Instruction: Generate impression based on findings.

Input: 17 year-old female status post trauma. Images through posterior fossa are unremarkable.Images through the supratentorial brain parenchyma demonstrates a subtle area of low attenuation in the periventricular white matter of the left parietal lobe. This is not associated with any additional areas of edema, hemorrhage, mass-effect, midline shift or hydrocephalus. This finding is not believed to be secondary to trauma. The exact nature of the finding is not clear and further evaluation with an MRI is highly recommended. This finding is best demonstrated on axial images 15 through 19. To exclude the possibility of a mass and MRI is recommended.Calvarium, soft tissues of the scalp, mastoid air cells and visualized portions of the paranasal sinuses are unremarkable.The above findings were relayed to Dr. Jeff Frank at the time of interpretation.

Output: 1.No definitive evidence of post traumatic findings.2.Focal area of low-attenuation in the periventricular white matter of the left parietal lobe which is non specific and nonhemorrhagic and does not appear to be a post traumatic finding. Further evaluation with an MRI is highly recommended.


Instruction: Generate impression based on findings.

Input: Resection of CCM on 4/23/15. There are postoperative findings related to right frontal craniotomy. There is a cavity in the right gyrus rectus region with linear susceptibility effect along the margins and mild confluent T2 hyperintensity in the surrounding white matter. There is diffuse mild thickening and hyperenhancement of the overlying dura. There is an unchanged punctate cavernous malformation in the pontomedullary junction. There are multiple nonspecific scattered foci of cerebral white matter T2 hyperintensity. There is no evidence of acute infarct or acute intracranial hemorrhage. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. Postoperative findings related to right frontal lobe cavernous malformation resection with mild susceptibility effect along the margins of the resection cavity, which is likely attributable to residual blood products from the surgery.2. Unchanged punctate probable cavernous malformation in the pontomedullary junction.


Instruction: Generate impression based on findings.

Input: Other specified congenital malformations of spinal cord [Q06.8], Reason for Study: ^Reason: eval for pseudomeningocele History: headache For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Post-untethering operation follow up.Again, the distal spinal cord appears to be adherent to the posterior thecal sac and does not show evidence of identifiable movement on prone images comparing to supine images.The maximum AP diameter of the lower thecal sac ectasia appears to be smaller than prior images (prior 46mm, now 38mm). Multiple internal septation of the lower thecal sac are again seen, unchanged.Syrinx cavity seen from L1 to L5 is again seen and is stable in size and extent since prior scan.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.

Output: 1. Post cord untethering status follow up. There is no evidence of cord motion on prone position images. The spinal cord appears to be adherent to the posterior thecal sac, unchanged.2. Unchanged spinal cord syrinx extent and size of syrinx cavity.3. Decreased maximum diameter of dural ectasia at the level of L5 and below since prior scan (from 46mm to 38mm).


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: ? CNS infection s/p DBS vs ischemia History: Fluid collection in head and chest There is fluid collection on the right frontal lobe middle frontal gyrus and right insular and internal capsule which show mass effects against surrounding structures. There is also high signal intensity on T2 weighted images on the right basal ganglia especially globus pallidus and posterior limb of internal capsule which surrounds DBS device.The signal intensity of the fluid collection is following the CSF signal intensity without showing any evidence of diffusion restriction. On contrast enhancement scan, the entry point of DBS device adjacent to the dura and proximal part show surrounding enhancement without evidence of peripheral enhancement. In addition, there is about 23.6mm x 17.1mm x 25.4mm sized peripherally enhancing subgaleal fluid collections on the site of the right frontal burr hole which may represent inflammatory/infectious nature. Diffuse right hemispheric meningeal enhancement was seen which could represent postoperative reactive changes. There is focal subtle susceptibility effects within the fluid collection especially inferior aspect of the right insular-external capsule lesion, but most of the lesion do not show any susceptibility effects.In summary, this most likely is the lesion of the CSF collection around the DBS device with evidence of contrast enhancement especially on both proximal part (intracranial portion) and entry point (extracranial portion) of the DBS device with mass effects, thus suggest possibility of inflammation or infection related nature. The possibility of acute ischemic lesion can be excluded. Although focal susceptibility effect was seen, the possibility of hemorrhagic lesion can also be excluded since it cannot explain the whole feature of the lesion. There is midline shift toward right side (about 3-4mm) but no evidence of uncal herniation.The cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Small retention cyst on the left maxillary sinus.

Output: 1. Possible inflammatory/infectious nature of both extra cranial and intracranial lesions including right frontal lobe and right insular-external capsule CSF collections with mass effects. 2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 45-year-old female with multiple liver adenomas. ABDOMEN:LIVER, BILIARY TRACT:Redemonstration of numerous well-circumscribed, enhancing masses in both lobes of the liver that demonstrate homogeneous washout on delayed hepatobiliary phase, compatible with nonsteatotic adenomas. Reference largest lesion is in the left lobe of liver measures up to 6.1 x 4.2 cm (series 3/9), slightly decreased since prior exam when it measured 6.7 x 4.5 cm. The remainder of the lesions are not significantly changed.No biliary ductal dilation. The main portal vein and its branches are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Numerous hepatic adenomas with slightly decreased size of the largest lesion in the left lobe, but no significant change in the remainder of the lesions.


Instruction: Generate impression based on findings.

Input: Left shoulder pain. History of rotator cuff repair in July 2000. Recent fall. Evaluate for rotator cuff tear. Numerous foci of signal void within the soft tissues of the shoulder represent metallic susceptibility artifact from prior surgery.ROTATOR CUFF: The supraspinatus tendon is thickened indicating tendinosis. There is increased signal intensity within the anterior fibers of the distal supraspinatus tendon immediately proximal to its insertion on the greater tuberosity indicating a near full-thickness to full-thickness tear. The signal abnormality involves the majority of the thickness of the tendon, particularly the bursal surface fibers, although there may be a thin residual strand of tendon closer to the articular surface extending to the greater tuberosity. There is minimal (5 mm) retraction of tendon fibers. The tear is approximately 1 cm in AP dimension. There is mild to moderate fatty atrophy of the supraspinatus along the myotendinous junction anteriorly. The infraspinatus tendon appears slightly thickened, indicating mild tendinosis, but I see no discrete tear. There is mild fatty infiltration along the myotendinous junction of the infraspinatus. The teres minor muscle and tendon appear normal. There is mild thickening of the subscapularis tendon indicating tendinosis, with more focal increased signal intensity along its undersurface fibers that may reflect mild undersurface fraying/tearing. The subscapularis muscle is within normal limits.SUPRASPINATUS OUTLET: There is widening of the acromioclavicular joint presumably reflecting prior surgery. There is a small amount of fluid within the subacromial/subdeltoid bursa, particularly anteriorly. The coracoacromial and coracohumeral ligaments appear intact.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is mild surface irregularity of the anterior labrum which may reflect degenerative fraying. The labrum otherwise is unremarkable given the limitations of a non-arthrogram study. Trace amount of fluid within the glenohumeral joint is within normal limits.BICEPS TENDON: There is mild increased signal intensity within the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular groove, suggesting tendinosis.

Output: Near full-thickness to full-thickness tear of the anterior fibers of the distal supraspinatus tendon and other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: MS, pres. Signs and symptoms: Headache. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates a few punctate nonspecific foci of FLAIR and T2 hyperintensity in the subcortical white matter of cerebral hemisphere and minimally in the periventricular white matter. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.There are multiple tiny foci of susceptibility in bilateral cerebellar hemispheres and bilateral cerebral hemispheres which are suspicious for a small chronic microhemorrhages. The less likely possibility of cavernoma's cannot be entirely excluded.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.Nonenhanced cervical MRI:Examination demonstrates normal signal intensity and anatomical alignment of cervical spine.There is no evidence of a spinal stenosis or neural foraminal compromise at any level.Examination at C3-C4 demonstrate a central and right paramedian small disc protrusion which effaces the ventral subarachnoid space and is in contact with the cord however without central spinal stenosis or cord signal abnormality.Additional tiny central disc protrusion at C2-C3 and C4-C5 levels are also present with only subtle bulge into the ventral subarachnoid space.There is normal signal intensity and caliber of the cervical and upper most visualized thoracic cord.Nonenhanced lumbar MRI:There is normal signal intensity and alignment of vertebral column.There is normal caliber, signal intensity and morphology of the lower thoracic cord from T10 inferiorly and no detectable abnormality of the cauda equina.No appreciable degenerative disease and no evidence of spinal canal or neural foraminal compromise or stenosis. Mild hypertrophic changes of posterior elements are however present.Images through perispinal soft tissues demonstrate bilateral small renal cysts which can be further evaluated with dedicated imaging. Unremarkable visualized SI joints.

Output: 1.Nonenhanced brain MRI demonstrate no acute intracranial findings. Few punctate flair hyperintensity in the periventricular and subcortical white matter which are nonspecific. Multiple tiny foci of cerebellar and bilateral cerebral susceptibility signal without FLAIR or T2 associated signal changes which could represent multiple small microhemorrhages.2.Nonenhanced MRI of cervical spine demonstrate normal signal intensity and caliber of the cervical and upper most visualized thoracic cord to T4 level. Central disc protrusion at C3-C4 with resultant partial effacement of ventral subarachnoid space, tiny central disc protrusion at C2-C3 and C4-C5 with minute bulge into subarachnoid space is noted. There is however no spinal canal or neural foraminal compromise/stenosis at any level.3.Unremarkable nonenhanced MRI of the lumbar spine. Please see above comments.


Instruction: Generate impression based on findings.

Input: 77-year-old male with elevated PSA PELVIS:PROSTATE:Prostate Size: 5.8 x 6.3 x 5.3 cm.Peripheral Zone: Focus of T2 hypointensity measuring 7 x 6 mm in the right peripheral zone base with associated diffusion restriction and early arterial enhancement suspicious for malignancy.Additional smaller 3 mm T2 hypointense focus in the mid gland posterior peripheral zone.Central Gland: Marked degree of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: The right peripheral zone lesion abuts but does not demonstrate definitive extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.BONES, SOFT TISSUES: Left acetabular cysts compatible likely degenerative.OTHER: No significant abnormality noted.

Output: 1.Focus of T2 hypointensity in the right peripheral zone base as described above suspicious for malignancy.2.Marked degree of benign prostatic hypertrophy.3.No significant lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Left cavernous sinus meningioma. Assess extent of disease for radiation treatment planning. There is an extra-axial, mildly lobulated mass in the region of the left petroclinoid ligament and cavernous sinus. The mass is relatively isointense to gray matter on both T1 and T2 and shows intense, heterogeneous contrast enhancement. The mass invades the left cavernous sinus and circumferentially encases and mildly narrows the cavernous segment of the left internal carotid artery. It also extends medially to mildly compress the pituitary gland. It does not extend into the optic canal and has only minimal superior extension into the suprasellar cistern which does not affect the optic chiasm. Left Meckel's cave is displaced and deformed. The lesion abuts the left anterolateral surface of the pons without significantly deformity.The mass is associated with fairly extensive dural thickening which extends and tapers and fashion along the floor of the middle cranial fossa, including the foramen ovale, and reaching anteriorly to the left greater wing of the sphenoid. It also extends posteriorly along the tentorium cerebelli. The mass itself measures in the axial plane 4.1 cm x 1.9 cm (as on series #2401, image #40). This, however, does not include the extensive dural tail described above.Compared to the previous examination from February 2015, the mass has slightly grown in size. Previously it did measure approximately 2.4 cm x 2.0 cm (series #301, image #7).The brain is otherwise normal. The ventricles are normal in size. There is minimal mucosal thickening in the anterior ethmoid sinuses without fluid. The paranasal sinuses are clear otherwise. The mastoid air cells are clear as well.Orbits:The orbits and the orbital structures are normal. As discussed above, the left petroclival meningioma reaches close to the optic canal but does not involve it.

Output: 1.Left petroclival meningioma with involvement of the cavernous sinus and sella as described above. The mass is also associated with extensive dural thickening extending some distance from the epicenter of the mass which might be reactive or tumoral. The mass has slightly increased in size since the previous examination of February 2015.2.There is no direct impingement on the optic nerve or chiasm.


Instruction: Generate impression based on findings.

Input: Pituitary lesion status post surgery: surveillance . There are postoperative findings related to transsphenoidal surgery. There is no evidence of recurrent tumor in the sellar region. There is unchanged mild thickening of the pituitary infundibulum. The cavernous sinuses and optic apparatus are intact. There is extensive cerebral white matter T2 hyperintensity. There is an unchanged probable hemangioma in the right calvarium.

Output: 1. Postoperative findings related to transsphenoidal surgery without evidence of gross recurrent tumor.2. Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 66-year-old male with new diagnosis of cutaneous B cell lymphoma. Scalp lesions. Staging evaluation. CHEST:LUNGS AND PLEURA: Multiple bilateral circumscribed lung nodules. In the left lung at image 42 of series 6 there is a 1 x 1.4 cm left upper lobe and a nodule. A right middle lobe lateral segment nodule measures 7 x 8 mm at image 69 of series 6.MEDIASTINUM AND HILA: Multiple subcentimeter mediastinal lymph nodes. No measurable lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 1.5 cm diameter right adrenal nodule is indeterminate. If indicated, obtain an adrenal MRI to exclude metastasis. Appearance and size, however, suggest this is a benign adenoma. KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral small lung nodules. No lymphadenopathy. Right adrenal nodule.


Instruction: Generate impression based on findings.

Input: Clinical question: Headaches. Signs and symptoms: Postoperative hemorrhage? Nonenhanced CT of brain:Expected postoperative changes of right-sided suboccipital craniotomy. Residual air within the subarachnoid space in the posterior fossa, soft tissues of the scalp.Four ventricle remains within normal size and in the midline. No hemorrhage within the posterior fossa. Small foci of increased density in the right cerebellopontine angle is believed to be a post operative replaced center thick material for treatment of trigeminal neuralgia (microvascular decompression).Images through supratentorial space demonstrate mild bifurcation of lateral ventricles which appears similar to prior MRI examination from 6 -- 1 -- 2010

Output: Expected postoperative changes of right suboccipital craniotomy as detailed.


Instruction: Generate impression based on findings.

Input: Pain and weakness. Cannot hold arm up. Rule out rotator cuff tear. ROTATOR CUFF: There is a full-thickness near-complete to complete tear of the subscapularis tendon with retraction of the tendon to the level of the glenoid. Small foci of heterotopic ossification are seen within the retracted tendon. There is severe fatty atrophy of the subscapularis muscle. There is thickening and intermediate signal intensity of the anterior fibers of the supraspinatus tendon at their insertion indicating mild to moderate tendinosis. A tiny (2 mm) focus of high signal intensity within the bursal surface fibers of the anterior supraspinatus tendon insertion may represent a tiny insertional tear, but this is equivocal. More posteriorly, there is intermediate signal intensity along the undersurface fibers of the cuff at the junction of the supraspinatus and infraspinatus tendons measuring approximately 1 cm in diameter involving approximately 50% of the thickness of the tendon. I suspect that this represents an undersurface tear. Although the remainder of the infraspinatus tendon can be traced to its insertion on the greater tuberosity, the intramuscular portion of the infraspinatus tendon appears unusually thickened, and there is moderate fatty atrophy of the infraspinatus muscle; these findings may reflect an old tear that I cannot otherwise discern on this study. There is minimal fatty atrophy of the supraspinatus muscle. The teres minor muscle and tendon appear normal.SUPRASPINATUS OUTLET: There is a small amount of fluid within the acromioclavicular joint. Small osteophytes indicate mild osteoarthritis. I see no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid in the joint but no large effusion. Mild osteoarthritis affects the glenohumeral joint. Branching signal within the superior labrum indicates tearing which appears to extend into the superior half of the anterior labrum. A couple of tiny foci of intermediate signal intensity within the glenohumeral joint may represent small cartilage fragments.BICEPS TENDON: A structure of the intermediate signal intensity within the bicipital groove presumably represents the biceps tendon, but it becomes indistinct within the superior aspect of the groove and I see no definite tendon within the rotator interval nor do I see the biceps anchor. These findings suggest rupture of the tendon of the long head of the biceps in the absence of prior surgery.

Output: 1.Near-complete/complete full-thickness tear of the subscapularis tendon with retraction to the level of the glenoid. Additional tendinopathy/tearing of the supraspinatus/infraspinatus as described above.2.Osteoarthritis.3.Superior labral tearing.4.Rupture of the tendon of the long head of the biceps assuming no prior surgery.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma with hyperprolactinemia treated with cabergoline surveillance. There is substantial interval decrease in size of the pituitary tumor, which now measures up to approximately 3 mm. The infundibulum is intact and midline. There is no mass effect upon the optic apparatus or cavernous sinuses. The imaged portions of the brain are grossly unremarkable.

Output: Interval decrease in size of the pituitary adenoma.


Instruction: Generate impression based on findings.

Input: History of hepatitis B. Presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: The liver morphology is unremarkable without specific changes of cirrhosis.Scattered bilobar cysts. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality.Partially distended gallbladder is otherwise unremarkable.SPLEEN: The spleen is normal in morphology size and signal intensity.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: Left sacral Tarlov cyst is partially imaged.OTHER: No significant abnormality noted.

Output: Bilobar liver cysts. No suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer, worsening pelvic pain There is an expansile mass within the left superior pubic ramus corresponding to an area of known metastatic disease. The mass measures at least 6.1 x 4.5 cm in the greatest transaxial dimensions. Accounting for differences in technique, this appears increased from the prior exam as evidenced by further extension towards the pubic symphysis, greater involvement of the anterior acetabulum, compression of the left femoral vein and extension into the obturator neurovascular bundle. An additional focus of low T1 signal is noted in the left iliac wing which demonstrates enhancement (series 1001, image 31/49) and is suspicious for an additional metastatic focus. Note is also made of a left-sided parasymphyseal fracture.Small focus of increased signal is noted along the right greater trochanter which may represent a component of bursitis. The remaining marrow signal of the pelvis is heterogeneous in nature which may reflect a combination of metaplastic reconversion and posttreatment change.

Output: 1. Expansile mass within the left inferior pubic ramus consistent with known metastatic disease. The mass has increased from comparison CT exam and is associated with a parasymphyseal fracture on the left. 2. Enhancing lesion within the left iliac wing is concerning for an additional focus of metastatic disease.


Instruction: Generate impression based on findings.

Input: 22-year-old male with leg pain for months in the middle one third of the tibia with point tenderness No acute fracture is evident. Alignment is anatomic. No abnormal bone marrow signal. Prominent nutrient foramen are noted in the middle one third of the tibial diaphysis bilaterally. No abnormal signal within the musculature or subcutaneous soft tissue. Normal muscle bulk without fatty infiltration.

Output: No evidence of stress fracture or stress reaction.


Instruction: Generate impression based on findings.

Input: Lhermittes sign, cognitive problems, bladder urgency weak in upper extremity with diminished vibration in toes. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal punctate foci of high T2 signal in the cerebral white matter. 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.Cervical Spine: The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is degenerative spondylosis at C4 through C6 with mild spinal canal and bilateral neural foramen stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Minimal nonspecific punctate foci of high T2 signal in the cerebral white matter, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Degenerative spondylosis at C4 through C6 with mild spinal canal and bilateral neural foramen stenosis, but no evidence of demyelinating lesions in the cervical spinal cord.


Instruction: Generate impression based on findings.

Input: Cervical stenosis, neck pain and upper extremity weakness, leg weakness There is mild straightening of the normal cervical lordosis. The vertebral body heights are well-maintained. Bone marrow signal is within normal limits. There are anterior flowing osteophytes without significant disc space loss at the levels of C4-C5, C5-C6 and C6-C7 suggestive of DISH as seen on recent CT. There are minimal foci of calcification/ossification involving the posterior longitudinal ligaments as seen on CT dorsal to the C5, C6, and C7 vertebral bodies. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disk osteophyte complex at the central and left central level and ligamentum flavum buckling. There is resulting moderate to severe spinal canal stenosis including flattening of the left greater than right cord. No cord signal abnormality. No significant neural foramina stenosis.C4-5: Disk osteophyte complex at the central and right central level. There is resulting moderate to severe spinal canal stenosis including flattening of the ventral cord greater on the right. Calcification as seen on CT. No cord signal abnormality. There is mild right neural foramina stenosis. No significant left neural foramina stenosis.C5-6: Disk osteophyte complex with effacement of the ventral thecal sac resulting in mild spinal canal stenosis. No cord signal abnormality. There is mild right and minimal left neural foramina stenosis. C6-7: No spinal canal stenosis. There is uncovertebral hypertrophy with mild to moderate right and mild left neural foramina stenosis.C7-T1: No spinal canal stenosis. There is uncovertebral hypertrophy with mild to moderate left (better seen on CT) and mild right neural foramina stenosis. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine with moderate to severe spinal canal stenosis at C3-4 and C4-5. There is flattening of the cord at these levels without definite cord signal abnormality.2. Minimal foci of calcification/ossification of the posterior longitudinal ligament and associated early findings of DISH as seen on recent CT. 3. Mild neural foraminal narrowing at multiple levels as detailed above.


Instruction: Generate impression based on findings.

Input: Recurrent medulloblastoma. There are postoperative findings related to prior right suboccipital craniotomy. There is a heterogeneous mass in the right cerebellar hemisphere treatment bed, which measures up to nearly 4 cm. There is no evidence of other intracranial lesions. The ventricles are unchanged in size and configuration, including partial effacement of the fourth ventricle, but no evidence of hydrocephalus. The cerebellar tonsils are mildly low-lying, but there is no midline shift. There are skin fiducial markers.

Output: Preoperative planning MRI demonstrates a mass in the right cerebellar hemisphere treatment bed, which likely represents recurrent neuroblastoma.


Instruction: Generate impression based on findings.

Input: Female, 77 years old, with aphasia and right-sided weakness. Findings are seen compatible with a very large AV malformation involving the left posterior frontal, parietal, and perhaps temporal lobes. This includes numerous convoluted and serpentine flow voids, several of which are markedly dilated. The left MCA vessels are generally enlarged indicating the likely primary source of supply. Numerous dilated draining veins are noted including surface veins which drain to the dural venous sinuses and veins which drain to the deep system. Accounting for differences in technique, the overall morphology and size of the lesion seem to be unchanged relative to prior CTs.No restricted diffusion is seen. No definite evidence of parenchymal edema is seen. Mild T2 hyperintensity within the AVM may represent gliosis. The lesion does cause generalized left cerebral mass effect with effacement of sulci, partial effacement of the left lateral ventricle, and a relatively mild 5 mm midline shift to the right. These findings do not appear to have changed significantly. Within the lesion, there is a 10 mm T1 hyperintense lobule which could represent a small hemorrhagic collection or perhaps a thrombosed vascular channel.

Output: Findings are seen compatible with a large left sided AV malformation involving the posterior frontal lobe, parietal lobe and perhaps a small portion of the temporal lobe. The overall size of the lesion does not seem to have changed significantly. It appears that the left MCA serves as a major source of supply for the lesion with venous drainage to both superficial and deep systems. The degree of associated mass effect does not appear to have changed. No definite acute abnormalities are seen.


Instruction: Generate impression based on findings.

Input: Right eye pain with movement. The images are generally degraded by patient motion.Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.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.

Output: 1. No evidence of optic neuritis or intracranial demyelinating lesions.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: History of rectal cancer. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a region of very low T2-weighted signal intensity affecting the anterior aspect of the distal rectum favoring post treatment related scarring. The signal abnormality abuts and is indistinguishable from the adjacent posterior aspect of the prostate, unchanged. No measurable intermediate T2-weighted signal intensity, restricted diffusion or abnormal enhancement to suggest residual disease. No mesorectal lymphadenopathy.OTHER: Small left hydrocele. Fat-containing inguinal hernias bilaterally.

Output: Post treatment related residual scarring/fibrosis of the anterior low rectal tumor without measurable disease appearing similar to the prior study. No suspicious pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 58 year old female with history of right lumpectomy for multifocal tubular carcinoma. History of sarcoid. Dense breasts. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes of a right lumpectomy including scarring, architectural distortion, and volume loss. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Other convulsions [780.39], Reason for Study: ^Reason: r/o demyelinating disease, Do only sagittal FLAIR History: R leg weakness There are multifocal bihemispheric white matter high signal intensities on FLAIR imaging which do not show any significant interval changes in terms of size, number and extent since prior scan. Especially the the right periventricular and caudate nucleus lesion is perpendicular to the ventricular axis indicating possibility of demyelinating disease.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal bihemispheric various sized scattered high signal intensity lesions on FLAIR imaging indicating possible demyelinating disease, no change of the extent, number and distribution since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Male, 8 years old, with brain tumor and epilepsy. Functional MRI and DTI requested for surgical planning. Sensorimotor cortical activation of the lower extremity/foot was unreliably visualized despite repeat attempts. Sensorimotor cortical activation of the hand and face/tongue was adequately visualized and maps as expected along the pre- and post-central gyri. Passive visual stimulation produced cortical activity as expected along the calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation was seen with the verb generation and sentence completion paradigms. Language is left dominant. Wernicke's area is well visualized on the sentence completion paradigm mapping along the posterior aspect of the left superior temporal sulcus. Broca's area is well visualized on the verb generation paradigm with several foci of activity in the left inferior frontal lobe. Both paradigms demonstrate expected secondary language activity in the left middle frontal gyrus and in the left SMA.The auditory word listening paradigm also demonstrates Wernicke's area in its expected location on the left. In addition, activation of primary auditory cortex is seen bilaterally along the superior surfaces of the superior temporal gyri. On the right, this activity maps immediately posterior and superior to the patient's temporal lobe tumor.

Output: 1.Sensorimotor cortical mapping of hand and facial motor activity was successful. Sensorimotor cortical mapping of the foot/lower extremity could not be achieved with adequate reliability. Primary visual cortical activity mapped as expected to the occipital lobes.2.Language mapping demonstrates left hemispheric dominance. Broca's and Wernicke's areas mapped to their expected locations as above.3.Auditory stimulation demonstrates the location of primary auditory cortex along the superior surfaces of the superior temporal gyri bilaterally. On the right, this activity maps immediately posterior and superior to the patient's right temporal tumor.


Instruction: Generate impression based on findings.

Input: Right shoulder pain, evaluate the posterior labrum ROTATOR CUFF: The supraspinatus, infraspinatus, teres minor, and subscapularis muscles and tendons are intact without evidence of tearing or inflammation.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Contrast is seen within the glenohumeral joint without communication into the subdeltoid or subacromial bursa. The anterior and posterior labrum is intact without evidence of tearing.BICEPS TENDON: The biceps tendon is intact without evidence of tearing or inflammation. ADDITIONAL

Output: Tiny amount of fluid in the acromioclavicular joint. Otherwise normal MRI of the right shoulder.


Instruction: Generate impression based on findings.

Input: 63 years, Male, Reason: hx of elevated PSA, and previous negative prostate biopsies, please evaluate, prostate biopsy to follow History: see above. PELVIS:PROSTATE:Prostate Size: 5.0 x 4.7 x 4.6 cmPeripheral Zone: There is a lesion in the left apex which is dark on ADC/T2 measuring 0.9 x 1.8 cm (704/84), suspicious for prostatic adenocarcinoma. A focus of low ADC signal posterior to this lesion (704/104) likely represents a draining vein.Central Gland: Multiple heterogeneous nodules suggests benign prostatic hypertrophy.Seminal Vesicles: No involvement.Extracapsular Extension: No extracapsular extensionBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left apical lesion is suspicious for prostatic adenocarcinoma.2.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Left lower extremity weakness and right eye vision loss. The right superior fissure and optic canal regions are unremarkable. There is no evidence of mass lesions. The bilateral orbital contents are intact. The optic nerves and chiasm are unremarkable. There is diffuse high T2 signal in the left mandible and right maxillary alveolus. There are prominent arachnoid granulations in the floor of the right middle cranial fossa. There is patchy scattered cerebral white matter T2 hyperintensity. There is mucosal thickening in the right ethmoid sinuses. There is mild mucosal thickening in the bilateral mastoid air cells.

Output: 1. The right optic nerve is unremarkable.2. Inflammatory changes in the bone marrow in the left mandible and right maxillary alveolus at the site of periodontal disease previously demonstrated on CT.3. Patchy scattered cerebral white matter T2 hyperintensity may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 29-year-old female with orbital mass found an outside hospital. Headaches, orbital lesion found incidentally on outside hospital CT. There is a well demarcated, ovoid lesion in the right intraconal space which is superior and lateral to the optic nerve and produces mild inferior displacement of the lateral rectus. On T2-weighted sequences, a fluid-fluid level is noted with a rim of susceptibility along the anterior margin. Some enhancement of the posterior aspect of the lesion is suspected with a contrast level corresponding to the fluid/fluid level seen on T2 images. This lesion produces mild proptosis on the right. The right extraconal space and globe are normal. The left orbit is normal.There is a focus of increased T1 signal posterior to the right mastoid air cell along the tentorium which suppresses on fat-suppressed images. No significant enhancement this lesion is evident. Brain parenchyma appears otherwise unremarkable. The ventricles and basal cisterns are grossly normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1.Enhancing lesion in the right intraconal space with a fluid fluid level is suggestive of a vascular lesion. A venous or venolymphatic malformation is favored with a hemangioma considered less likely.2.Incidental lesion along the right tentorium has signal suggestive of fat. Differential includes a small lipoma or dermoid, among other benign etiologies.


Instruction: Generate impression based on findings.

Input: 49-year-old female patient with right knee pain. MENISCI: There is an obliquely oriented tear through the body and posterior horn of the medial meniscus with what appears to be a flipped fragment within the weightbearing portion of the medial compartment. There is additional intrasubstance signal extending to the periphery in the posterior horn, suggestive of degeneration or a horizontal tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is complete and near complete articular cartilage loss in the medial patellar facet. There is subjective thinning of the articular cartilage in the lateral compartment without a fluid-filled cartilage defect.There is complete cartilage loss in the weightbearing portion of the medial femoral condyle, measuring approximately 2 cm in diameter. There is underlying subchondral linear low T2 signal intensity and reactive marrow changes. LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament complex, medial collateral ligament, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Full-thickness chondral defect in the medial femoral condyle with underlying reactive marrow changes.2.Tearing of the body and posterior horn of the medial meniscus and findings compatible with a flipped fragment in the weightbearing portion of the medial compartment.


Instruction: Generate impression based on findings.

Input: There are postsurgical findings consistent with midline suboccipital craniotomy relating to resection of pontine cavernous malformation. Susceptibility related to hemosiderin deposition is demonstrated in the posterior pons with small foci of nonspecific T1 and T2 signal. The exophytic portion of the pontine lesion has been resected. The lesion now measures 8 x 6 mm, previously 12 x 15 mm. A prominent adjacent DVA in the left cerebellum is again demonstrated. The ventricles and sulci are within normal limits. Slightly prominent perivascular spaces are incidentally noted along the ventricular atria within the periventricular white matter. The cisterns remain patent. There is no midline shift or mass effect. There are no additional areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: There are interval postoperative findings related to resection of dorsal pontine cavernous malformation with a residual rounded dorsal pontine signal abnormality suspected to represent a small residual component of the lesion. The exophytic component has been entirely resected. A prominent left cerebellar DVA is again demonstrated.


Instruction: Generate impression based on findings.

Input: Clinical question: 30-year-old male with headaches with associated epistaxis and blurry vision. Non-enhanced CT of brain:Images through supratentorial space demonstrate no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The gray/white matter differentiation is well preserved.Images through posterior fossa demonstrate a large heavily calcified lesion in the right cerebellum posteriorly. This lesion measures approximately 21 mm in transverse axis and 26-mm in transverse axis (image 8 of 31). This finding is not associated with any vasogenic edema. Etiology of this finding is not certain the finding however could represent a dystrophic calcification, cavernoma or a partially calcified neoplasm. Further evaluation with an MRI is recommended.The folia of the cerebellum and vermis appears more pronounced than is expected for patient's stated age of 30 and this is concerning for underlying parenchymal volume loss.The calvarium, paranasal sinuses, mastoid air cells and middle ear cavities are well pneumatized and unremarkable.

Output: 1.26-mm x 21 mm irregularly shaped heavily calcified lesion in the posterior aspect of right cerebellum. Dystrophic calcification, cavernoma or a partially calcified neoplasm is suspected and follow-up with a enhanced dedicated MRI of brain is recommended.2.Suspected parenchymal volume loss of the cerebellum and vermis for patient stated age.3.No abnormality in the supratentorial space.4.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.


Instruction: Generate impression based on findings.

Input: Reason: R Knee Meniscus Tear, Chondromalacia History: Pain, Swelling Loss ROM MENISCI: There is a horizontal tear through the anterior horn of the lateral meniscus extending into the body and inferiorly to the tibial articular surface with partial extrusion of the lateral meniscus. There is a horizontal tear extending through the posterior horn of the medial meniscus into the body and inferiorly to the inferior articular surface with relative preservation of the anterior horn. The menisci remains properly anchored posteriorly.ARTICULAR CARTILAGE AND BONE: There is minimal, patchy edema within both femoral condyles and the tibial plateau. The Insall-Salvati ratio is within normal limits. There is diffuse thinning with small focal areas of fissuring involving the patellar facet without additional focal defects. Moderate osteoarthritis affects the knee. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: 1. Medial and lateral meniscal tears extending to the inferior articular surface as detailed above.2. Osteoarthritis and degeneration of the articular cartilage of the knee. 3. Moderate-sized Baker's cyst.


Instruction: Generate impression based on findings.

Input: Reason: aortic dissection History: incidental abnormal ct with aortic abnormality with question of thrombus vs dissection LUNGS AND PLEURA: Probable bibasilar atelectasis.MEDIASTINUM AND HILA: The ascending aorta is mildly ectatic measuring up to 4.1 cm in diameter. There is no evidence of aortic dissection or suggestion of intramural thrombus is stated in the clinical history. Heart size is normal. There is no pericardial effusion.CHEST WALL: T2 lobulated hyperintense lesion superior to the left clavicle best seen on image 15 of series #2 measuring approximately 2.6 x 1.2 cm, possibly a small fluid collection, cyst, or lymphangioma.UPPER ABDOMEN: Numerous hepatic cysts and a left upper pole renal cyst are noted.

Output: No evidence of aortic dissection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 57-year-old female with intermittent headaches. Small cell lung cancer. Evaluate for metastases. Enhanced CT of brain:There is no evidence of normal enhancement of brain parenchymal or leptomeninges to suggest metastatic lesion. The cortical sulci, ventricular system and all CSF cisterns remain within normal limits for patient's stated age. There is heavy vascular calcification of intracranial vertebral arteries and bilateral cavernous carotid. I suspect subtle low-attenuation in the subcortical white matter of bilateral cerebral hemispheres. This findings are nonspecific however considering patients provided clinical data and heavy intracranial vascular calcification, the above findings may represent small vessel disease of indeterminate age. Follow-up with an MRI examination is recommended.Calvarium is intact. Mastoid air cells and middle ear cavities and limited view of paranasal sinuses are negative.

Output: 1.No evidence of metastatic disease to brain, leptomeninges or of the calvarium.2.Vascular calcification of bilateral intracranial vertebrals and cavernous carotids consistent with atherosclerotic disease.3.Minimal small vessel disease of indeterminate age is suspected.


Instruction: Generate impression based on findings.

Input: Female, 77 years old, with sudden onset of ptosis. Brain:Scattered small foci of white matter T2 hyperintensity are seen without evidence of edema, mass effect or diffusion restriction. No pathologic parenchymal or extra-axial enhancement is detected. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology.Orbits:Mild bilateral proptosis is seen. However, the globes are symmetric and round. The lenses are normally positioned. The extraocular muscles demonstrate normal caliber and enhancement. The optic nerves are not thickened and are free of pathologic enhancement. The intraorbital fat is clean with no evidence of any mass, fluid collection or inflammatory stranding. The superior ophthalmic veins are not engorged. There is no asymmetric or abnormal orbital enhancement. The cavernous sinuses are within normal limits.

Output: 1.Mild bilateral proptosis is seen with no clear underlying etiology.2.No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Characterize liver lesion seen on outside hospital CT. ABDOMEN:LIVER, BILIARY TRACT: Please note that the outside hospital CT from July is not available for comparison. There are several scattered T1- weighted hypointense lesions within the liver parenchyma the majority of which measure less than 1 cm with minimal thin-walled peripheral enhancement. The largest is a segment 8 lesion measuring 1.2 x 0.8 cm. This corresponds to the subtle hypoattenuating lesion seen on the CT dated 11/22/2014 where it measured 2.9 x 1.9 cm. The additional hypoattenuating lesion seen on CT have corresponding lesions on the MRI which are also significantly decreased in size.No new suspicious liver lesion. No biliary ductal dilatation. The vessels are patent.Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Few left renal cyst. No suspicious renal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis. Interval improvement in previously seen partially imaged pericolonic inflammatory changes.BONES, SOFT TISSUES: Very small fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: 1. Please note that the outside hospital CT referred to in the order is not available for comparison. However, given this limitation the largest lesion measures 1.2 cm and is significantly decreased in size from the 11/2014 CT study. Additional subcentimeter thin peripherally rim-enhancing hypointense lesions demonstrate interval decrease in size and are compatible with treated residua of previously seen large abscesses. No suspicious liver lesion is identified.2. Interval improvement in previously partially imaged pericolonic inflammatory changes.


Instruction: Generate impression based on findings.

Input: Posterior fossa tumor assessment. Presented with neck pain and torticollis. There is a large mass filling the fourth ventricle and extending through its outflow tracts (especially the right foramen Luschka and foramen Magendie) into the right cerebellopontine angle as well as the upper cervical spinal canal posterior to the spinal cord down to lower C2 vertebral level. The mass is associated with obstructive dilatation of the lateral and third ventricles as well as transependymal CSF flow in the periventricular white matter. The mass has a largest axial diameter (as measured on image #7 of series #4 all 1) of 6.3 cm x 4.2 cm. Craniocaudally, as measured on image #98 of series #902, it measures maximally 5.8 cm. The mass is mildly T2 hyperintense and is T1-hypoointense (relative to gray matter) and shows only heterogeneous, predominantly peripheral contrast enhancement. The mass shows diffusion characteristics that are similar to gray matter. The mass displaces and partially encases the right posterior inferior cerebellar artery and its branches which are asymmetrically enlarged compared to the left side. It abuts and displaces the right intracranial vertebral artery as well. It deforms the brainstem and the cerebellar hemispheres but does not invade them. There is no sign of leptomeningeal metastasis. The dural venous sinuses and major intracranial arteries are patent. There is very minimal mucosal thickening/fluid in the paranasal sinuses and the right mastoid air cell. The orbits are unremarkable.

Output: 1.Fourth ventricular mass with extension into the right cerebellopontine angle and the upper cervical spinal canal is most compatible with ependymoma. Much less likely considerations include medulloblastoma and an exophytic juvenile pilocytic astrocytoma. 2.The mass causes obstructive hydrocephalus.3.Presurgical planning sequences were also performed as above.


Instruction: Generate impression based on findings.

Input: Reason: Assess for meniscal tear - h/o pain with deep squat and mechanical locking of knee History: Knee pain and mechanical symptoms MENISCI: The medial and lateral meniscus appear intact. There is increased signal abnormality within the posterior horn of the lateral meniscus indicating mild intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: The medial and lateral compartment articular cartilage appear relatively spared. There is full-thickness articular cartilage degeneration along the lateral facet of the patella with large areas completely devoid of articular cartilage. There is underlying subchondral signal abnormality. There is focal full-thickness articular cartilage degeneration along the lateral facet of the femoral trochlea as well.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is intermediate signal intensity within the patellar tendon which may reflect mild tendinosis.ADDITIONAL

Output: Articular cartilage degeneration and full thickness defects affecting the patellofemoral articulation. The menisci appear intact.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with left chest pain and T11 radiculopathy, assess for compression fractures. Thoracic:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. T1 and T2 hypointensity within the T11 vertebral body, contiguous with the inferior endplate, is seen suggestive of a Schmorl's node. No significant associated marrow edema is seen. A T1 hypointense, T2 isointense lesion is evident anteriorly within the T12 vertebral body, contiguous with the superior T12 endplate, with a mild rim of associated marrow edema. Neither vertebral body shows significant loss of height and no frank compression deformities are seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.A small left paracentral disc protrusion is seen at T7-8. A small right paracentral disc protrusion is seen at T8-9. The T10-11 and T11-12 discs show loss of T2 signal and mild loss of height. Facet hypertrophy develops at lower thoracic levels, particularly notable at T10-11 and T11-12. The left T11-12 neural foramen is mildly narrowed as a result. No other significant spinal canal or foraminal compromise is seen.Limited views of the cervical spine demonstrate multilevel disc osteophyte formation and perhaps some thickening of the posterior longitudinal ligament which results in spinal canal stenosis and possible cord impingement.Lumbar:Spinal alignment is anatomic. Vertebral body heights are preserved. No pathologic marrow replacement or marrow edema is seen.The visualized distal spinal cord, conus and cauda equina are within normal limits. No epidural abnormalities are suspected.Significant loss of disc height is seen at L5-S1 with endplate irregularity. Additional level specific degenerative findings are as follows:L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L4-5: Facet hypertrophy and ligamentum flavum thickening. Bulging disc with a small superimposed central protrusion. Mild generalized spinal canal narrowing with some effacement of the left lateral recess. Both neural foramina are significantly narrowed. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Bulging disc with a superimposed left paracentral disc protrusion. This protrusion may impinge upon the descending left S1 nerve root. No significant generalized spinal canal stenosis is seen. However, both neural foramina are severely narrowed.

Output: 1.Marrow signal change is evident within T11 and T12, centered along the endplates, and favored to represent degenerative Schmorl's nodes. Although Schmorl's nodes are a frequent incidental finding, they can be symptomatic in the acute phase.2.No evidence of any frank compression deformity is seen in the thoracic or lumbar spine.3.At L4-5, disc degeneration and facet hypertrophy result in a mild spinal canal narrowing and significant compromise of the bilateral neural foramina grade4.L5-S1, disc degeneration with a left paracentral disc protrusion is seen with possible impingement of the left S1 nerve root. This, along with facet hypertrophy, contributes to severe bilateral foraminal narrowing.5.Multilevel degenerative findings are partially visualized in the cervical spine with areas of canal stenosis and possible cord impingement. This can be assessed with dedicated cervical spine imaging if clinically warranted.


Instruction: Generate impression based on findings.

Input: Evaluate lumbar fluid collection. History of CSF leak following microdiscectomy in June 20, 2016. Prior surgical repair on 9/7/2016, lumbar drain placement, as well as epidural blood patch a 9/21/2016. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There are postsurgical changes of discectomy at L5-S1 with a left-sided laminotomy at L5 and a fluid collection extending from the spinal canal, including the subdural and epidural spaces, and extending posteriorly into the left paraspinous and subcutaneous soft tissues. Compared to 9/1/2016, there has been decrease in size of the fluid collection. For example majority of the previously seen small subdural component has resolved although there remains small amount of subdural fluid at the right L4-L5 level. There is a subcutaneous fluid collection component which measures approximately 16 x 23 mm x 21 mm in the AP, transverse, and craniocaudal dimensions, previously 18 x 44 x 41 mm, findings compatible with decrease in size of pseudomeningocele. There is fluid/blood products predominantly along the right L4 to S1 dorsolateral epidural space related to recent blood patch with mild local mass effect on the thecal sac at the right L5 level. Lumbar drainage catheter is noted entering the spinal canal at the L3-L4 level and extending superiorly.Mild L4-L5 disc bulges again seen with dorsal annular fissure. There is otherwise no significant disc disease, spinal canal, or neural foraminal stenosis at any level.

Output: Compared to 9/1/2016, there is decrease in size of pseudomeningocele centered at the left L5-S1 level with residual fluid, changes related to discectomy, and expected changes related to recent epidural blood patch as detailed above.


Instruction: Generate impression based on findings.

Input: History of olfactory neuroblastoma and CRT. Orbits: There are postoperative findings related to sinonasal surgery and bifrontal craniotomy. There is unchanged minimal distortion of the right medial rectus muscle, which may be due to scar tissue formation. Otherwise, the orbital contents are unremarkable, without evidence of mass lesions. There is diffuse mild mucosal thickening and enhancement along the medial margin of the right lamina papyracea and along the reconstructed ethmoid roof. There is also moderate mucosal thickening and enactment within the remaining portions of the inferior right maxillary sinus and mild mucosal thickening within the sphenoid sinuses. There is also a new air-fluid level within the left maxillary sinus. There is unchanged diffuse enhancement within the obliterated frontal sinus bed. The right pterygopalatine fossa, foramen rotundum, Vidian canal, and foramen ovale appear intact. The left orbit is unremarkable. Brain: There is slight interval decrease in size of the enhancing tissue in the surgical bed along the right ethmoid roof. There are minimal nonspecific scattered foci of T2 hyperintensity in the cerebral white matter. 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.

Output: 1. Post-treatment findings in the sinonasal region with slight interval decrease in size of the enhancing tissue in the surgical bed along the right ethmoid roof, which is likely treatment-related, but otherwise no convincing evidence of recurrent olfactory neuroblastoma.2. New fluid within the left maxillary sinus may represent acute sinusitis, in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The myelination is appropriate for age. The pituitary region is within normal limits. Brainstem and cerebellum are normally formed and unremarkable. The corpus callosum is fully formed and normal.

Output: Normal MRI of the brain without specific findings to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: Clinical question: 83-year-old female with myelofibrosis with neutropenia and altered mental status and congestion. Signs and symptoms: Neutropenia Nonenhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal for patient stated age of 83. Limited view of orbits are unremarkable. Calvarium demonstrates old biparietal burr holes and is otherwise unremarkable. Limited view of paranasal sinuses are unremarkable.Nonenhanced CT of paranasal sinuses:Routine nonenhanced CT of paranasal sinuses are obtained.The paranasal sinuses are well pneumatized and with no evidence of acute or chronic sinus disease. The frontal sinuses are not developed.Images through the nasal cavity are essentially unremarkable with the exception of a small septal bony spur projecting to the left and measuring 4-mm in size. Diffuse sclerotic changes of clivus without any bony destructive changes is noted. Please correlate with history and if clinical concern persist follow-up with an MRI is recommended.

Output: 1.Negative CT of brain .2.Negative CT of paranasal sinuses. Frontal sinuses are not pneumatized which is an anatomical variation.3.Diffuse sclerotic changes of clivus with no destructive bony changes. Correlate with history and follow-up with an MRI if there is a clinical concern for malignancy.


Instruction: Generate impression based on findings.

Input: MRI brain: There are numerous punctate to small supratentorial and infratentorial areas of diffusion restriction with corresponding T2/FLAIR hyperintensity, with most centered in the bilateral cerebellar hemispheres posteriorly where there is effacement of sulci. There are foci of diffusion restriction in the central portion of the superior pons and cerebellar vermis. There are multiple small punctate punctate foci involving the bilateral parahippocampal gyri, left greater than right temporal and occipital lobes, bilateral parietal and frontal lobes. There is also involvement of the bilateral basal ganglia and right thalamus. There are innumerable punctate foci of susceptibility effect in the bilateral frontal, parietal and anterior temporal lobes, splenium of the corpus callosum, most of which do not definitively cross-reference with the areas of acute infarction. These are nonspecific and may represent chronic microhemorrhages.There is diffuse mild volume loss. There is mild periventricular white matter T2 signal abnormality which is nonspecific, likely representing chronic microvascular ischemic change. There is moderate left and trace right maxillary sinus mucosal thickening. There is mild to moderate ethmoid sinus and trace bilateral sphenoid mucosal thickening. There is left greater than right mastoid opacification. There is fluid in the posterior nasal cavity with a nasogastric tube partly imaged. The left V4 vertebral artery segment is diminutive with indistinct flow void.MRA brain: There is mild motion artifact degrading image quality. Within this limitation, the anterior and posterior circulation are intact with the exception of the left V4 vertebral artery segment which shows only minimal flow related enhancement and is much smaller compared to the right.MRA neck: The left subclavian artery origin is not well seen. The remaining great vessel origins are grossly intact. There is no flow related enhancement in the left subclavian artery approximately at the location of the expected left vertebral artery origin. The entire left vertebral artery is not seen except distally intracranially, compatible with occlusion with probable minimal retrograde flow. There is mild focal irregularity without significant stenosis at the origin of the right internal carotid artery suspected, best seen on the 3-D vessel images (series 505 image 13). There is mild asymmetric fullness of the left thyroid lobe with suspected decreased signal possibly representing a nodule (series 501 image 103).

Output: 1.Innumerable punctate to small acute foci of diffusion restriction in the supratentorial and infratentorial brain. Given recent history of cardiac arrest, these most likely represent numerous tiny infarcts which may be secondary cardiac embolic etiologies. Differential diagnosis also includes hypotension and/or hypoxic/anoxic injury, although the pattern seen on the study is atypical for these entities.2.Occlusion of the entire left vertebral artery with minimal retrograde flow intracranially, likely chronic.3.Occlusion of the left subclavian artery at the level of the expected left vertebral artery origin, extending distally, also likely chronic.4.Fullness and asymmetric decreased signal intensity in the left thyroid lobe suspicious for a thyroid nodule. Further dedicated thyroid sonogram can be helpful for further evaluation if clinically indicated.Findings were discussed with Dr. Ali Mansour over the telephone at 2:45 p.m. today by Dr. Uppuluri.


Instruction: Generate impression based on findings.

Input: There is no evidence of mass or acute infarct. There are multiple patchy foci of T2 hyperintensity within the supratentorial white matter, thalami, and basal ganglia. There are a few punctate foci of susceptibility effect within the supratentorial and infratentorial white matter compatible with chronic micro hemorrhages. There is no abnormal intracranial enhancement. 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 skull and scalp soft tissues are unremarkable. There is mild polypoid mucosal thickening within the left maxillary sinus.

Output: 1. No evidence of mass or acute infarct. 2. Moderate small vessel ischemic disease and scattered chronic micro hemorrhages that may be hypertensive in etiology.


Instruction: Generate impression based on findings.

Input: Epilepsy, unspecified, not intractable, without status epilepticus [G40.909], Reason for Study: ^Reason: MRI stealth with contrast, depth electrodes History: pre op planning 32 years Male (DOB:9/15/1984)Reason: MRI stealth with contrast, depth electrodes History: pre op planningPROVIDER/ATTENDING NAME: KRUPA G ANDALKAR JAMES X. TAO There are electrodes inserted one through the right occipital burr hole and the tip is located at the mesial aspect of the right temporal lobe and another through the right frontal burr hole and the tip is located at the lateral aspect of the right side caudate head. Again seen and bilateral hemispheric and heterotopia, unchanged since prior scan.Diffuse pachymeningeal enhancement is seen most likely related to electrode insertion.Cerebellar volume loss is again seen, unchanged.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. Two burr holes (one at the right frontal and another at the right occipital) with electrode insertion.2. Unchanged bilateral hemispheric band heterotopia.


Instruction: Generate impression based on findings.

Input: Possible wound infection versus osteomyelitis. History of stump infections. Fell today. Bilateral BKA secondary to diabetes. Several sequences are limited by motion artifact.Patient is status post right below-the-knee amputation. There appears to be a small skin defect of the distal stump (series 5, images 11-13). The subcutaneous fat of the stump distal to the tibia demonstrates intermediate signal intensity on T1-weighted images, mixed signal intensity on T2-weighted images, and enhancement on postcontrast images. This likely represents a combination of inflammation and scarring. However, the underlying marrow signal intensity of the adjacent tibia appears normal on T1-weighted images without evidence of osteomyelitis. The marrow intensity of the fibula likewise appears normal.No rim-enhancing fluid collection is present to suggest abscess. Overall there is expected fatty atrophy of the musculature of the leg with mild edema of the remaining tibialis anterior muscle, which is nonspecific. Mild edema and enhancement of the lateral aspect of the patella may represent a bone contusion.Postoperative changes of left below-the-knee amputation are also noted, without evidence of osteomyelitis of the left tibia or fibula.

Output: 1.Mild inflammatory changes of the distal soft tissues of the stump, without evidence of abscess or osteomyelitis.2.Mild edema and enhancement of the patella may represent contusion.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with new arm numbness and weakness and worsening leg weakness. History of multiple myeloma. Brain:A moderately sized chronic infarct of the right middle frontal gyrus is unchanged. Numerous small cortical infarcts are evident elsewhere within the right cerebral hemisphere and in the bilateral cerebellum. No evidence of restricted diffusion is seen to suggest acute ischemia.Extensive patchy periventricular and subcortical T2 hyperintensity is seen, a nonspecific finding which is nevertheless unchanged. No evidence of parenchymal edema or mass-effect seen. No significant intracranial hemorrhage is detected. The ventricular system is normal in size and morphology. A developmental venous anomaly is evident within the left corona radiata. No pathologic parenchymal or extra-axial enhancement is seen.Cervical spine:Image quality is degraded by motion artifact. Within this limitation, the following observations are made.Bone marrow signal characteristics are mildly but diffusely heterogeneous. In addition, the C3 vertebral body is uniformly T2 hyperintense and mildly enhancing. Similar findings are seen within the right aspect of the T1 vertebral body and both pedicles. A few foci of abnormal T2 hyperintense signal is also seen within the C7 vertebral body and right pedicle, and the left T2 pedicle and facet complex. Ill-defined abnormal signal and enhancement is also seen along the proximal left T2 and T3 ribs.Spinal alignment is anatomic. Vertebral body heights and morphology are normal.No evidence of pathologic intradural or spinal cord enhancement is seen.C2-3: Mild facet hypertrophy. Otherwise unremarkable.C3-4: Mild facet hypertrophy. Mild posterior disk osteophyte formation. Mild spinal canal stenosis without cord impingement. No significant foraminal narrowing.C4-5: Mild facet hypertrophy. Posterior disk osteophyte formation with a right paracentral protrusion. Mild to moderate spinal canal stenosis with slight deformation of the ventral cord but no cord signal abnormality. Mild left and moderate right foraminal narrowing. C5-6: Mild facet hypertrophy. Posterior disk osteophyte formation. Mild spinal canal stenosis with slight deformation of the ventral cord but no abnormal cord signal. Mild left foraminal narrowing. C6-7: Facet hypertrophy. Posterior disk osteophyte formation. Mild spinal canal stenosis with very slight flattening of the ventral cord but no cord signal abnormality. No significant foraminal narrowing. C7-T1: Mild facet hypertrophy. Posterior disk osteophyte formation with a left paracentral protrusion. No significant spinal canal stenosis or cord impingement. No significant foraminal narrowing.

Output: 1.Evidence of extensive chronic cortical and small vessel ischemic disease. No evidence of any acute intracranial abnormality.2.Scattered areas of pathologic marrow signal intensity and enhancement are seen within the cervical region. These may reflect the patient's stated history of multiple myeloma. These lesions do not result in any significant epidural encroachment, spinal canal or neuroforaminal stenosis.3.Multilevel cervical spondylosis is seen with mild to moderate spinal canal stenosis and mild cord impingement as discussed above.


Instruction: Generate impression based on findings.

Input: Male 14 years old Reason: 14 yr old w/history of CRMO, pain concerning for new lesions vs worsening of old lesions History: pain, fever BONE MARROW: High signal in T2 and low signal on T2 of the right and left iliac bones adjacent to the SI joint. No enhancement was visualized after administration of IV contrast.SOFT TISSUES: No evidence of soft tissues compromise. JOINTS: Enhancement of the SI joint after administration of contrast with no evidence of joint effusion is at the SI joint or both hips.ADDITIONAL

Output: High signal in T2 and low signal on T2 of the right and left iliac bones adjacent to the SI joint, with no enhancement after administration of contrast. Mild SI joint synovial contrast enhancement but no joint effusion or soft tissue compromise.


Instruction: Generate impression based on findings.

Input: Reason: L shoulder pain, eval for labral tear History: see above. ROTATOR CUFF: Mild supraspinatus tendinopathy. Infraspinatus, subscapularis, and teres minor tendons are intact. No muscle atrophy or edema. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. The labrum is intact with no discrete tears. BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild supraspinatus tendinopathy with no discrete rotator cuff tear. No discrete labral tear.


Instruction: Generate impression based on findings.

Input: 20 year-old woman with history of shoulder pain following a diving injury, evaluate for labral tear. ROTATOR CUFF: The muscles and tendons of the rotator cuff are intact.SUPRASPINATUS OUTLET: There is a minimal amount of fluid in the subacromial bursa. The acromioclavicular joint appears normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: A small focus of intra-articular contrast at the base of the anterior labrum at the 3 o'clock position likely represents a sub-labral foramen, a normal variant. There are no definite tears of the glenoid labrum. Glenohumeral joint alignment is normal.BICEPS TENDON: The long head of biceps tendon is intact. ADDITIONAL

Output: 1.No definite labral tear.2.Small focus of signal abnormality in the superior humeral head, likely resolving marrow edema seen on prior study.


Instruction: Generate impression based on findings.

Input: Evaluate for myelitis: Pain on back and right-sided numbness. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of spinal cord lesions.


Instruction: Generate impression based on findings.

Input: 69-year-old male with squamous cell carcinoma found on biopsy of urethra. Need MRI of pelvis. Multiple sequences are limited due to patient motion artifact.ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. No intra or extrahepatic biliary ductal dilatation. Patent vasculature.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing punctate T2 hyperintensity of the right lower renal pole is too small to characterize. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Ectasia of the infrarenal abdominal aorta measuring 2.6 cm in AP diameter.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Right-sided pelvic lymphadenopathy in the pelvic sidewall, external iliac and inguinal regions (series 24 images 88, 102, 104, 111). The largest pelvic lymph node is in the right external iliac station measuring 1.9 x 3.8 cm (series 27 image 33).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is nonspecific heterogenous T2 signal intensity of the distalmost penile urethra (series 27 image 34). Periurethral or urethral wall hyperintense T2 signal and postcontrast enhancement are also noted of the corpus spongiosum /anterior urethra (series 27 image 45, series 26 image 94).

Output: 1. Right-sided lymphadenopathy involving the pelvic sidewall, external iliac and inguinal regions.2. Periurethral or urethral wall enhancement involving anterior urethra, most pronounced at the level of the bulbar urethra. May reflect prior inflammation, neoplastic extension not excluded. Correlation with patient's procedural history and pathology is needed.3. There is ovoid heterogenous T2 intermediate signal intensity of the distalmost penile urethra seen with indistinct margins, nonspecific, again correlation with patient's history required to exclude site of patient's known malignancy.4. No acute abnormality of the abdomen.


Instruction: Generate impression based on findings.

Input: 61-year-old female with lateral joint line pain. Unable to flex without pain. Evaluate lateral meniscus. Due to patient's body habitus, the high-definition coil could not be utilized resulting in slightly suboptimal image quality.MENISCI: There is globular increased signal abnormality within the anterior horn of the lateral meniscus consistent with intrasubstance degeneration. Some of the signal extends to the femoral articular surface consistent with a complex tear. The posterior horn appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a full articular cartilage degeneration along the anterior aspect of the lateral femoral condyle with underlying subchondral signal abnormality. There is full-thickness articular cartilage degeneration along the lateral facet of the patella with underlying degenerative subchondral signal abnormality. The femoral trochlea is shallow/flat, superiorly, and the medial facet appears disproportionately small relative to the lateral facet, indicating femoral trochlear dysplasia.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The Insall Salvati ratio is 1.2, suggestive of patella alta. The extensor mechanism appears intact.ADDITIONAL

Output: 1. Degeneration and complex tear of the lateral meniscus.2. Full-thickness articular cartilage degeneration most pronounced along the patellofemoral joint with findings consistent with femoral trochlear dysplasia.3. Small joint effusion.


Instruction: Generate impression based on findings.

Input: History of abdominal pain nausea and vomiting. Pancreatic dilatation seen on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: The common bile duct and pancreatic duct are dilated to the level of the ampulla where they taper smoothly. No discrete masses evident on this limited noncontrast examination. No filling defects to suggest a stone. Normally distended gallbladder. Several well-defined T2 weighted hyperintense liver foci likely represent benign hepatic cysts.SPLEEN: No significant abnormality noted.PANCREAS: 1.6 x 1.2 cm distal pancreatic tail T2-weighted hyperintense lobular mass without definite communication with the pancreatic duct. Pancreatic ductal dilatation with smooth tapering at the level of the ampulla.ADRENAL GLANDS: 3.3 x 2.0 cm smoothly marginated right adrenal homogeneous mass demonstrating signal dropout on out of phase imaging likely representing a lipid rich adrenal adenoma. Mildly thickened left adrenal gland.KIDNEYS, URETERS: Numerous bilateral well-defined T2 hyperintense and intermediate intensity foci are incompletely characterized without contrast, likely representing multiple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Incompletely characterized the left lower lobe pulmonary nodule.

Output: 1.1.6 cm distal pancreatic tail cystic mass may represent and intraductal pancreatic mucinous neoplasm (IPMN) however a mucinous cystadenoma/cystadenocarcinoma remains a possibility.2.Biliary ductal and pancreatic ductal dilatation to the level of the ampulla without a discrete mass lesion evident on this limited noncontrast examination or gallstone. If this remains of concern an ERCP should be considered.3.Incompletely characterized left lower lobe pulmonary nodule. A dedicated CT examination is recommended.4.Lipid rich right adrenal adenoma.5.Incompletely characterized renal lesions likely represent multiple cysts.Incidental left lung nodule and recommendation for a dedicated CT of the chest was relayed to the ordering physician (Dr. Marc Robinson) using the paging system at 1356 on 08/04/2015.


Instruction: Generate impression based on findings.

Input: Reason: assess for labral tear History: had traumatic dislocation and now 6mo instability ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact. There is subtle increased signal abnormality on fluid sensitive sequences within the superior muscle belly of the subscapularis.SUPRASPINATUS OUTLET: No fluid or intra-articular gadolinium is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is separation of the anterior and superior labrum from the underlying glenoid at the level of the 12 o'clock position to the 3 o'clock position, which may reflect a normal variant sublabral foramen.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Increased signal abnormality within the superior aspect of the muscle belly of the subscapularis which is nonspecific, but can be seen in subacute denervation or perhaps in Parsonage Turner syndrome.


Instruction: Generate impression based on findings.

Input: 56-year-old male with recent prostate biopsy undergoing a heart transplant workup. Postbiopsy pathology results 5/3/2016 - Gleason score 6 at right apex lateral. PELVIS:PROSTATE:Prostate Size: 4.0 x 5.8 x 3.7 cmPeripheral Zone: There is increased T1 signal throughout the prostate compatible with hemorrhage from recent biopsy. The right apex lesion is not conspicuous by MRI. There is a T2 hypointense lesion with corresponding low signal in the left apex measuring 7 x 5 mm.Central Gland: Heterogeneous central gland compatible with benign prostatic hypertrophy.Seminal Vesicles: No evidence of invasion of the seminal vesicles.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited examination given recent biopsy. Within this limitation, there is a suspicious subcentimeter left apex lesion. No suspicious right apex lesion.2.No evidence of metastatic disease in visualized pelvis.


Instruction: Generate impression based on findings.

Input: Anterior neck mass with abnormal CT scan finding of possible lymphatic malformation. There is a multiloculated fluid signal mass with mild diffuse peripheral enhancement in the anterior right neck that insinuates along the facial planes anterior to the sternocleidomastoid muscle and into the submandibular and deep parotid spaces measuring up to approximately 8 cm in length. There is no evidence of significant cervical lymphadenopathy based on size criteria. The left salivary glands are unremarkable. There is a punctate cystic nodule in the right thyroid gland. The osseous structures are intact. The imaged intracranial structures and orbits are unremarkable. The imaged portions of the lungs are clear.

Output: A cystic mass in the anterior right neck that insinuates along the facial planes anterior to the sternocleidomastoid muscle and into the submandibular and parotid spaces measuring up to approximately 8 cm in length likely represents a macrocystic lymphatic malformation.


Instruction: Generate impression based on findings.

Input: Pancreatitis. Evaluate for recurrent pancreatitis.EXAMINATION: MRI/MRCP without and with IV contrast 4/9/2015 ABDOMEN:LIVER, BILIARY TRACT: The common bile duct is dilated measuring up to 8-10 mm. No filling defect is seen within the common bile duct. SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct within the head and proximal body of the pancreas is non-dilated with dilated side branches. The distal portion of the pancreatic duct in the tail is dilated and irregular in appearance, which suggests a stenosis in the distal pancreatic body. The pancreas enhances without evidence of necrosis. Mild inflammatory change is noted about the head of the pancreas. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Irregular pancreatic duct consistent with chronic pancreatitis with upstream dilatation of the pancreatic duct suggesting stenosis in the distal body.2. Dilated common bile duct without filling defect.


Instruction: Generate impression based on findings.

Input: Brain: There are postoperative findings related to Chiari decompression. There are foci of deformity of the posteroinferior aspect of the cerebellum, with tenting towards the overlying dura. There is a retroflexed dens with associated narrowing of the column of cerebrospinal fluid flow across the anterior neo-foramen magnum. Cerebrospinal fluid flow across the posterior neo-foramen magnum appears to be intact. There is no evidence of acute infarction or hemorrhage. There is mild scattered paranasal sinus mucosal thickening.Spine: There interval decrease in size of the thoracic syrinx, which now measures up to 1 mm in width, previously 6 mm. The vertebral bone marrow signal is within the normal limits. There is lack of the usual cervical lordosis, but no spondylolisthesis. There is normal alignment of the lumbar vertebral bodies. The vertebral bone marrow signal appears unremarkable. The conus medullaris is located at the level of L1. The filum terminale appears unremarkable. There is no evidence of spinal canal or neural foraminal stenosis. The paraspinal soft tissues are unremarkable.

Output: 1. Postoperative findings related to Chiari decompression. A retroflexed dens is associated narrowing of the column of cerebrospinal fluid flow across the anterior neo-foramen magnum and tenting of cerebellar tissue towards the overlying dura may indicate adhesion formation. 2. Marked interval decrease in size of the thoracic syrinx.


Instruction: Generate impression based on findings.

Input: Known cerebral aneurysms: yearly surveillance. There is an unchanged 2 mm wide left cavernous sinus aneurysm, a 1-2 mm wide right paraclinoid aneurysm, and a 2 mm wide left A1 segment aneurysm. Other tiny aneurysms suggested on the prior catheter angiogram are not discernible and there is no evidence of new cerebral aneurysms. There is no evidence of significant steno-occlusive lesions.

Output: Unchanged 2 mm wide left cavernous sinus aneurysm, a 1-2 mm wide right paraclinoid aneurysm, and a 2 mm wide left A1 segment aneurysm. Other tiny aneurysms suggested on the prior catheter angiogram are not discernible.


Instruction: Generate impression based on findings.

Input: Reason: right ankle tenderness after fall r/o fracture No evidence of acute fracture or malalignment. If there is continued clinical symptoms and high suspicion of internal arrangement, MRI may be obtained.

Output: No evidence of acute fracture or malignant. If there is continued clinical symptoms and high suspicion of internal arrangement, MRI may be obtained.


Instruction: Generate impression based on findings.

Input: Male, 78 years old, with brain lesion. fMRI examination for surgical planning. The hand sensory cortex is identified along the bilateral post-central gyri (see the yellow colored regions on key image 151 series 601). The corresponding motor cortex, although not explicitly visualized, can be extrapolated as directly across the central sulcus from the sensory cortex, which would place the hand motor area in very close proximity and possibly contiguous with the patient's right pre-central mass. (Please note that areas of yellow color mapping along the ventricles and brainstem are likely related to motion. Areas of violet color mapping reflect activation which correlates negatively with the task and which are irrelevant for the purposes of this study.)

Output: Very limited functional MRI due to patient sedation. Only passive sensorimotor manipulation could be performed, and only manipulation of the hands produced reliable functional activation. The hand sensory cortex maps as expected to the bilateral post-central gyri. The corresponding motor cortex can be extrapolated as being directly across the central sulcus from the sensory cortex.


Instruction: Generate impression based on findings.

Input: Migraine (346.90) No evidence of acute ischemic or hemorrhagic lesion on the scan.There are few multifocal bihemispheric white matter high signal intensities on FLAIR imaging without evidence of enhancement, no evidence of hemorrhage, no diffusion restriction indicating nonspecific white matter lesion.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Nonspecific white matter high signal intensity lesions on bilateral hemisphere as described above.Otherwise no remarkable finding.


Instruction: Generate impression based on findings.

Input: Right leg and arm weakness. Brain MRI:There are multiple scattered restricted diffusion on the left frontal, parietal and occipital lobes, in particular cortical and subcortical location. In addition, the left caudate head as well as anterior aspect of basal ganglia also show restricted diffusion. These lesions represent acute ischemic infarct.There is no evidence of acute hemorrhagic lesion.There is evidence of chronic ischemic infarct on the left PCA territory, especially occipital lobe with encephalomalacia.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Whole spine MRI (acute cord compression protocol) and thoracic MRI;There is no evidence of cord compression on the scan.Normal cervical lordosis, thoracic kyphosis as well as lumbar lordosis were seen.There is evidence of soft tissue mass involvement on the T11 and T12 including bilateral pedicels indicating metastatic lesions. Those lesions narrows bilateral (more on the right) neural foramen. Especially at the level of T11, the right side pedicle as well as neural foramen appears to be invaded by the mass lesion. The lesions show mainly peripheral enhancement and encasing the spinal canal at the level of T11 and T12, however, there is no evidence of spinal cord signal abnormality.Included thoracic cavity shows multiple enhancing lesions bilateral pleural spaces with pleural effusion again indicating metastatic lesion.

Output: 1. Acute ischemic infarctions on the left hemisphere including left caudate head and basal ganglia without evidence of hemorrhagic conversion.2. Multifocal soft tissue masses including T11 and T12 vertebral bodies and adjacent muscle indicating metastatic lesions.3. Multifocal bilateral pleural mass lesions with pleural effusions also suggest possible metastatic lesions. 4. T11 and T12 level spinal canal appears to be encased by soft tissue mass lesions, however, there is no evidence of abnormal spinal cord signal intensity indicating cord compression.


Instruction: Generate impression based on findings.

Input: Clinical question:? Intracranial hemorrhage. Signs and symptoms: Seizures. CT of brain without infusion:Large area of vasogenic edema is noted in the right frontal lobe causing significant effacement of adjacent cortical sulci. A subtle mass effect on the right lateral ventricle. Within the area of vasogenic edema a partially cystic and partially solid mass is present. The larger cystic component of the mass measures 28 mm x 32-mm in transaxial dimensions (axial image 14. This finding is highly suspect of a neoplasm. There is no evidence of hemorrhage associated with this finding. There is a single small focus of low attenuation in the subcortical white matter of left posterior frontal (axial image 18). This finding is nonspecific and may represent an additional foci of neoplasm/metastases or a small foci of ischemic change. Further evaluation with an infused MRI examination is recommended. There is no evidence of hemorrhage, midline shift or hydrocephalus.Calvarium, limited paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.Large area of vasogenic edema containing a partially cystic and partially solid mass highly concerning for malignancy. Follow-up with an MRI examination with infusion is recommended.2.Small foci of subcortical low attenuation is nonspecific however it may represent a second foci of malignancy or small vessel disease.3.No areas of hemorrhage, midline shift or hydrocephalus.4.Calvarium is intact.