in size within the area of vasogenic edema. There is resultant effacement of adjacent cortical sulci however no midline shift is present. There is no evidence of hemorrhage associated with this finding. A questionable area of low attenuation in the inferior aspect of the left cerebellum may represent an additional focus of edema and or an artifact. Recommend follow-up with an MRI exam.

1.Right frontal lobe tumor measuring 17 times 14-mm in size with surrounding vasogenic edema.2.Either artifact or an additional small foci of edema in the inferior left cerebellum.3.Recommend follow-up with an MRI.

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Female 59 years old; Reason: knee pain and instability MENISCI: There is fragmentation of the posterior horn of the lateral meniscus, with lateral extrusion of the body of the lateral meniscus. Increase signal within the anterior horn of the lateral meniscus likely represents degeneration. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the knee with foci of full thickness cartilage loss in the lateral tibiofemoral compartment and patellofemoral compartment. The lateral facet of the patella and lateral facet of the femoral trochlea are nearly devoid of cartilage. Reactive bone marrow changes and subchondral cyst formation are present in the lateral and midline tibial plateau, lateral femoral trochlea, and throughout the patella. There is mild cartilage degeneration in the medial tibiofemoral compartment, without fluid-filled defects. Tricompartmental osteophytes are present. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

1. Severe osteoarthritic changes, with areas of full thickness cartilage loss, as described above.2. Fragmentation of the posterior horn of the lateral meniscus, with lateral extrusion of the body of the lateral meniscus.

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Male 51 years old with headaches and dizziness and decreased right-sided hearing abnormality. Visual disturbances on the right for the past 2-3 years. No trauma reported. The patient is claustrophobic. Please note that the brain exam does not include diffusion-weighted images, which are considered a standard component of our brain imaging protocol. Within this limitation, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable with no evidence of pathologic signal abnormality. With contrast, there is no evidence of abnormal parenchymal enhancement.No extra-axial collection, midline shift, or hydrocephalus. There appear to be flow voids consistent with patency of the major proximal intracranial arteries. No enhancing extra-axial mass.Paranasal sinuses and mastoids are grossly clear.

Unremarkable evaluation of the brain with no specific findings to account for the patient's symptoms.

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74 years, Female, lung cancer, evaluate for metastasis. Examination slightly motion degraded. There is no intracranial mass or abnormal parenchymal or meningeal enhancement to suggest metastatic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

No evidence of intracranial metastatic disease

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12-year-old with history of Chiari malformation and syrinx. Interval follow-up exam. Cervical spine: Redemonstrated findings of a partially visualized Chiari 1 malformation with extension of the cerebellar tonsils 10 mm below the foramen magnum. There is crowding of the foramen magnum with partially diminished CSF spaces foramen magnum. CSF flow imaging shows diminished but present biphasic flow both anteriorly and posteriorly. Stable syringomyelia of the low cervical spine cord at the C6 and C7 levels which measures 16 mm in the craniocaudal dimension and 2 x 3 mm and axial dimension. There is also trace prominence of the central canal in the mid lower thoracic cord without frank syrinx formation, similar to prior. Redemonstration of decreased signal in the vertebral discs at C2-3 and C3-4 indicating desiccation which is associated with slight reversal of the cervical lordosis. Alignment is otherwise maintained. The vertebral body and intervertebral disc heights are preserved. Bone marrow signal is within normal limits. No significant spinal canal or neural foraminal stenosis.Thoracic spine:Alignment is within normal limits. The vertebral body and intervertebral disc heights are preserved. Bone marrow signal is within normal limits. No significant spinal canal or neural foraminal stenosis. Slight prominence of the central spinal canal as described above, otherwise the cord has normal signal and morphology.Lumbar spine:Alignment is within normal limits. The vertebral body and intervertebral disc heights are preserved. Bone marrow signal is within normal limits. No significant spinal canal or neural foraminal stenosis. The spinal cord has normal signal and morphology throughout. The conus medullaris terminates at the L1-2 level. The filum terminale is normal in appearance.

1. Stable findings of Chiari 1 malformation with the cerebellar tonsils extending 10 mm below the foramen magnum. There are diminished CSF spaces at the foramen magnum with preserved biphasic flow ventrally and dorsally. 2. Stable mild syringomyelia of the cervical spinal cord and trace prominence of the central canal in the thoracic cord.3. No findings to suggest tethered cord.

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25-year-old male with lateral joint line pain, rule out lateral meniscal tear MENISCI: There is a thin vertical band of increased signal intensity traversing the inner fibers of body of the lateral meniscus indicating a radial tear, which we suspect spares the most peripheral fibers. There is also a horizontally oriented band of increased signal intensity within the anterior aspect of the body of the lateral meniscus which may be contiguous with the aforementioned radial tear. The posterior horn of the lateral meniscus and medial meniscus are intact.ARTICULAR CARTILAGE AND BONE: No abnormal marrow signal. The articular cartilage is intact.LIGAMENTS: The ACL and PCL are intact. The MCL and lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Thin radial tear of the body of the lateral meniscus.

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70 year old with palpable lump in the right 2 o'clock position, which had been sampled with FNA with palpation guidance and ultrasound guided core biopsy. FNA result was suspicious for malignancy, and the core biopsy result was benign; dense fibrosis with acute and chronic perivascular inflammation and focal fat necrosis. Problem solving MRI is requested. History of right lumpectomy in 2001 followed by radiation and tamoxifen. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Post-surgical scar with multiple signal voids by the surgical clips is seen in the right upper inner quadrant.Hydromark clip is identified at 2 o'clock position in the right breast, at the site of recent ultrasound guided core biopsy performed on 5/5/15. No abnormal enhancement is present near the Hydromark clip, or elsewhere in the right breast. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.

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Diagnosis: Carpal tunnel syndrome, right upper limb. Carpal tunnel syndrome, left upper limbClinical question: disk disease or post traumatic injurySigns and Symptoms: hand pain The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is mild posterior subluxation of C5 on C6 associated with the diffuse disc bulge, disc desiccation, small central disc protrusion, endplate and uncovertebral osteophytes as well as mild ligamentum flavum hypertrophy. There is effacement of spinal fluid ventral and posterior to the spinal cord at this level and overall mild to moderate degree of spinal stenosis. There is encroachment of the exiting nerve roots within the neural foramina bilaterally due to combination of disc material and osteophytes.At C6-7 there is loss of disc space height, disc desiccation and a disc bulge associated with endplate and uncovertebral osteophytes and encroachment of the exiting nerve roots bilaterally. There is mild hypertrophy of the ligamentum flavum hypertrophy present. There is mild narrowing of the spinal canal at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

1.There are degenerative changes present in the cervical spine with mild to moderate spinal stenosis at C5-6 associated with mild subluxation as well as encroachment of exiting nerve roots bilaterally at C5-6 and C6-7.

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Assess for right L5 radiculopathy. Pain in the right lower extremity Five lumbar type vertebral bodies are presumed to be present. Again seen are postsurgical changes of posterior spinal fusion with hardware extending from the L2 to the S1 levels bilaterally. Paraspinous rods and pedicle screws as well as interconnecting rod at the L3 level are better assessed on prior CT and plain films. Right sacroiliac fusion hardware is also partially visualized.Vertebral body heights are within normal limits. Anterolisthesis of L4 on L5 is again seen as well as minimal anterolisthesis of L3 on L4. Bone marrow signal is benign. The conus medullaris is normal in position.Susceptibility artifact limits evaluation however no high-grade spinal canal or neural foraminal stenosis is appreciated at any level. Nerve roots of the cauda equina appear grossly unremarkable without imaging findings to suggest arachnoiditis.Atrophy of the right psoas muscles again noted.

Postoperative changes of L2-S1 posterior spinal fusion as well as right sacroiliac fusion. Associated susceptibility artifact limits evaluation, however, no high-grade spinal canal or neural foraminal stenosis is appreciated at any level in the lumbar spine. Specifically, no appreciable neural foraminal narrowing at the right L5-S1 level is appreciated. Hardware integrity and position can be better assessed with CT or radiographs.

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Clinical question: Assess for hematoma, either compression of nerve roots, specifically at postoperative T12-L5. Signs and symptoms: L3, L4 and L5 weakness. Pre- and post enhanced lumbar MRI:Moderate dextroscoliosis of lumbar spine centered at L1-L2 level is noted. There is mild right lateral subluxation of L2 on L3 and L3 on L4 levels.T10-T11 demonstrate degenerative changes with mild central spinal stenosis and no significant neural foraminal compromise.T11-T12 demonstrate moderate disc disease without spinal stenosis or significant neural foraminal compromise.T12-L1 demonstrate moderate disc disease and without spinal stenosis or neural foraminal compromise.L1-L2 demonstrate postoperative changes and including a disc space prostheses. No spinal stenosis however mild to moderate left lateral recess and left neural foraminal compromise secondary to scoliosis and asymmetric left-sided hypertrophic changes is noted. There is a tiny left lateral disc protrusion (axial T2 series 501 image 38 and sagittal T2 series 801 image 13) with resultant mild compression effect on the thecal sac is also noted.L2-L3 demonstrate advanced disc disease and significant loss of disc height, no spinal stenosis or neural foraminal compromise. Disc space prosthesis is identified.L3-L4 demonstrate moderate disc disease and loss of disc height, disc space prosthesis is present. There is mild asymmetric right-sided facet hypertrophic changes result in mild to moderate right neural foraminal compromise and no evidence of central spinal stenosis.L4-L5 demonstrate mild disc disease and mild facet and ligamentum flavum hypertrophy. There is a disc space prosthesis at this level. No spinal stenosis or neural foraminal compromise.L5-S1 demonstrate mild disc disease and degenerative changes of posterior elements without spinal stenosis or neural foraminal compromise.There is no evidence of epidural hemorrhage as is questioned clinically.There is mild increased T1 hyperintensity of the right psoas muscle suggestive of fatty infiltrate and possible atrophy. No evidence of spinal hemorrhage or mass effect. The visualized abdominal aorta demonstrate normal caliber and signal intensity.Post enhanced images demonstrate subtle expected enhancement of degenerative changes and including mild enhancement along the adjacent endplates to L1-L2 disc level.

1.Examination demonstrate no findings to account for patient's symptomatology.2.Postoperative changes and including disc space prostheses as detailed above and without evidence of complication.3.No evidence of central spinal stenosis at any level.4.Neural foraminal compromise secondary to degenerative changes and an alternating pattern related to scoliosis as detailed. 5.Expected enhancement of the degenerative changes and unremarkable post contrast images otherwise.

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Clinical question: Evaluate for mass/hydrocephalus/abnormality. Signs and symptoms: Enlarged head. Nonenhanced CT of brain:Significant pan ventriculomegaly with diffuse areas of periventricular low attenuation consistent with transependymal exudate. There is total effacement of cortical sulci and bulge of the brain parenchymal to the patent anterior fontanelle. There is no evidence of intracranial hemorrhage or midline shift. Further evaluation with MRI is recommended. There are no old studies available for comparison.Calvarium is intact however thin secondary to significant hydrocephalus.Visualized mastoid air cells, middle ear cavities, paranasal sinuses and orbits are unremarkable.

Significant pan ventriculomegaly with transependymal exudate of periventricular white matter of bilateral cerebral hemispheres.

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Female, 74 years old, with right-sided weakness. Corresponding to the area of abnormality noted on prior CT, there is restricted diffusion involving the left operculum and insula, as well as the left frontoparietal junction, with smaller scattered foci of diffusion restriction in the left anterior frontal lobe, the temporal lobe and the occipital lobe. Mild T2 hyperintensity is seen corresponding to these areas of restricted diffusion. No significant generalized mass effect is detected. There may be minimal petechial blood product in the infarct region but no frank hemorrhagic conversion is seen.Elsewhere, scattered foci of T2 hyperintensity are seen within the cerebral hemispheres appearing similar to those noted on prior MRI. No abnormal fluid collections are detected. The ventricular system is normal in size and morphology.Abrupt occlusion of the inferior division of the left MCA is seen within the sylvian fissure. No other significant intracranial stenosis is suspected. No aneurysms are detected within the limitations of technique. The region of the ACOM artery is unremarkable. Prominent bilateral PCOM arteries are seen.In the neck, there is moderate narrowing of the right carotid bifurcation but no significant stenosis by NASCET criteria. The carotid system is otherwise unremarkable. The vertebral vessels of the neck are likewise free of significant vascular stenosis.

1.Findings compatible with acute left MCA stroke fusion infarction. No significant generalized mass effect or frank hemorrhagic conversion is seen.2.Abrupt occlusion of the inferior division of the left MCA is seen. Elsewhere, no significant intracranial vascular stenosis is detected.3.No significant vascular stenosis is seen in the neck.

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The last well-formed disk space is referred to as L5-S1. There is a well-circumscribed heterogeneous T1 and high T2 signal lesion in the right iliac bone measuring 12 x 8 mm with an apparent tract extending to the inner cortex of the iliac bone toward the right SI joint space, better visualized on earlier CTs. On prior CT, it has a sclerotic margin and appears to have benign features. It is stable dating back to 11/22/2009. There is normal alignment of the spine with normal osseous marrow signal and vertebral body heights. There is dessication of L4-5 and L5-S1 disks with mild loss of height at L4-5 and moderate loss of height at L5-S1 disks. The conus shows normal signal and caliber, terminating at L1-2.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: No disk herniation or spinal stenosis.L3-4: Minimal disk bulge, mild posterior epidural fat prominence and mild bilateral facet arthropathy causing no significant spinal canal or neural foraminal stenosis.L4-5: Mild disk bulge, facet arthropathy causing no significant spinal canal or neural foraminal stenosis.L5-S1: No spinal stenosis or disk herniation.

Mild multilevel spondylotic changes with no significant spinal stenosis at any level in the lumbar spine.

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New onset bilateral hand numbness over one month with cervical radiculopathy. Bilateral C5-C6 radiculopathy. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is grade 1 anterolisthesis of C3 on C4 measuring 4 mm. There is minimal anterolisthesis of C7 on T1. Alignment is otherwise maintained. Bone marrow signal is within normal limits. Subtle cord signal abnormality suspected at C3-C4. Cord signal and morphology is normal at the other levels.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina. Partial effacement of the dorsal thecal sac related to ligamentum flavum thickening. Bilateral facet arthropathy.C3-4: There is moderate to severe spinal canal stenosis with mild flattening of the cord related to disc osteophyte complex including a central protrusion. Grade 1 anterolisthesis also contributes. There is mild right and moderate left neural foraminal stenosis. There is moderate degree of bilateral facet arthropathy with fluid distention involving the facet joints.C4-5: Small disc osteophyte complex and ligamentum flavum thickening contribute to mild spinal canal stenosis. There is also mild right neural foraminal narrowing. Bilateral facet arthropathy.C5-6: Minimal disc osteophyte complex. No significant compromise to the spinal canal or neural foramina. Mild facet arthropathy.C6-7: No significant compromise to the spinal canal or neural foramina. Mild facet arthropathy.C7-T1: No significant compromise to the spinal canal or neural foramina. Mild facet arthropathy.Paraspinous soft tissue structures appear within normal limits. Partially empty sella incidentally noted which can be normal variant in this age group.

1. Degenerative changes in the cervical spine particularly at the C3-C4 level, where anterolisthesis, disc osteophyte complex, and ligamentum flavum thickening contribute to moderate to severe spinal canal stenosis. There is subtle associated cord signal abnormality suspected at this level.2. There is mild right and moderate left neural foraminal stenosis at C3-C4 as well as mild spinal canal and mild right neural foraminal narrowing at C4-C5.

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Female, 12 years old, with rapidly changing scoliosis, headaches and syncopal events. Evaluate for Chiari malformation, syringohydromyelia, and tethered cord. Brain:Brain parenchymal morphology is within normal limits. No evidence of Chiari malformation or any other structural abnormality is seen. No parenchymal signal abnormality, edema or mass effect is observed. No intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The pineal gland is slightly prominent though it measures less than 1 cm in diameter and if anything this simply represents a benign pineal region cyst. The left lateral ventricle is slightly larger than the right, but this is within the limits of normal variation.Spine:A scoliotic curvature of the spine is seen, though this is better assessed on prior radiographs. The sagittal alignment of the spine is otherwise unremarkable. A normal complement of vertebral bodies is present. Vertebral body morphology and signal characteristics are within normal limits. The intervertebral discs are preserved. No spinal canal or foraminal stenosis is detected.The spinal cord demonstrates normal signal intensity and morphology. The conus tip terminates at the L1 level which is normal. The nerve roots of the cauda equina disperse evenly through the thecal sac. No fatty filum terminale or other intraspinal fatty lesion is seen. No epidural abnormality is suspected. On prone imaging, there is anterior displacement of the conus and cauda equina.

1.Unremarkable evaluation of the brain. At most there may be a mild pineal region cyst which requires no specific follow-up.2.Apart from scoliosis, unremarkable evaluation of the spine. No evidence of Chiari malformation, syringohydromyelia or tethered cord.

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

Interval decrease in size of the pituitary macroadenoma.

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Diagnosis: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: 24 hr post L MCA strokeSigns and Symptoms: stroke MRI of the brainThere is a focus of diffusion restriction present involving left inferior frontal gyrus, left insular cortex and left middle frontal gyrus with some extension into the lateral aspect of the left precentral gyrus and a small component in the left inferior parietal lobule supramarginal gyrus. There are associated FLAIR and T2 signal changes. There is a focus of susceptibility effect present along the left inferior frontal gyrus anteriorly. This focus of susceptibility measures 18 x 9 mm axial dimensions on the T2 axial images.A small focus of encephalomalacia is present along the right occipital lobe the lower portion of the cuneus and region measuring approximately 15 x 20 mm in sagittal dimensions.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal 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 demonstrate mucosal thickening in the right maxillary sinus associated with a small right maxillary sinus. There is depression of the floor of the right orbit and the medial deviation of the medial wall of the right orbit. The visualized portions of the mastoid air cells are clear. MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.There is fetal origin of the posterior cerebral arteries bilaterally associated with small P1 segments. The A1 segments are similar in size. The anterior communicating artery appears small. The left vertebral artery is slightly larger than the right vertebral artery. There is thickening of the walls of the right vertebral artery along its proximal intracranial segment and distal extracranial segment without significant stenosis.

1.Subacute infarction in the left middle cerebral artery territory as detailed above associated with the a small area of hemorrhagic conversion.2.Small focus of encephalomalacia is present along the right occipital lobe. Most likely this is related to remote cerebral infarction. Please note that there is fetal origin of the posterior cerebral arteries.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.Findings suggest an old right orbital blowout fracture.

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62 year old with history of hypertension, diabetes, and acute lymphoblastic leukemia presenting for evaluation of left ventricular systolic dysfunction.MEDICATIONS: metoprolol succinate, lisinopril, hydralazine First Pass PerfusionDuring hyperemia, there is a small perfusion defect in the basal infero-septal and possibly extending to the mid-inferoseptal slice. 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 mildly reduced systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 57 ml/m2 (normal range: 74+/-15), the LVEDV is 95 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 48 ml (normal range 47+/-19), the LV mass index is 40 g/m2, and the LV mass is 67 g. The systolic dysfunction is global.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 68 ml/m2 (normal range 82+/-16), the RVEDV is 113 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 54 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 FindingsBilateral small pleural effusions. 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.

1. There is a small defect in the basal infero-septum (possible extending to the mid-inferoseptum). 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and mildly reduced systolic function (LVEF 50%).4. Normal RV size and systolic function (RVEF 52%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.

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Abdominal painEXAMINATION: MR Abdomen/MRCP without and with IV contrast date ABDOMEN:LIVER, BILIARY TRACT: The hepatic ducts, cystic duct, and common bile duct are normal in course and caliber.PANCREAS: The pancreatic duct is not visualized on this exam.Significant interval decrease in size of the retroperitoneal fluid collection, consistent with a pancreatic pseudocyst, status post drainage. Cystogastric communication device in place along the posterior wall of the stomach adjacent to the fluid collection. Patency of the device cannot be assessed on this exam. The main residual collection now measures approximately 3.8 x 2.4 x 3.5 cm (series 401, image 16; series 301, image 17). An additional small component of fluid collection lying lateral to the left kidney measures approximately 3.5 x 1.5 cm (series 501, image 24), and appears to communicate with the previously described collection.The pancreatic tail is not well visualized, but the remainder of the pancreas enhances normally.SPLEEN: Decreased local mass effect on the splenic vessels. The splenic vein is now patent.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant mass-effect by the residual collection on the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal bowel wall thickening or evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1.Significant decrease in size of a pancreatic pseudocyst status post drainage device placement. Patency of the drain cannot be assessed on this exam.2.The pancreatic duct is not visualized on this exam.3.Decreased mass effect on the splenic vasculature. The splenic vein is now patent.

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Clinical question: Evaluate for cervical stenosis or foraminal stenosis. Signs and symptoms: LUE paresthesia and hyperreflexia. Nonenhanced cervical spine MRI:The alignment of the vertebral column is anatomical.There is uniform generalized small caliber of the cervical spinal canal which is believed to represent a congenital anatomic variation of the short pedicle.Foramen Magnum is unremarkable.C2 -- C3 is unremarkable.C3 the C4 is unremarkable.C4--C5 demonstrate mild degenerative changes with result in mild to moderate right neural foraminal compromise however without spinal stenosis or neural foraminal compromise. There is a tiny linear T2/T2 stir hyperintensity within the fundus of the disk in the midline and to the right consistent with a tiny annular fissure. This finding is best appreciated on sagittal T2 stir images 7 and 8 and axial T2 series 6 on image 21. C5 -- C6 demonstrate mild disk disease and loss of disk height. There is a tiny focus of T2 hyperintensity laterally on the right (sagittal T2 stir series 3 image 5 and axial T2 series 6 image 27) suspicious for small disk extrusion or annular fissure. There is moderate bilateral neural foraminal compromise secondary to degenerative changes. Mild degenerative changes at this level in combination with congenitally small canal results in mild central spinal stenosis at this level.C6 -- C7 demonstrate a small left lateral disk protrusion (sagittal T2 stir image 8 and axial T2 series 6 images 30 and 31). There is moderate left and mild right neural foramina compromise without central spinal stenosis.C7 -- T1 is unremarkable.Unremarkable signal intensity and caliber of cervical and uppermost visualized thoracic cord.

1.There is uniformly smaller caliber of the cervical spinal canal which represent a congenital anatomical variation.2.Mild degenerative changes at C5 -- C6 in combination with congenitally small canal results in central spinal stenosis only at this level.3.Tiny disk extrusion or annular fissure on the right at C5 -- C6 is noted.4.Shallow broad-based disk protrusion on the left at C6 -- C7 with moderate left neuroforaminal compromise.5.Multi-level neural foraminal compromise as detailed per level above.6.Normal signal intensity and caliber of cervical cord.

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Altered mental status. Evaluate for acute stroke. There is a punctate focus of diffusion restriction in the right thalamus. There is no evidence of intracranial hemorrhage or mass effect. There is mild parenchymal volume loss. There are scattered areas of abnormal T2 hyperintensity within the periventricular white matter, consistent with chronic small vessel ischemic changes. There is no midline shift or herniation. There is opacification of the right maxillary sinus and to a lesser degree left maxillary sinus with low T2 signal and remodeling of the right medial maxillary sinus wall. There is deformity of the right lamina papyracea, likely from prior blowout fracture. The skull and extracranial soft tissues are otherwise unremarkable. Incidentally noted is a partially empty sella. There are bilateral lens implants.

1. Acute right thalamic microinfarct.2. No evidence of intracranial hemorrhage or mass effect.3. Opacification of the bilateral maxillary sinuses. Based on comparison to an MRI from 6/6/2003, this most likely represents inspissated secretions and is chronic. Please correlate with patient's clinical history and symptoms.

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29 years, Male, headache, evaluate Chiari decompression and syrinx. Additional history per chart, hx of SAH as child, chiari decompression, cervical syrinx, SVT, LPS & VPS presents with 3 week history of worsening headache, worsening nausea, blurred vision & gait instability. Brain: Again seen are postoperative findings related to right PICA aneurysm clipping as well as suboccipital craniotomy for Chiari decompression. There is artifact related to the aneurysm clip, which obscures the surrounding anatomy. There is encephalomalacia and susceptibility effect in the right caudate head likely related to prior hemorrhage. The ventricles are not significantly changed in size and configuration compared to 8/12/2015 MRI, with a left transparietal ventricular shunt catheter unchanged in position. Prior additional ventriculostomy tracts are also evident. There is no evidence of acute infarction. The cerebellum assumes an unchanged position and configuration. Unchanged signal abnormality involving the right cerebellar tonsil consistent with post treatment change. Susceptibility artifact related to aneurysm clip limits assessment for CSF spaces and flow dorsally at the foramen magnum; there is however preserved ventral CSF space at the foramen magnum with preserved biphasic flow.Cervical and Thoracic Spine:There is no significant change in size of the cervicothoracic syrinx. For example the syrinx at the C1-C2 level measures 2 x 5 mm in the AP and transverse dimensions, not significantly changed. In the lower cervical cord the syrinx occupies the right aspect of the cervical cord as before. There may be minimal decrease in component of the syrinx. For example at the mid C6 level, syrinx measures approximately 2.5 mm in the AP dimension, previously 2.7 mm. No significant change in the caudal extent of the syrinx which is at the lower T10 level. Unchanged reversal of cervical lordosis. Moderate degree of thoracic scoliosis with apex at approximately the T8 level is again noted and better assessed with standing radiographs. There is no significant spinal canal stenosis at any level. Bone marrow signal is benign.

1. Compared to prior brain MRI from 8/12/2015 there is no significant change in findings of Chiari decompression and left parietal ventriculostomy. Unchanged caliber of the ventricular system. Also evidence of prior right PICA aneurysm clipping.2. Compared to prior spine MRI from 8/12/2015 there is overall no significant change in the caliber or craniocaudal extent of the syrinx, although there are levels where the syrinx measures minimally smaller than prior.

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Male, 60 years old, with low right-sided back pain, getting worse over the past one year. Minimal anterolisthesis of L3 relative to L4 is seen without change. Spinal alignment is otherwise anatomic. Mild chronic wedging of the anterior aspect of the T11 vertebral body is again seen. Vertebral body heights are otherwise within normal limits. No evidence of marrow replacement is observed. Mild edema is evident centered on the L4-5 facet complexes, similar to prior. The visualized distal spinal cord and conus are within normal limits. No epidural abnormalities are suspected. Disorganization of the cauda equina nerve roots is seen likely secondary to spinal canal stenosis at the L3-4 level.T11-12: Facet arthropathy and disc bulging. No significant spinal canal or foraminal stenosis.T12-L1: Mild disc bulging. A superimposed left paracentral disc extrusion is new. Mild generalized spinal canal narrowing with effacement of the left ventral thecal sac, new from prior. No significant foraminal narrowing.L1-2: Unremarkable. L2-3: Mild facet arthropathy. Ligamentum flavum thickening. Mild disc bulging with a superimposed left foraminal and far lateral protrusion, unchanged. No significant generalized spinal canal stenosis. Mild left foraminal narrowing, unchanged. L3-4: Facet arthropathy. Ligamentum flavum thickening. Disc bulge. Severe generalized spinal canal stenosis with effacement of CSF and crowding/impingement of the nerve roots of the cauda equina, unchanged. Mild lateral foraminal narrowing, unchanged. L4-5: Facet arthropathy. Ligamentum flavum thickening. Bulging disc with a superimposed left foraminal and far lateral protrusion which has increased in size. Moderate generalized spinal canal stenosis, particularly affecting the left lateral recess. Moderate left foraminal narrowing, unchanged. L5-S1: Facet arthropathy. No significant spinal canal or foraminal stenosis.

1.Severe spinal canal stenosis at L3-4, caused by a combination of posterior element hypertrophy and disc bulging, has not significantly changed.2.A left paracentral disc extrusion at T12-L1 is new, though it causes only mild effacement of the thecal sac. A left foraminal/far lateral protrusion at L4-5 has also increased in size though the resulting left foraminal stenosis is unchanged.

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Female, 71 years old, history of colon cancer with severe right greater than left back pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen. The distal spinal cord and conus are within normal limits. No pathologic intrathecal enhancement is seen. A left renal cyst is noted incidentally.L1-2: Minimal disc bulging. No significant compromise of the spinal canal or neural foramina. L2-3: Mild left facet arthropathy. Minimal disc bulging. No significant compromise of the spinal canal or neural foramina. L3-4: Mild bilateral facet arthropathy. Mild disc bulging. No significant compromise of the spinal canal or neural foramina. L4-5: Moderate bilateral facet arthropathy and ligamentum flavum thickening. An extruded or sequestered disc encroaches upon the right lateral recess through the length of the L4 vertebral body. The source of this herniation is difficult to identify with certainty, but it probably arises from the L4-5 disc rather than the L3-4 disc. The descending right L4 nerve root is likely displaced and impinged by this process. There is a moderate generalized spinal canal stenosis with some crowding of the cauda equina. There is a moderate to severe stenosis of the right neural foramen. L5-S1: Moderate bilateral facet arthropathy and ligamentum flavum thickening. Bulging disc. Mild generalized spinal canal stenosis. Moderate left and mild right foraminal narrowing.

1.An extruded or sequestered disc is evident effacing the right lateral recess along the L4 vertebral body. The source of this herniation is more likely to be the L4-5 disc rather than the L3-4 disc. The descending right L4 nerve root may be displaced or impinged by this process. There is, in addition, a moderate generalized spinal canal stenosis at L4-5.2.Mild degenerative findings are seen at other levels with no additional areas of significant spinal canal compromise.3.No evidence to suggest osseous metastases.

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Headache and thoracic and lumbar pain and left arm shaking and numbness after MVA. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: The spinal cord displays normal signal and morphology and the conus medullaris is unremarkable. There is no evidence of tumors within the spinal canal. The vertebral column alignment is within normal limits. There are a few small Schmorl nodes in the lumbar spine. The vertebral body and disc space heights are otherwise preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

1. No evidence of gross intracranial structural abnormalities. 2. No evidence of spinal cord lesions.

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Ms. Lee is a 47-year-old female who is BRCA1 positive. Family history of breast cancer in maternal grandmother, maternal great grandmother, maternal aunt and several maternal cousins. Personal history of benign left breast MRI guided biopsy in 2012. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Previously identified high probability benign focus of enhancement in the right upper inner breast is no longer appreciated on today's examination. There is no new abnormal enhancement identified in either breast.No abnormal axillary lymph nodes are identified in either axillary region.

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

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Floor of mouth cancer. There is an ill-defined lesion in the anterior floor of mouth that measures up to approximately 15 mm. There is a cluster of small posterior level 2B lymph node, which appear to be somewhat prominent in terms of signal characteristics. There is otherwise no evidence of significant cervical lymphadenopathy based on size criteria. The major salivary glands are unremarkable, although there is herniation of the left sublingual gland through a mylohyoid defect. There is a punctate cystic nodule in the left thyroid lobe. There is multilevel degenerative cervical spondylosis. The imaged intracranial structures are unremarkable. There are bilateral lens implants.

An ill-defined lesion in the anterior floor of mouth that measures up to approximately 15 mm is compatible with the known cancer. A cluster of small posterior level 2B lymph node, which appear to be somewhat prominent in terms of signal characteristics may be reactive or neoplastic in nature. Otherwise, no evidence of significant cervical lymphadenopathy based on size criteria.

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Male, 6 years old, with stage I rectal mass, of the left orbit status post 42 weeks in CR1. Infiltrative T2 hyperintensity involving the superolateral aspect of the left extraconal orbit is unchanged from the prior examination. Mild enhancement in this region continues to diminish from prior examinations.No new intraconal or extraconal T2 hyperintense or enhancing lesions are demonstrated. The globes are round and symmetric. The extraocular muscles demonstrate normal signal and enhancement. The optic nerves are unremarkable.Mucosal thickening and opacification of the paranasal sinuses persists, similar to prior. Opacification of the mastoid air cells is stable on the left and decreased on the right.

1.Post treatment findings in the left orbit with no evidence of recurrent or progressive tumor.2.Persistent pan-sinus inflammation.

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Female 67 years old patient has bilateral inguinal pain BONE MARROW: Scattered foci of marrow edema involving the right femoral head, acetabulum bilaterally. No acute fracture is evident.SOFT TISSUES: Mild global muscle atrophy. JOINTS: Severe osteoarthritis affects the left hip joint with osteophytes and intra-articular loose bodies located posteriorly. The left hip labrum appears torn. There is a small left hip effusion.Severe osteoarthritis affects the right hip joint with bone on bone apposition. The right hip labrum appears torn.Severe degenerative changes affect the lower lumbar spine with endplate changes at L4-L5 and L5-S1. There is a disk bulge at the L5-S1 disk space.ADDITIONAL

Severe bilateral hip osteoarthritis, left worse than right. Lower lumbar spine degenerative changes, partially imaged

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There are 2 intra-axial enhancing lesions within the right frontal lobe. The lesions are heterogenous on T1 and T2-weighted images and demonstrate susceptibility artifact compatible with associated blood products. Both lesions are surrounded by signal abnormality compatible with vasogenic edema. The larger lesion is centered within the deep white matter of the right frontal lobe, and the enhancing component of which measures 23 x 36 x 10 mm. This lesion also has associated prominent flow voids indicating vascularity. The smaller lesion is centered within the right superior frontal gyrus, the enhancing component which measures 9 x 9 x 10 mm. There is associated mass effect including sulcal effacement in the right frontal lobe, approximately 5 mm of leftward midline shift, and partial effacement of the right lateral ventricle. The basal cisterns are maintained. There are additional punctate foci of abnormal enhancement within the bilateral cerebellar hemispheres which are suspicious for additional metastatic lesions. The puncture lesion in the right cerebellar hemisphere demonstrates associated susceptibility artifact. There is no territorially restricted diffusion to suggest acute ischemic infarction. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.

Hemorrhagic metastases within the right frontal lobe with associated right hemispheric mass effect and midline shift. Additional cerebellar lesions also suspicious for metastases.

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Personal history of other disorders of nervous system and sense organs [V12.49] / Disturbance of skin sensation [782.0] / Other musculoskeletal symptoms referable to limbs(729.89) [729.89], Reason for Study: ^Reason: r/o stroke/mass lesion There is no evidence of acute ischemic or hemorrhagic lesion.On gadolinium enhanced scan, there is a prominent right posterior sylvian vein which is connected to the the left hemispheric parietal vein without evidence of vascular tingling or increased vascularity indicating most likely normal variation.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Normal brain MRI scan.

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Worsening right sided weakness. There is an area of restricted diffusion and high T2 signal in the left coronal radiata, which is similar in size as on the prior CT, but larger than on the prior MRI. There are a few scattered foci of nonspecific cerebral white matter T2 hyperintensity, but no evidence of additional areas of restricted diffusion in the brain. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unremarkable.

A subacute infarct in the left coronal radiata is similar in size as on the prior CT, but larger than on the prior MRI. There is no evidence of hemorrhagic transformation.

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Ms. Marty is a 30-year-old female with BRCA1 gene mutation. Family history of breast cancer in mother, maternal grandmother, maternal aunt, paternal grandmother, and two paternal cousins. Personal history of benign left breast biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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

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Diagnosis: Disturbance of skin sensationClinical question: please do Dr Javed MS protocol on 3 Tesla MRI, compare to image in PAXSigns and Symptoms: numbness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a punctate T2 and T2 and FLAIR hyperintense lesion present in the right temporal lobe subcortical white matter which is unchanged since the prior exam. Additionally there are several more subcortical white matter lesions in the subcortical white matter of the frontal lobes which also present on the prior exam and are unchanged.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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is straightening of the normal cervical curvature present with mild reversal centered at C5-6. Mild disc bulge present at C5-6.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

1.There are several subcortical white matter lesions present in the brain which are nonspecific and most likely of little clinical relevance given their number and stability.2.No cervical spinal cord lesions are appreciated to explain the patient's symptoms.3.There is a minor disc bulge present at C5-6 without significant compromise to spinal canal or exiting nerve roots

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11-year-old female with history of leukemia and chronic steroid use now post-transplant with persistent chronic ankle, knee, and hip pain. History of Osteochondritis dissecans of left talar dome. Evaluate avascular necrosis. History: Chronic Steroid Use. Bone infarcts of bilateral distal tibia on ankle MRI. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: See below.OTHER: Trace amount of free fluid is noted within the pelvis, likely physiologic.BILATERAL HIPS:There is mild collapse and fragmentation of the medial aspect of the left femoral head, with marrow signal changes of the lateral aspect of the left femoral head, compatible with stage III avascular necrosis. Minimal enhancement is noted within the areas of necrosis. The remainder of the proximal left femur demonstrates normal signal intensity. Small left hip joint effusion is present.The right femoral head is normal in bone marrow signal intensity without evidence of avascular necrosis. Remainder of osseous structures of pelvis are normal in appearance and marrow signal intensity.

Stage III avascular necrosis of the left femoral head with small left hip joint effusion.

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45-year-old male with maxillary sinus cancer. To status post chemo. Evaluate disease compared to the prior study. CT of the soft tissues of the neck.A very large destructive mass within the bilateral ethmoid sinuses with extension bilaterally into the orbits (right greater than left with significant mass-effect on the optic nerve), sphenoid sinus, nasal cavity, right maxillary sinus with extensive bony destruction is again identified. The mass at the level of skull base causes erosion and extends into bilateral subfrontal extra-axial space. No definitive evidence of any parenchymal edema is detected. In comparison with the prior exam no appreciable interval change in the size of this tumor is detected. The mass on the right involves the right pterygopalatine fossa. No abnormality of the cavernous sinus can be detected on this exam. If this area needs to be further evaluated an MRI examination is recommended.Images through the rest of the soft tissues of the neck demonstrate no pathologic adenopathy.No evidence of spinal column abnormality is detected.Limited images through the apices of the lungs are negative. Limited view of mediastinum is negative for lymphadenopathy. Please review the dictated report of CT of chest performed the same date.CT of brain with infusion.Enhancing mass in bilateral subfrontal region secondary to spread of tumor into the intracranial spaces noted. No areas of vasogenic edema of the frontal lobes is detected. No evidence of enhancement of the brain parenchyma or the leptomeninges is identified. The brain parenchyma remains essentially within normal limits.

1.No definitive evidence of any appreciable change in in the size, morphology or pattern of enhancement of a large destructive mass in bilateral ethmoid air cells, sphenoid sinus, skull base, nasal cavity and right maxillary sinus.2.Bilateral subfrontal tumor spread with no evidence of edema or leptomeningeal enhancement all frontal lobes.3.Unremarkable CT I examination of brain parenchyma and leptomeninges.

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Renal mass. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild diffuse thickening of the adrenal glands bilaterally, without focal masses.KIDNEYS, URETERS: Unchanged size of the 2.1 x 1.5 cm complex T1 hyperintense, T2 hyperintense lesion (series 801, image 15) in the midpole of the left kidney. The multiple thick enhancing septations are unchanged. Additional subcentimeter simple and hemorrhagic cysts are noted in both kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Unchanged appearance of the complex cystic lesion in the left midpole kidney, again suspicious for a cystic renal cell carcinoma.

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58 years Female (DOB:11/17/1957)Reason: Increased vertigo and episodes of loss of consciousness and h/o posterior circulation aneurysm. Eval for structural lesion/aneurysm change History: vertigo, loss of consciousnessPROVIDER/ATTENDING NAME: SANDRA LYNN ROSE SANDRA LYNN ROSE MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:The left posterior communicating artery has a sizable infundibulum measuring approximately 3 mm in diameter. There is a 3.5 mm aneurysm originating from the infundibulum and projecting posteriorly, laterally and inferiorly when compared to prior exam of 11/18/2014 it appears slightly enlarged.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

1.There is redemonstration of a left posterior communicating artery aneurysm associated with an infundibulum of the left PCOMA which appears to be perhaps a millimeter larger on the current versus the prior exam. 2.No evidence for cerebrovascular occlusive disease.3.No evidence for acute ischemic cerebral infarction.

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Knee pain MENISCI: Abnormal linear signal within and attenuation of the posterior horn of the medial meniscus, compatible with a horizontal cleavage tear. No significant abnormality noted in the lateral meniscus.ARTICULAR CARTILAGE AND BONE: Tricompartmental joint space narrowing with small osteophytes. Diffuse marked cartilage loss in all three compartments of the knee, with areas of partial thickness cartilage defects at the bilateral femoral condyles and full thickness loss at the lateral facet of the patella. Bone marrow signal is within normal limits. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

1. Horizontal cleavage tear of the posterior horn of the medial meniscus.2. Marked tricompartmental cartilage loss, as described above.3. Large knee joint effusion with loose bodies.

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Syrinx, tethered spinal cord and back pain. For the purposes of numbering, the most inferior well-defined disc space is labeled L5-S1. Low-lying conus near the lumbosacral junction and postoperative changes related to prior cord untetherings again seen. Distal thecal sac is ectatic and demonstrates septations, findings which are not appreciably changed. As before, the distal spinal cord abuts and may be adherent to the posterior thecal sac. Cauda equina nerve roots are also peripherally located as seen before which may also be reflective of adhesion/arachnoiditis. Prone images demonstrate no appreciable ventral motion of the distal cord again raising possibility of re-tethering in the appropriate clinical setting.No significant change in diameter or craniocaudal extent of visualized distal cord syrinx extending from approximately the L1 to the L3-L4 levels and measuring up to 2 x 4 mm in the axial plane. Syrinx is decreased in size when compared to earlier MRI from 3/30/2016.Alignment is anatomic. Vertebral body heights and intervertebral disc spaces are preserved. The bone marrow demonstrates a normal signal. No spinal canal or neural foraminal stenosis is seen at any level.

1. No significant change in examination compared to 7/14/2016 including the small distal cord syrinx. Syrinx is mildly decreased in size when compared to 3/30/2016. 2. There is no significant ventral motion of the distal cord in the prone position raising possibility of re-tethering, although this finding has been present on multiple prior studies.

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Reason: Tumor Rt distal phalanx little finger History: pain and swelling. Within the distal phalanx, there is an expansile mass, that is predominantly T2 hyperintense, T1 hypointense in signal intensity with small foci of signal void compatible with calcifications seen on radiograph. This mass is bilobed and predominantly peripherally enhances compatible with low internal vascularity or tumor necrosis. This mass measures approximately 1.1 x 0.9 x 2.3 cm (AP by transverse by CC). Small amount of adjacent soft tissue edema.The remainder of the bone marrow signal is within normal limits. The remainder of the soft tissue structures are within normal limits.

Expansile mass involving the distal phalanx of the right fifth finger. MRI findings in conjunction with radiographic findings are compatible with a cartilaginous lesion and malignancy cannot be excluded.

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Patient with history of parotitis and sialolithiasis status post endoscopic removal of stones. Now with right parotid cutaneous fistula and infection, recurrent abscess in the past 3 months. There has been interval removal of the right parotid duct calculi. However, there is now a tract that extends from the overlying skin to the and decreased inflammation involving the junction between the parotid gland and parotid duct. There is diffuse enhancement of the right parotid gland and overlying subcutaneous tissues, but this is less extensive than on the prior exam and there is no evidence of abscess or discrete tumor. There are mildly prominent right parotid lymph nodes, which are likely reactive. The left parotid gland and submandibular glands appear to be unremarkable. There is interval resolution of the fluid and mucosal thickening within the right maxillary sinus. There is a ovoid cystic lesion in the left auricle, which may represent an inclusion cyst. There is a partially-characterized left supraclinoid internal carotid artery aneurysm that measures up to approximately 15 mm.

1. Interval removal of the right parotid duct calculi with development of a parotid-cutaneous fistula. Diffuse enhancement of the right parotid gland and overlying subcutaneous tissues related to parotitis, albeit less extensive than on the prior exam and no evidence of abscess or discrete tumor.2. Partially-characterized left supraclinoid internal carotid artery aneurysm that measures up to approximately 15 mm.

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There are two small foci of restricted diffusion with associated T2 signal abnormality within the right occipital lobe and the lateral right precentral gyrus compatible with acute ischemic infarcts. There is no associated susceptibility artifact to suggest hemorrhage. There is no abnormal intracranial enhancement. There are no masses, mass effect, or midline shift. The ventricles and sulci are normal in size. The cerebral tonsils are normal in position. There are no extra-axial fluid collections. The paranasal sinuses and mastoid air cells are clear.

Two small foci of restricted diffusion within the right precentral gyrus and right occipital lobe compatible with acute ischemic infarcts.

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Reason: mildly dilated bile ducts History: severe abd pain ABDOMEN:LIVER, BILIARY TRACT: There is focal ductal dilatation in the right lobe of the liver without definite associated lesion (series 301 image 18), close continued follow-up is recommended.SPLEEN: No significant abnormality noted.PANCREAS: Small peripancreatic nodes noted. The pancreatic duct and parenchyma appear within normal limits.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1.Focal ductal dilatation in the right lobe of the liver without definite associated lesion. This may be due to mild underlying stricture that is not well-visualized, or given patient's age this may be from autoimmune pancreatitis, please correlate with IgG4 levels. Continued close follow-up is recommended.

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Diagnosis: Unspecified convulsionsClinical question: Seizure protocol 2Signs and Symptoms: new onset seizure The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of cavum septum pellucidum and cavum vergae.A small focus of encephalomalacia is present along the left inferior parietal lobule. Another smaller focus of encephalomalacia is present along the lateral aspect of the left precentral gyrus which is associated with a small focus of susceptibility effect..Normal vascular flow voids are present in the distal carotid and right 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 left vertebral artery is not readily identified intracranially. The left posterior inferior cerebellar artery is identified likely a very small left vertebral artery.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening along the right maxillary sinus and frontal sinuses. The visualized portions of the mastoid air cells demonstrate some opacities in the right mastoid air cells. The visualized portions of the orbits are intact.

1.Foci of encephalomalacia are present along the left inferior parietal lobule as well as the lateral aspect of the left precentral gyrus.2.The left vertebral artery is not readily identified intracranially. It is suspected to be hypoplastic.

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Mark Cichra is a 32Yrs male with history of bicuspid aortic valve with associated dilated aortic root, bradycardia and history of vasovagal syncope presenting for routine evaluation. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 107 ml/m2 (normal range: 74+/-15), the LVEDV is 214 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 69 ml (normal range 47+/-19), the LV mass index is 59 g/m2 (normal range 85+/-15), and the LV mass is 119 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 98 ml/m2 (normal range 82+/-16), the RVEDV is 197 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 88 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is bicuspid opens widely and there is no significant aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated with sinus of Valsalva 43x32mm and the sino-tubular junction at 30mm. The ascending aorta is 31x30mm when measured 5cm from the aortic valve plane. No aortic coarctation is noted. 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 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.

1. Mild LV dilation with normal systolic function (LVEF 68%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 55%).3. Mild aortic root dilation.4. Bicuspid aortic valve. When compared to the prior study, there is no significant change.

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42 years Male (DOB:5/26/1973)Reason: please do dr Javed MS protocol compare to prior History: weakness, blurring of visionPROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD There is redemonstration of periventricular white matter lesions perpendicularly oriented to the lateral ventricles as well as a lesion in the right cerebral peduncle and some subcortical white matter lesions. These appear stable and compared to the previous exam. No abnormal foci of contrast enhancement are appreciated within the brain parenchyma. Another FLAIR hyperintense lesions present in the left half of the cervical medullary junction.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 mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

There is redemonstration of periventricular and subcortical white matter lesions as well as a lesion the right cerebral peduncle and left anterolateral aspect of the cervicomedullary junction which are stable since the prior exam and support the patient's clinical diagnosis of demyelinating disorder.

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Multiple vertebral fractures and focal pain in lumbar and thoracic spine and history of multiple myeloma. Thoracic Spine: There appear to be 11 thoracic type vertebrae and a transitional S1 vertebra. There is a T2 and T1 hyperintense lesion in T12 with peripheral enhancement and at least 50% compression deformity with slight focal kyphosis, but no significant retropulsion or neural foramen stenosis. There is diffusely abnormal signal within the bone marrow of the rest of the thoracic vertebral column with multiple small foci of enhancement, but no evidence of associated pathological fractures elsewhere in the thoracic spine. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a septated left renal cyst. Lumbar Spine: There is an unchanged compression fracture of the L1 vertebral body with circumferential cortical step offs and cleft without significant spinal stenosis or neural foraminal compromise. There is unchanged compression fracture of L2 vertebrae with considerable loss of height and approximately 5 mm of retropulsion of the posterior vertebral body as well as contiguous disc material into the spinal canal with focal kyphotic angulation, but no significant spinal stenosis or neural foraminal compromise. The other lumbar vertebrae display heterogeneous signal characteristics, but no evidence of pathologic fracture. There is mild multilevel degenerative spondylosis in the lower lumbar spine and mild lumbosacral epidural lipomatosis without significant spinal stenosis or neural foraminal compromise.

Diffuse involvement of the imaged axial skeleton by multiple myeloma with no significant change in the pathological fractures affecting the T12, L1, and L2 vertebrae, but no evidence of spinal cord or cauda equina compression.

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The exam is limited by motion artifact and the lack of intravenous contrast. Within these limitations, there is no evidence of intracranial mass. The ventricles and sulci are normal in size. There is no or midline shift. The pituitary gland is unremarkable. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem, or cerebellar infarction. The major cerebral flow voids appear to be intact. There is mild mucosal thickening in the sphenoid sinuses. The skull, orbits, and scalp soft tissues are unremarkable.

No discernible evidence of intracranial metastases, although the assessment is limited by the lack of intravenous contrast and patient motion artifact.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.

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49 year old with hypertension, LV dysfunction and family history of NICM presenting for evaluation. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 118 ml/m2 (normal range: 74+/-15), the LVEDV is 287 ml (normal range 142+/-34), the LV end systolic volume index is 75 ml/m2 (normal range 25+/-9), the LVESV is 181 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 126 g (normal range 164+/-36). The left ventricular systolic dysfunction is global with a septal bounce consistent with left bundle branch block. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native T1 time is in borderline range at 1100 ms. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 98 ml/m2 (normal range 82+/-16), the RVEDV is 236 ml (normal range 142+/-31), the RV end systolic volume index is 50 ml/m2 (normal range 31+/-9), and the RVESV is 120 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely 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 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.

1. The left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 2. The right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%.

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55 years Male (DOB:6/5/1961)Reason: Re-evaluate disease status following completion of immunotherapy, compare to last scans, per RECIST 1.1 History: Metastatic MelanomaPROVIDER/ATTENDING NAME: JASON J LUKE JASON J LUKE The patient status post right parietal craniotomy.There are numerous foci of the susceptibility effect scattered in both hemispheres of the brain and in the cerebellum without any significant contrast enhancement. Compared to the previous exam these do not appear to have changed one in the left parietal lobe currently measures 5 mm and previously measured the same.The patient is status post right-sided parietal craniotomy. There is encephalomalacia present along the right inferior parietal lobule extending to the right temporal lobe associated with susceptibility effect.There is redemonstration of diffuse periventricular and subcortical white matter confluent signal changes which were also present on the previous exams to a similar extent.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacities in the right mastoid air cells. The visualized portions of the orbits are intact.

1.There are multiple hemorrhagic type lesions scattered throughout the brain which appear relatively stable compared to the exam from August. The patient is known to have metastatic melanoma to the brain.2.Extensive and diffuse white matter signal changes have been present on prior exams and are most likely treatment related.

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Clinical question: Evaluate for growth of GBM. Patient on PD L1 abnormality immunotherapy trial. First MRI on treatment. Signs and symptoms: Evaluate GBM. Pre and post enhanced brain MRI:Examination demonstrates significant interval increased vasogenic edema surrounding an interval increased enhancing left posterior temporal necrotic GBM.The enhancing necrotic tumor measures at least at 44 x 41x 38 mm in transaxial dimensions compared to prior study remeasurement of 27 x 25 x 23 mm. Thick tumor extensively encases the left occipital horn of lateral ventricle and reaches the trigone the surrounding vasogenic edema that was localized around the tumor now extends anteriorly to nearly the tip of the left temporal lobe and into the left basal ganglia/thalamus and posteriorly extending to left occipital lobe. Findings results in increased intracranial pressure and weightRightward deviation of midline of approximately 14 mm. There is also mild increased size of left lateral ventricle since prior study which measures approximately 16 mm in largest transverse axis compared to prior study measurement of 13.5 mm.All the CSF spaces remain widely patent. Stable postoperative changes of left posterior temporal craniotomy.No detectable new foci of parenchymal abnormal signal intensity or ecchymosis/leptomeningeal abnormal enhancement.Unremarkable images through the orbits, calvarium, paranasal sinuses and mastoid air cells.

1.Interval increased size of a necrotic enhancing left posterior temporal GBM and its surrounding vasogenic edema with resultant new rightward deviation of midline as detailed/measured above. Tumor currently measures at 44 x 41 x 38 mm compared to prior study measurement of 27 x 25 x 23mm.2.Mild interval increased size of left lateral ventricle since prior exam is also noted.

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Jaw pain, juvenile arthritis Left TMJ: There is a normal rounded appearance of the mandibular condyle without evidence of discrete bony erosion. There is synovial thickening, increased fluid signal, and enhancement surrounding the left temporomandibular joint. The articular disc is normally positioned between the mandibular condyle and the temporal bone in both open and closed positions. There is normal anterior translation of the mandibular condyle with jaw opening.Right TMJ: There is a normal rounded appearance of the mandibular condyle without evidence of discrete bony erosion. There is mild synovial thickening without significant inflammatory change. The articular disc is normally positioned between the mandibular condyle and the temporal bone in both open and closed positions. There is normal anterior translation of the mandibular condyle with jaw opening.

1. Mild synovitis of the left TMJ. There is no significant enhancement or inflammatory changes of the right TMJ to suggest acute synovitis although the synovium appears slightly thickened.2. Normal articular disc positioning and motion of both the left and right TMJ.

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Small cell lung cancer restaging. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged predominantly periventricular white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and sulci are diffuse prominent due to cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a right lens implant and scleral buckle.

1. No evidence of intracranial metastases.2. Unchanged diffuse white matter abnormalities are nonspecific, but may represent chronic small vessel disease and/or treatment effects.

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Male 81 years old Reason: eval adrenal hemorrhages History: as above ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Fatty infiltration of the pancreas.ADRENAL GLANDS: Bilateral adrenal hemorrhage with a right adrenal gland measuring 2.4 x 1.8 cm and the left adrenal gland measuring 2.5 x 1.6 cm. On the subtraction images, no specific evidence for underlying tumor as there is no enhancement.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis.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.

1.Slight decrease in the size of the adrenal hemorrhage. No specific evidence for underlying lesion.

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Multiple sclerosis: weakness. There is no significant interval change in the extent of the supratentorial and infratentorial white matter lesions. Many of the lesions demonstrate T1 hypointensity, but no abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst.

No significant change in the intracranial demyelinating lesions.

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90 years Female (DOB:4/6/1926)Reason: assess for new stroke History: right-sided weakness and slurred speechPROVIDER/ATTENDING NAME: THOMAS L FISHER JACQUELINE T. BERNARD There is a punctate focus of diffusion restriction present in the right paramedian pons. This is newThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are several lesions of T2 and FLAIR signal hyperintensity in the brainstem and cerebellum.On susceptibility imaging there is a focus of susceptibility effect associated with low signal on T2 imaging in the left postcentral gyrus which on T2 measures approximately 19 x 7 mm axial dimensions. This was present on the prior exam and is unchanged Additionally there are multiple punctate foci of susceptibility effect in the subcortical white matter of both hemispheres. Additionally there is a punctate focus of susceptibility effect in the left medial thalamus and the left upper thalamus. These were also present on the prior exam and have not changed significantly.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 demonstrate mucous retention cysts in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

1.There is a punctate acute microinfarct infarct in the right paramedian pons. This is new since the prior exam.2.There is redemonstration of a hemorrhagic focus in the left postcentral gyrus probably from an old hemorrhage.3.Multiple microhemorrhages in the brain parenchyma involving predominantly subcortical white matter are present. Most likely these are related to amyloid angiopathy based on the pattern but this is somewhat nonspecific.4.Periventricular and subcortical white matter lesions as well as a couple lesions in the brainstem and cerebellum of a mild degree are nonspecific. At this age they are most likely vascular related. They are essentially stable and compared to prior exam

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Pain along the lateral aspect of the right knee, evaluate for meniscal pathology. MENISCI: There is minimal fraying of the inner edge of the lateral meniscus. There is minimal globular signal in the posterior horn towards the attachment of the lateral meniscus, but no specific findings to suggest a tear. The menisci are well anchored posteriorly.ARTICULAR CARTILAGE AND BONE: The cartilage is intact; specifically, there are no focal defects. The bone marrow signal is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

1. Minimal fraying and globular signal in the menisci as described, but no specific findings to suggest a tear.2. Very small Baker's cyst without internal contents.

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Reason: left ankle injury 3 weeks ago persistent swelling and pain History: pain and edema TENDONS: There is a small amount of fluid within the peroneus longus tendon sheath. The peroneal tendons appear intact. The flexor and extensor tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The proximal fibers of the ATFL are not well visualized and likely disrupted. The PTFL appears intact. The calcaneofibular ligament appears intact. There is loss of the normal fatty striation of the visualized components of the deep component of the deltoid ligament indicating prior injury or sprain. The distal tibiofibular syndesmotic complex appears intact.ARTICULAR SURFACES AND BONE: There is increased bone marrow signal abnormality within the medial aspect of the body of the talus. Additionally, there is apparent cortical disruption along the medial aspect of the posterior facet of the talus which may represent a small nondisplaced fracture (image 25 and 26; series 901).ADDITIONAL

1. Bone marrow edema within the body of the talus as well as cortical irregularity along the medial aspect of the posterior facet of the talus, which may represent a small nondisplaced fracture.2. Disruption of the ATFL.3. Loss of the normal fatty striation of the deep component of the deltoid ligament indicating a sprain or prior injury.

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Diagnosis: Altered mental statusClinical question: strokeSigns and Symptoms: stroke MRI of the brainThere are multiple foci of diffusion restriction present. As a patchy areas of diffusion restriction involving the cerebellar hemispheres bilaterally. The area involved in the right cerebellar hemisphere measures approximately 44 x 36 mm axial dimensions. The area involving the left cerebellar hemisphere measures 25 x 38 mm in axial dimensions. There are punctate foci of diffusion restriction scattered in the subcortical and periventricular white matter of the supratentorial brain and all lobes. The periventricular lesions appear to be somewhat larger. Additionally there are small foci of diffusion restriction present in the basal ganglia bilaterally. On susceptibility imaging there is signal loss present in the cerebellar hemispheres bilaterally and relatively small regions suggesting either petechial blood or small foci of hemorrhagic conversion.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is triplication of the anterior cerebral artery. The one segments are similar in size. The left posterior communicating artery is medium-sized. The right posterior cerebral artery has fetal origin. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.3.Multiple foci of infarction are present in the periventricular white matter, subcortical white matter, basal ganglia and cerebellar hemispheres. There is a small amount blood associated with the cerebellar lesions which are somewhat larger.4.Findings were discussed with Dr Kramer at the time of the exam.5.There is no compromise cervical spinal canal or exiting nerve roots. There is mild reversal of normal cervical curvature which could be related to patient positioning or muscle spasm.

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Right knee pain. Evaluate for lateral meniscus tear. MENISCI: The posterior anchor of the lateral meniscus is indistinct with increased signal, which may represent degeneration though tearing cannot be excluded. Focal punctate increased signal at the anterior apex of the lateral meniscus seen on a single slice and may represent a small cleft, of uncertain clinical significance. The medial meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: Bone contusions are present in the bilateral femoral condyles and tibial plateaus, lateral greater than medial. No fracture is present.LIGAMENTS: The anterior cruciate ligament is thickened and indistinct, with increased signal. No distinct fibers are visualized, suspicious for partial tearing. However, no retraction is evident. The posterior cruciate ligament is intact. The collateral ligaments are intact. Minimal signal adjacent to the MCL likely represents a mild sprain. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

1. Findings suspicious for partial tearing of the anterior cruciate ligament, with associated bone contusions and mild MCL sprain.2. Degeneration of the posterior horn of the lateral meniscus, with possible tearing.

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A 54 year old female with past history of patent foramen ovale close in 2008 with a occluder device, then diagnosed with mild left ventricular dysfunction and right ventricular enlargement by echocardiography. A cardiac MRI on 4/2014 showed normal left and right ventricular function with no late gadolinium enhancement. Referred now for cardiac MRI to evaluate cardiac function. Left VentricleThe left ventricle is normal in size with mild systolic dysfunction. There is mild reduced contractility of the apical anterior and inferior walls compared to the previous exam. There is slight paradoxical motion of the interventricular septum which may be conductional, stable. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 79 ml/m2 (normal range: 65+/-11), the LVEDV is 163 ml (normal range 109+/-23), the LV end systolic volume index is 41 ml/m2 (normal range 18+/-5), the LVESV is 85 ml (normal range 31+/-10), the LV mass index is 37 g/m2 (normal range 67+/-11), and the LV mass is 75 g (normal range 114+/-24). Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 88 ml/m2 (normal range 69+/-14), the RVEDV is 180 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 90 ml (normal range 35+/-13). Left and Right AtriumThe left and right atrium are mildly dilated. Susceptibility artifact in located at the interatrial septum which may be the PFO closure device.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation which visually appears mild but was not quantified.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. No thoracic aortic aneurysm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.

1. The left ventricle is normal in size with mild systolic dysfunction, with an LVEF of 48%, reduced from 55% in 2014. 2. The right ventricle is normal in size with normal systolic function, the RVEF is 50%, also slightly decreased from prior exam.3. The left and right atrium remain mildly dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.

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Shoulder pain. Four views of the right shoulder reveal no acute fracture or dislocation. There is interval widening of the acromioclavicular joint with resorption of the distal end of the clavicle.

Widening of the AC joint and resorption of the distal clavicle compatible with osteolysis, similar in appearance to a recent MRI.

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New onset seizure. Examination demonstrates diffuse edema in the right frontal lobe and genu of corpus callosum. The appears slightly effacement of the frontal horn of the right lateral ventricle. These findings have been unchanged since prior MRI. There is no intracranial hemorrhage, midline shift or abnormal extra-axial fluid collection. The ventricles are normal in size and symmetric.The visualized paranasal sinuses and mastoid air cells are normally pneumatized. In view of the orbits is unremarkable. The calvarium is intact.

Right frontal cerebral edema with involvement of the genu of corpus callosum likely represent underlying tumor (primary versus metastasis).

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Male 53 years old Reason: Rectal cancer please assess and evaluae extent of disease prior to start of therapy History: As above Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: Tumor abuts the posterior aspect of the prostate with loss of normal fat plane. No gross invasion is evident.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Scattered small lymph nodes, largest is 5 x 4 mm (series 13, image 25)Lymph nodes outside the mesorectal fascia: Bilateral pelvic sidewall mildly enlarged lymph nodes, on the right there is a node that is 10 x 9 mm (series 11, image 303).BOWEL, MESENTERY: Rectal Tumor:Size: 4.4 x 2.8 x 5.4 cm (image 25/series 7 and image 23/series 6)Tumor appearance on T2-weighted images: Lobulated T2 intermediate signal intensity mass.Tumor location: Lower-third(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 3.9 cm.Distance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): Tumor extends down to the anus at the level of the puborectalis muscle with suspicion for invasion through the external sphincteric complex on the right at the 10 o'clock position (series 6, image 29)Circumference of the rectum involved: Anterior to left rectal wall (10 o'clock to 4 o'clock position).Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): Abuts the posterior aspect of the prostate (series 6, image 25) without evidence of gross invasion.MRI T-stage: T3Tumor Distance to Mesorectal Fascia: Extends to the mesorectal fascia anteriorly and abuts the posterior prostate (image 25/series 6).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1. Stage T3 lower rectal cancer extending to the anus with suspicion of invasion of the external sphincteric complex.2. Mildly enlarged extramesorectal lymph nodes, suspicious for local metastases. Additional lymph nodes as described above.

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Visual changes and metastatic melanoma on immunotherapy - numbness/tingling in left hand ring and middle finger. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of non-enhancing T2 hyperintensity in the cerebral white matter, which are nonspecific. The pituitary gland appears unremarkable. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbit, and scalp soft tissues are unremarkable. There is mild scattered paranasal sinus mucosal thickening.

No evidence of intracranial metastases of acute infarction.

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Right-sided weakness and numbness, evaluate for neurosarcoidosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right cerebellar hemisphere developmental venous anomaly with mild associated linear T2 hyperintensity. The brain parenchyma otherwise appears to be 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. There is opacification of the left maxillary sinus, left frontal sinus, as well as mild mucosal thickening on the right maxillary and ethmoid sinuses. There is an anterior nasal septal defect and absence of the let inferior turbinate. The orbits, skull, and scalp soft tissues are grossly unremarkable.

1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Incidental right cerebellar hemisphere developmental venous anomaly.3. An anterior nasal septal defect and absence of the let inferior turbinate may be postoperative in nature.

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Frontal and retro-orbital pressure bilaterally after fall while snowboarding 6 wks ago, with symptoms worsening over past 3 weeks, but the neurological exam is non-focal. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small area of mild patchy posterior right frontal lobe periventricular white matter T2 hyperintensity. The brain parenchyma otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Nonspecific mild patchy posterior right frontal lobe periventricular white matter T2 hyperintensity, which may possibly be related to remote ischemia, but no evidence of intracranial hemorrhage, mass, or acute infarct.

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Altered mental status, multiple myeloma. The images are degraded by patient motion. There is a mass centred within the clivus with extension into the left cavernous sinus. There is no gross mass effect upon the pons. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits and scalp soft tissues are grossly unremarkable. There is mild right maxillary and bilateral sphenoid sinus mucosal thickening and fluid in the left maxillary sinus.

1. A lesion in the central skull base with extension into the left cavernous sinus is likely related to multiple myeloma, but assessment of the previously demonstrated epidural extension is limited by patient motion and the lack of intravenous contrast.2. No evidence of acute intracranial hemorrhage or acute infarct.3. Findings suggestive of acute sinusitis.

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Pancreatic lesion found incidentally on CT ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology, no suspicious liver lesion. Adenomyomatosis of level of the gallbladder fundus. Rounded foci of signal void on T2-weighted sequence seen layering in gallbladder, corresponding T1 hyperintensity seen, findings consistent with pigment gallstones.SPLEEN: Splenomegaly, measures 14 cm in longitudinal dimension. 1.4 cm splenule.PANCREAS: At junction of pancreatic head and uncinate process is well-circumscribed 1.1 x 1 cm T2 hyperintense focus, likely a sidebranch intraductal papillary mucinous neoplasm. No suspicious nodularity or enhancement delineated. Nondilated pancreatic duct. Intrinsic T1 signal of pancreatic parenchyma is relatively maintained. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple varices. Small retrocrural, periportal and retroperitoneal lymph nodes, likely reactive in setting of chronic liver disease.BOWEL, MESENTERY: Percutaneous gastrostomy located in distal gastric body. Edematous bowel, likely reactive in etiology/related to hypoalbuminemic state. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of ascites. Moderate-sized left pleural effusion. Left-sided retroperitoneal hematoma formation seen on prior CT study not well assessed on current exam.

1. Well-circumscribed 11 mm nonenhancing T2 hyperintense focus located at junction of pancreatic head/uncinate process likely a sidebranch IPMN, no suspicious features depicted. Accounting for differences in technique and absence of intravenous contrast on earlier study, lesion was likely present on earlier noncontrast CT study from March 2015 (refer to image 42 series 3 on 3/23/15 CT study). 2. Cholelithiasis.3. Stigmata of cirrhosis, including nodular liver, splenomegaly and variceal formation. Large ascites and moderate-sized left pleural effusion.