Instruction: Generate impression based on findings.

Input: Female 12 years old Reason: simple partial epilepsy History: smiling and starring spells There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. There are no areas of abnormal signal. There is no diffusion abnormality. Hippocampi are symmetric in size, with normal signal characteristics and preserved architecture.Normal flow-voids are demonstrated in the major intracranial vascular structures. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: Unremarkable brain MRI. No lesions are appreciated to suggest seizure focus.


Instruction: Generate impression based on findings.

Input: There is an unchanged ovoid, homogeneously enhancing, extra-axial mass centered in the left prepontine cistern. The mass is measures up to 13 mm, previously also 13 mm. There is unchanged mass effect on the left pons, left oculomotor nerve, left posterior cerebral artery, and left cerebral peduncle. However, the intracranial portion of the left trigeminal nerve appears to be intact. There are a few scattered T2 hyperintensities in the subcortical and periventricular white matter. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There are small mucous retention cysts in the bilateral maxillary sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Unchanged mass centered in the left prepontine cistern.2. Stable mild probable chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small developmental venous anomaly along the inferior and anterior aspect of the right thalamus. The brain parenchyma and pituitary gland otherwise appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and scalp soft tissues are grossly unremarkable. There are small mucous retention cysts in the right maxillary sinus and in the right nasopharyngeal mucosal space.

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


Instruction: Generate impression based on findings.

Input: There are scattered punctate foci of T2 hyperintensity in supratentorial white matter, primarily in subcortical white matter locations, without mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There are no similar appearing lesions within the posterior fossa. There is a small area of T2 hyperintensity involving the medial-most aspect of the right caudate head with associated focal ex vacuo dilatation of the lateral wall of the right lateral ventricle. Overall lateral ventricular asymmetry is the within acceptable limits of anatomic variation. There are no findings of hydrocephalus. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.There are scattered punctate foci of T2 hyperintensity in supratentorial white matter, primarily in subcortical white matter locations. Lesional morphology, locations, and distributions are not typical for migraine sequela, residua from prior trauma, or demyelination. Thus, this most likely represents mild chronic small vessel ischemic disease.2.There is a small focal area of gliosis and encephalomalacia involving the medial-most aspect of the right caudate head.


Instruction: Generate impression based on findings.

Input: Female, 7 years old, increased right-sided weakness, low muscle tone, precocious puberty. Recent MRI showed possible abnormality in the upper cervical region. Spinal alignment is anatomic. Vertebral body height and morphology are normal. No evidence of marrow replacement or marrow edema is seen.The visualized spinal cord, conus and cauda equina are unremarkable. No pathologic cord signal abnormality is seen. The conus tip terminates at the L1 level which is normal. The nerve roots of the cauda equina disperse evenly through the thecal sac. No evidence of fatty filum terminale or any intraspinal mass is seen.On postcontrast images, no pathologic paraspinal or marrow enhancement is seen. Likewise, no evidence of abnormal intradural enhancement is detected.At no level is there any significant spinal canal or neuroforaminal stenosis.

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


Instruction: Generate impression based on findings.

Input: 77-year-old male with metastatic prostate cancer and history of lung cancer. CHEST:LUNGS AND PLEURA: Postsurgical changes with volume loss from prior right lower lobectomy noted.No new infiltrates, nodules, masses or effusions seen. Elevation of the right hemidiaphragm persists.MEDIASTINUM AND HILA: Calcifications from prior granulomatous disease again noted. No enlarged lymph nodes identified. No other abnormalities.CHEST WALL: Again noted are diffuse sclerotic skeletal metastases there sclerotic in nature. Previous lesions identified have increased in size and there are scattered newer foci.ABDOMEN:LIVER, BILIARY TRACT: Diffuse low-attenuation liver is present indicative of diffuse fatty infiltration. This obscures metastatic lesions on CT and if concern over metastases to liver exists, ultrasound or MRI would be recommended. No such lesions are identified. Patient is status post cholecystectomy. No intrahepatic or extrahepatic bile duct dilatation is seen.SPLEEN: No significant abnormality notedPANCREAS: Resection of the pancreatic head mass noted on 2005 CT is present. The pancreatic duct has returned to near normal diameter compared to the marked dilatation previously. No evidence of recurrent tumor is seen in surgical bed. No other abnormalities are noted.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Enlarged retroperitoneal lymph node posterior to the aorta seen inferiorly at the abdominal/pelvic junction (series 4, image 127) measuring 1.7 x 1.2 cm. This was not present on the December, 2005 examination.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatectomy. No evidence of tumor recurrence in surgical bed.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse sclerotic metastases seen throughout the bony skeleton. These were not present on 2005 CT examination. New since 2005 examination right inguinal hernia containing small bowel and mesenteric fat/vessels without apparent complication.OTHER: No significant abnormality noted

Output: 1. Prior right lower lobe lung resection. Diffuse thoracic skeletal metastases with slight increase number and size of sclerotic lesions noted previously. 2. Diffuse fatty infiltration of the liver. This obscures the ability to detect liver metastases as described above. 3. New lymphadenopathy in retroperitoneum of the abdomen measured above. 4. Resection of prior noted pancreatic neuroendocrine tumor without evidence of recurrence. 5. Diffuse sclerotic metastases in the abdomen and pelvis. 6. New right inguinal hernia with small bowel without complication evident.


Instruction: Generate impression based on findings.

Input: 63-year-old man with non-small cell lung cancer with metastases to brain. Presented with seizure and right-sided paralysis. No new seizures on medications. Improved right sided strength with Decadron. Evaluate status of brain. The left frontal metastasis (series 2 image 23) now measures 1.0 x 0.8 cm compared to 1.0 x 0.9 cm on study dated 6/30/2008. The amount of peritumoral edema is stable from CT dated 7/31/2008 slightly increased from the study dated 6/30/2008. A smaller left frontal lesion visible on MRI is once again not seen on the CT.The right frontal metastasis (series 2 image 18) now measures 1.2 x 0.8 cm compared to 1.4 x 0.8 cm on the prior study. The amount of peritumoral edema is stable from the study dated 7/31/2000.The left temporal metastasis seen on the MRI is still not clearly visible on CT. The associated peritumoral edema has stable CT appearance from the prior study.The metastatic lesion in the cerebellar vermis is not visible on CT.There is no mass-effect, midline shift, hydrocephalus, or CT evidence of hemorrhage. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Multiple brain metastases with peritumoral edema stable from study dated 7/31/2008. Peritumoral edema remains increased from study dated 6/30/2008.


Instruction: Generate impression based on findings.

Input: worsening headache No evidence of acute ischemic or hemorrhagic lesion.Scattered multifocal high signal intensities on FLAIR images indicate non specific small vessel disease.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: No evidence of acute ischemic or hemorrhagic lesion.Mild to minimal non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 30 year-old male with perianal mass/wart. Status post excision of condyloma with flap closure on 1/9/08. Postop day 6. Presents with feculent material at wound. Evaluate for fistula communication or abscess formation. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There are multiple small to borderline enlarged retroperitoneal and mesenteric lymph nodes.BOWEL, MESENTERY: There are multiple mildly dilated loops of large and small bowel throughout the abdomen, probably due to ileus. This may be exacerbated by air swallowing and spasm in the sigmoid and rectum.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: The sigmoid and rectum are minimally distended, possibly due to spasm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There are bilateral surgical drains in the dorsolateral buttocks with subcutaneous soft tissue air and multiple superficial skin staples. These findings are compatible with history of recent surgical procedure. No abscess or fistula was found. There is subcutaneous fat stranding in the buttocks medially which may be due to a minimal cellulitis.In some cases, small fistulas are very difficult to demonstrate, especially with CT. If symptoms persist, MRI examination of the buttocks and perineum with Crohn's protocol may be helpful for further evaluation.

Output: No evidence of abscess or fistula. Recent surgical changes in the superficial buttocks, as described above. Ileus.


Instruction: Generate impression based on findings.

Input: 21-year-old female with chronic daily headaches since age 13 There is no evidence of acute intracranial hemorrhage, mass or edema. No areas of abnormal enhancement are identified. The gray-white matter differentiation is preserved.Crowding of the foramen magnum is partially visualized suggesting a Chiari one malformation. Further correlation with MRI is recommended. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Likely Chiari 1 malformation. Recommend further correlation with MRI.


Instruction: Generate impression based on findings.

Input: Dysarthria and anarthria [R47.1] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: pre-op planning for OR History: new brain lesion Left frontal and temporal lobe in homogeneously enhancing intra-axial lesion with significant surrounding edema and mass effect, unchanged in terms of size, MR signal intensity, enhancement pattern and extent of surrounding edema and mass effect since prior scan.Effacement of the left lateral ventricle is again seen, unchanged since prior scan. The mastoid air cells are clear. Left sphenoid sinus and right posterior ethmoid sinus lesions are again seen, unchanged since prior scan.

Output: Left fronto-temporal intra axial lesion with significant surrounding edema and mass effects, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Recent neck injury. Pain and numbness in the neck, right shoulder and right arm/hand. Craniovertebral junction appears within normal limits. There is reversal of normal cervical lordosis with mild kyphotic angulation centered at the C4-C5 level. The cervical vertebral bodies are appropriate height. Bone marrow signal is benign with T1 hyperintense lesion involving the C7 vertebral body compatible with focal fat or hemangioma.Motion artifact limits evaluation for cord signal abnormality; however, no definite cord signal abnormality is appreciated. There are possible T2 hyperintense foci in the right ventral cord at C4-C5 (series 1001 axial T2 image 17 of 45 and separate focus at sagittal T2 image 8/15 series 901).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: No significant compromise to the spinal canal or neural foramina.C4-5: There is a diminished intervertebral disc height and disc osteophyte complex. There is uncovertebral hypertrophy particularly on the left with foraminal disc protrusion. There is resultant moderate left and mild right foraminal stenosis. There is partial effacement of the ventral and dorsal thecal sac resulting in mild to moderate spinal canal stenosis.C5-6: There is diminished disc height, disc osteophyte complex, with right greater than left disc protrusion which extends into the right-sided neural foramen. There is effacement of the ventral thecal sac and mild indentation on the ventral cord right greater than left. There is moderate to severe right foraminal narrowing and mild left foraminal narrowing.C6-7: Small disc osteophyte complex and uncovertebral hypertrophy on the right. There is small right foraminal disc protrusion with minimal right foraminal narrowing. No significant left foraminal narrowing. Partial effacement of the ventral thecal sac without significant spinal canal stenosis. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Degenerative changes in the cervical spine, worst at C4-C5 and C5-C6, with up to moderate spinal canal stenosis and mild cord deformity at these levels. Motion artifact limits evaluation for cord signal abnormality; there is however possible associated punctate T2 cord signal abnormality in the right ventral cord at the C4-5 level, as described above.2. Moderate to severe right C5-C6 foraminal stenosis related to disc extrusion and uncovertebral hypertrophy, which may be impinging on the right C6 nerve root.


Instruction: Generate impression based on findings.

Input: Cervical disc status post C6 corpectomy and fusion. Ongoing radicular upper extremity pain. There are postoperative findings related to C6 corpectomy and C5 to C7 anterior fusion. There are minimal posterior disc-osteophytes at C3-4 and C4-5, but no significant spinal canal stenosis at any cervical spine level. However, there is at least moderate bilateral neural foraminal narrowing at C5-6 due to facet and uncovertebral joint hypertrophy. There is no significant neural foramen narrowing at the other cervical spine levels. The vertebral column alignment is within normal limits. The remaining vertebral body heights are preserved. The remaining vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable, aside from expected surgical alterations.

Output: Expected postoperative findings related to C6 corpectomy and C5 to C7 anterior fusion. However, there is at least moderate bilateral neural foraminal narrowing at C5-6 due to facet and uncovertebral joint hypertrophy.


Instruction: Generate impression based on findings.

Input: 63 years Male (DOB:12/18/1952)Reason: prior acdf History: samePROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present. The patient is status post anterior fusion at C3-4.There is mild thickening of the cruciate ligaments at C1-2.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level. There is mild facet hypertrophy at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. The patient status post anterior fusion at this level.At C4-5there are endplate uncovertebral osteophytes present associated with a disc bulge and hypertrophy of the ligamentum flavum. There is effacement of spinal fluid ventral and posterior the spinal cord and flattening of the spinal cord at this level. Overall there is a moderate degree of spinal stenosis at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At C5-6 there is no significant compromise to the neural foramina. There is a disc bulge present at this level associated with mild ligamentum flavum hypertrophy. There is partial effacement of spinal fluid ventral and posterior the spinal cord and overall a mild degree of spinal stenosis.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a left paramedian small disc protrusion present at this level which partially effaces spinal fluid ventral to the left hemicord.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery is small.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present this level associated with facet hypertrophy. The facet hypertrophy is worse on the right compared to the left side.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with bilateral facet and ligamentum flavum hypertrophy. There is triangulation of the thecal sac associated with effacement of fat at the lateral recess is at this level. There is encroachment of the nerve roots at the lateral recess bilaterally at this level and mild to moderate degree of spinal stenosis. This has not substantially changed compared the prior exam.At L3-4 there is loss of disc space height, disc desiccation and endplate reactive changes. Endplate reactive changes are bright on T2 STIR imaging and lower signal on T1 imaging. This indicates that the endplate reactive changes are in the subacute stage. There is effacement of the fat at the lateral recess bilaterally at this level and crowding of nerve roots and overall a moderate to severe degree of spinal stenosis. The exiting nerve roots are surrounded by fat within the neural foramina . This has not substantially changed compared to the prior exam the exception that inflammatory changes are new since then and the ligamentum flavum is thicker.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is ligamentum flavum hypertrophy present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present cervical spine worse at C4-5 where there is a moderate degree of spinal stenosis associated with some flattening of the spinal cord due to degenerative changes. There is mild spinal stenosis at C5-6.2.There are degenerative changes present in the lumbar spine worse at L3-4 there is a moderate to severe degree of spinal stenosis associated with subacute inflammatory changes at the endplates. This has not substantially changed compared to the prior exam the exception that inflammatory changes are new since then and the ligamentum flavum is a little thicker.


Instruction: Generate impression based on findings.

Input: 58-year-old woman with history of subtotal pancreatectomy for IPMN. ABDOMEN:LIVER, BILIARY TRACT: A small focus of calcification is seen in the liver (series 12, image 47), otherwise the liver is normal in signal and morphology. There is no focal lesion or intrahepatic duct dilatation.The patient is status post cholecystectomy. The remnant cystic duct is seen without adjacent fluid collection/biloma. There is no significant extrahepatic biliary duct dilatation and the common duct measures 8 mm in diameter. No choledocholithiasis identified.SPLEEN: The spleen appears normal.PANCREAS: The patient is status post partial pancreatectomy and a small residual pancreas is noted without discrete lesion.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a 3.8 cm right superior pole renal cyst, otherwise the kidneys are normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel and colon are normal.BONES, SOFT TISSUES: Small amount of anterior subcutaneous signal is likely related to postoperative scarring.OTHER: No significant abnormality noted.

Output: Findings of partial pancreatectomy without discrete pancreatic mass.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Evaluate for intracranial process. Signs and symptoms: 51-year-old female with severe headaches x 4 days, family history of brain aneurysm. MRI CT of brain without and with infusion of contrast.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.Post infusion images demonstrate no abnormal enhancement the brain parenchyma or leptomeninges. This examination cannot exclude possibility of aneurysm. If an aneurysm is highly suspected a CTA of intracranial circulation is the appropriate test for detection of aneurysm.65 cc of Omnipaque was utilized for this study.

Output: Normal CT of brain without and with infusion of contrast.


Instruction: Generate impression based on findings.

Input: 6-year-old female with left neck mass. Assess after treatment. Images through the skull base including cavernous sinuses remain within normal limits. Mastoid air cells and middle ear cavities are well pneumatized and unremarkable. Chronic inflammatory sinus disease of all paranasal sinuses are noted.Images through the soft tissues of the neck demonstrate an enhancing mass superficial to the left sternocleidomastoid muscle and immediately posterior and inferior to the left parotid gland. This lesion measures 15.7-mm in AP access and 12 mm in transverse axis (axial image 75 of 171). On coronal image 109 of 229 the mass measures 13.4-mm x 9.8-mm. the mass is well demarcated and demonstrates no evidence of any surrounding edema. The mass appears to be external to the parotid call her on coronal images the mass appears to be at least partially within the superficial lobe of left parotid. A pleomorphic adenoma or a lymph node are the most likely etiology however further evaluation with an MRI is recommended. There is no evidence of inflammatory changes surrounding the mass or the parotid gland.Several bilateral cervical lymph nodes with no enhancement are believed to be within normal range for patient's stated age of 6 years. The bony density at the area of the exam is unremarkable. The vasculature remains intact. Limited images of the apices of the lungs and mediastinum are unremarkable.

Output: 1.Enhancing lesion likely within the left parotid gland as detailed.2.There are no old films available for comparison.3.Unremarkable examination of soft tissues of the neck otherwise.4.Extensive chronic sinus disease.


Instruction: Generate impression based on findings.

Input: Bilateral wrist drop. Evaluate for cervical lesion. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Bone marrow signal is benign. No cord signal abnormality. There is loss of normal cervical lordosis with associated altered contour of the cervical cord. There is mild anterolisthesis of C4 on C5 and mild retrolisthesis C6 on C7. Multilevel degenerative changes are present including severe disc height loss at the C4-C5 level and to a lesser degree C5-6 and C6-C7 levels. Additional details as below:C2-3: No significant compromise to the spinal canal. There is bilateral facet arthropathy with mild narrowing of the left neural foramen. No significant right neural foraminal narrowing.C3-4: Mild disc bulge and ligamentum flavum thickening contribute to mild spinal canal narrowing. There is mild right and moderate to severe left neural foraminal stenosis. Prominent left-sided facet arthropathy.C4-5: There is effacement of the ventral thecal sac without significant stenosis of the spinal canal overall. There is mild right and moderate left neural foraminal stenosis.C5-6: There is moderate spinal canal stenosis related to disc osteophyte complex, ligamentum flavum thickening, and kyphotic deformity of the cervical spine at this level. There is severe right and mild left neural foraminal stenosis.C6-7: No significant compromise to the spinal canal. There is mild narrowing of the neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina. Bilateral facet arthropathy.The vertebral artery flow voids appear to be intact. There is artifact involving the left lateral C4 and C5 levels favored to be related to tortuosity of the left vertebral artery. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Moderate degenerative changes throughout the cervical spine. There is up to moderate spinal canal stenosis at the C5-C6 level. There is multilevel neural foraminal stenoses, particularly at the left C3-C4 and C4-C5 levels as well as the right C5-C6 level.2. No abnormal cord signal or masses involving the spinal canal.


Instruction: Generate impression based on findings.

Input: Advanced degenerative changes in the lumbar spine with back and leg pain. Evaluate for worsening. There are five lumbar type vertebral bodies. There is severe levoscoliosis of the mid to lower lumbar spine with the apex of curvature at L3. There is 8 mm right lateral translation of L2 on L3 and left lateral translation of L3 on L4. The sagittal alignment remains normal with straightening of the normal lumbar lordosis. The vertebral body heights are well-maintained. There is moderate to severe multilevel disc narrowing in the lumbar spine. The T10-L1 disc heights are maintained. Nonspecific, slight diffuse heterogeneity of the bone marrow signal intensity and a focus of high STIR signal in S1 are unchanged. The conus medullaris terminates at upper L2 level.On sagittal image a left paracentral/foraminal disc protrusion at T11-12 appears unchanged.Multilevel degenerative changes are stable as outlined below.T12-L1: There is ligamentum flavum thickening and bilateral left greater than right facet arthropathy but no significant spinal canal or foraminal narrowing.L1-L2: A mild disc bulge is slightly more prominent on the left. There is bilateral facet arthropathy and ligamentum flavum thickening with mild spinal canal and mild to moderate bilateral foraminal narrowing.L2-L3: Small posterior disc osteophyte complex with mild spinal canal stenosis. There is facet arthropathy on the right and bilateral ligamentum flavum thickening resulting in mild to moderate bilateral foraminal narrowing.L3-L4: Diffuse disc bulge is more prominent on the right with moderate spinal canal stenosis. Mild bilateral facet arthropathy and ligamentum flavum thickening narrows the lateral recesses. There is severe foraminal narrowing on the right.L4-5: Diffuse disc bulge is more prominent on the right with mild to moderate spinal canal stenosis. There is left greater than right facet arthropathy and ligamentum flavum thickening with mild to moderate right and moderate left foraminal narrowing.L5-S1: Mild diffuse posterior disc osteophyte complex slightly more prominent on the left encroaching on the left lateral recess and resulting in mild-to-moderate left foraminal narrowing.

Output: Stable scoliosis and multilevel spondylosis again most severe at L3-4 where there is severe right foraminal narrowing and moderate spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified nature of brain [239.6], Reason for Study: ^Reason: preoperative planning History: LLE weakness Postcontrast enhancement preoperative stealth protocol brain MRI was performed with the fiducial markers attached on scalp.Redemonstration of large right convexity extra-axial mass likely representing meningioma, no change since prior scan in terms of size, surrounding edema and MR characteristics including enhancement pattern. Largest diameter of the mass on axial scan was of 51.9 mm x 54.8 mm.The right lateral ventricle appears to be compressed due to mass effect. 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: Large [51.9 mm x 54.8 mm] sized right high convexity extra-axial mass likely represent meningioma, no change since prior scan.


Instruction: Generate impression based on findings.

Input: Localized swelling, mass and lump, head [R22.0] / Cellulitis of face [L03.211], Reason for Study: ^Reason: eval infection History: abscess Re-demonstration of right paraorbital sinus inflammation with subperiosteal abscess formation along the lamina papyracea with proptosis. There is 8.8mm x 33mm sized extra axial fluid collection with internal air at the right anterior cranial fossa just above the cribriform plate with peripheral enhancement indicating extension of ethmoid sinus lesion extension. Right frontal and temporal area dura and the left frontal dural enhancement indicating local inflammatory reaction.Subtle high signal intensity on FLAIR/T2 at the right mesial orbital gyrus indicating possible reactive inflammatory changes of the brain parenchyme. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.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 mastoid air cells are clear.

Output: 1. Right paraorbital-paranasal abscess with intracranial extension results right side anterior cranial fossa extra-axial fluid collection as described above associated with reactive changes of right mesial orbital gyrus and overlying dura.2. No evidence of brain parenchymal abscess, no acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 74 years Male (DOB:7/5/1942)Reason: asses for ischemia/CVA History: right sided weakness, slurred speechPROVIDER/ATTENDING NAME: ROBERT A MULLIKEN There is a focus of diffusion restriction present left centrum semiovale extending to the adjacent left basal ganglia measuring 20 x 13 mm axial dimensions. This is associated T2 and flair hyperintensitySmall foci of T2 and FLAIR signal hyperintensity are present in the right and left basal ganglia as well as the right thalamus and in the brainstem.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings compatible with a small subacute infarction involving the left centrum semiovale. There is no evidence for hemorrhagic conversion at this time.2.Small lesions in the brainstem, basal ganglia and thalami are suspected represent lacunar infarcts in the chronic stage with the exception of the above described lesion.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 37 year old female patient with Takayasu arteritis and bruits. CHEST:There is no significant aneurysmal dilatation, narrowing, or irregularity of the thoracic aorta. The aortic arch vessel ostia are patent. The visualized main pulmonary artery is patent.ABDOMEN:There is no significant aneurysmal dilatation, narrowing, or significant irregularity of the abdominal aorta. The origins of the celiac artery, superior mesenteric artery, and inferior mesenteric artery are patent without narrowing. The bilateral renal arteries are patent.

Output: No dilatation, narrowing, or significant irregularity of the thoracic and abdominal aorta with patent ostia of the arch and mesenteric vessels.


Instruction: Generate impression based on findings.

Input: Low back pain, myeloma Lumbosacral spine: Mild degenerative disc disease affects L5-S1 and there is mild loss of height of the superior endplate of L1 which appears similar to the exam dated 11/20/2015. The marrow abnormalities as described on the comparison MRI are not well appreciated on this exam. The remaining vertebral body heights and alignment are preserved.Pelvis: The bones are demineralized. Evaluation of the sacrum is limited secondary to overlying bowel gas. There are deformities of the left superior and inferior pubic rami relating to healed fractures. A large lucency adjacent to the left sacroiliac joint represents an area of known myelomatous involvement. There is otherwise no evidence of an acute fracture or malalignment.

Output: 1. Lumbosacral spine: Mild loss of height of the superior endplate of L1 which is unchanged from prior exams. There is otherwise no acute osseous abnormality.2. Pelvis: Healing/healed fractures of the left inferior and superior rami with unchanged appearance of left iliac lesion.


Instruction: Generate impression based on findings.

Input: Female, 78 years old. Reason: please define margins of right buttock neurofibroma History: painful right buttock lesion in woman with NF1 and history of a malignant peripheral nerve sheath tumor There is a well-defined mass within the subcutaneous fat of the right buttock that measures approximately 6 x 4 cm in transverse dimension and 4.5 cm in craniocaudal dimension. Its signal intensity is similar to that of skeletal muscle on T1-weighted images. It is heterogeneous on fat-suppressed T2-weighted images containing foci that are isointense to hyperintense to skeletal muscle. On a CT scan from 12/04/2014, this mass was approximately 5.1 x 3.8 cm in transverse dimension and 3.4 cm in craniocaudal dimension. The overlying skin appears thickened. Currently the mass does not appear to abut the underlying gluteal musculature. There is a small plaque-like lesion lateral to the mass which is presumed to represent a cutaneous neurofibroma. Multiple additional cutaneous neurofibromas are noted bilaterally. A mass within the subcutaneous fat of the posterior left buttock measures approximately 3 cm in greatest dimension, representing an additional neurofibroma, similar size to that seen on the prior CT scan. An amorphous mass within the musculature anterior to the proximal left femur and probably involving the inferior aspect of the left hip joint is associated with chronic erosion of the anterior aspect of the proximal femoral. It measures approximately 5 x 6 cm in transverse dimension and 15 cm in craniocaudal dimension. This mass was present on the prior CT study from 12/2014, but it is difficult to evaluate for changes in size between the two studies. This mass is predominantly isointense to skeletal muscle on T1-weighted images and heterogeneously hyperintense to skeletal muscle on T2-weighted images. A smaller neurofibroma is seen anterior to this mass within the rectus femoris muscle. A couple of additional intramuscular neurofibromas are noted. A structure of intermediate to high signal within the left adnexal region probably represents an intrapelvic neurofibroma. A mass of low signal intensity within the uterus likely represents a fibroid.Heterogeneous appearance of medullary bone likely reflects residual or reconverted red marrow. Mild osteoarthritis affects the hips and sacroiliac joints. Severe degenerative disc disease affects L5-S1.

Output: Findings compatible with neurofibromatosis with neurofibromas as described above. The right buttock neurofibroma appears to have increased in size slightly from the CT study dated 12/2014. Please note that we cannot determine on the basis of imaging if this mass is benign or malignant.


Instruction: Generate impression based on findings.

Input: Abdominal pain in patient with history of liver transplant. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are identified. The common hepatic duct appears dilated upstream to the anastomoses measuring up to 12 mm in diameter, not significantly changed. There is mild, diffuse intrahepatic biliary ductal dilatation which may have been seen on the prior study.The intrahepatic portal veins appear patent. There is once again significant narrowing of the portal vein at the confluence which remains patent (series 9, image 170) and appears similar to 2012 exam. The splenic vein and superior mesenteric vein appear patent. The hepatic veins appear patent. Evaluation of the hepatic arteries is somewhat limited by suboptimal arterial phase timing. The conduit connecting the hepatic arteries to the infrarenal aorta remains patent. The IVC is severely narrowed at the level of the hepatic anastomosis with dilation of the IVC just inferior to this level.SPLEEN: The spleen is mildly enlarged measuring up to 13.6 cm, previously 17.7 cm. An approximately 1 cm lesion within the superior aspect of the spleen which demonstrates peripheral, nodular enhancement is compatible with a hemangioma.PANCREAS: Pancreatic duct is nondilated.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: Previously seen ascites has resolved.PELVIS:UTERUS, ADNEXA: Normal variant nabothian cysts are present in the cervix.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Previously seen ascites has resolved.

Output: 1.Postsurgical changes of liver transplant. Persistent narrowing at the portal vein confluence which remains patent. Evaluation of the hepatic arteries is suboptimal due to timing of arterial phase, but the hepatic artery conduit remains patent.2.Improving splenomegaly and resolution of ascites.


Instruction: Generate impression based on findings.

Input: Reason: h/o sacral osteomyelitis still on antibiotics. Also with prostate ca History: pain Again seen is enhancement of the left sacroiliac joint indicating sacroiliitis, compatible with the stated history of infection. Small erosions are again noted about the left sacroiliac joint, appearing similar to the prior study, but the degree of edema and enhancement of the adjacent ilium and sacrum has decreased when compared to the prior study. The edema and enhancement of the adjacent musculature has likewise decreased when compared to the prior examination. There is low signal intensity on the T1-weighted images along the iliac margin of the joint likely representing sclerosis. The bone marrow signal intensity is otherwise normal in appearance. Please note that the study was not protocoled for dedicated evaluation of the prostate gland; however the prostate gland appears similar to the prior study.

Output: Findings compatible with left sacroiliac joint inflammation with interval decrease in inflammation of the adjacent bone and soft tissue structures.


Instruction: Generate impression based on findings.

Input: History of new visual changes, seizure/seizure-like events, stroke. Evaluate for structural abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. This is an area of high T2 signal and perhaps mild swelling within the inferior left postcentral gyrus involving both the gray and white matter that measures up to approximately 20 mm. There is an additional linear area of high T2 signal with perhaps mild volume loss predominantly involving the white matter of the superior left postcentral gyrus that measures up to approximately 15 mm. There are a few additional punctate foci of high T2 signal cerebral white matter and pons. There are also subcentimeter foci of high T2 signal in the bilateral basal ganglia. The pituitary gland appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is trace mucosal thickening within the paranasal sinuses. There is an area of high T2 and low T1 signal in the left petrous apex region that measures up to approximately 15 mm.

Output: 1. No evidence of acute ischemic infarction.2. A lesion in the left parietal lobe which are nonspecific but may reflect sequela from prior infarction with superimposed effects related to seizure versus a neoplasm. However, assessment is limited due to the lack of intravenous contrast.3. A lesion with possible mild volume loss predominantly involving the white matter of the superior left postcentral gyrus that measures up to approximately 15 mm may represent sequela from prior infarction.4. Probable chronic bilateral basal ganglia lacunar infarcts.5. Incompletely characterized area of high T2 and low T1 signal in the left petrous apex region that measures up to approximately 15 mm. This likely represents trapped secretions versus less likely a chondroid matrix tumor. An MRI with contrast may also be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: MVA in 8/14. He has worsening pain located mostly lateral to the spine scapular region. Has noted occasional tingling in hands bilaterally. Cervical Spine: The vertebral column alignment is within normal limits. There is slightly deceased T2 signal in the C5-6 disc and minimal associated disc bulging. Nevertheless, the vertebral body and disc space heights are preserved and there is no significant spinal canal or neural foramen stenosis. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Thoracic Spine: 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: Slight desiccation and disc bulging at C5-6, but no evidence of bone marrow edema or ligamentous injury and no evidence of significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Ataxia. The patchy and confluent periventricular cerebral white-matter T2-hyperintensity has not significantly changed since the previous examinations. Some of the lesions are also mildly to moderately T1-hypointense. The corpus callosum is involved by some lesions and is thinned, as part of the generalized brain volume loss. There are also a few lesions involving the brainstem and cerebellum. An area of linear and branching subcortical enhancement in the anterior paramedian right left frontal lobe is unchanged.

Output: 1. Extensive white matter lesions that are compatible with multiple sclerosis remain unchanged since May 2015. Associated moderate brain volume loss remain unchanged.2. A small enhancing subcortical lesion in the left anterior frontal lobe may represent a developmental venous anomaly rather than an enhancing demyelinating lesion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Nontraumatic intracerebral hemorrhage, unspecified. Bladder cancerClinical question: sinus thrombosis underlying cause of hemorrhage MRI of the brainA focus of diffusion weighted imaging signal hyperintensity is present in the left posterior temporal lobe subcortical white matter several foci of diffusion-weighted imaging signal hyperintensity are present in the right temporal lobe subcortical white matter.There is a 62 x 30 mm hematoma centered in left gyrus rectus and extending superiorly from the to the cingulate gyrus. It is associated with surrounding T2 and FLAIR signal hyperintensity compatible with vasogenic edema.On susceptibility imaging there is signal loss along the sulci in the medial aspect of supratentorial hemispheres. Additionally there are punctate foci of signal loss along subcortical white matter in the occipital lobes as well as the posterior temporal lobes and basal frontal lobes subcortical white matter with punctate foci of signal loss also in the cerebellar hemispheres.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Some images are degraded due to patient motion artifact.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left jugular vein, sigmoid sinus and transverse sinus are smaller than the right-sided counterparts. There appears to be a fenestration along the superior sagittal sinus posteriorly.

Output: 1.There is a hematoma centered in the left anterior frontal lobe associated with some local mass effect. No underlying mass lesion is appreciated on the current exam.2.There are multiple microhemorrhages scattered predominantly in subcortical white matter. This pattern could suggest amyloid angiopathy.3.There is siderosis present along the supratentorial brain medially which is suggestive of prior subarachnoid blood.4.MR venogram of the brain is within normal limits. There is no evidence for dural venous sinus or deep vein thrombosis5.Several acute microinfarcts may be present and subcortical white matter of the temporal lobes.6.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: lung cancer (adenocarcinoma) staging work up No evidence of acute ischemic or hemorrhagic lesion on this scan.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: No evidence of acute ischemic or hemorrhagic lesion on this scan.No abnormal enhancement.Normal brain MRI scan.


Instruction: Generate impression based on findings.

Input: 14-year-old male with history of ACL tear, unable to bend knee in brace MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is normal. Increased T2 signal is noted involving the apophysis at the tibial tuberosity without overlying soft tissue swelling.LIGAMENTS: Increased T2 signal along distal fibers of the ACL at its insertion indicates a sprain or partial thickness tear. No full thickness tear is present. The PCL is intact. The medial and lateral collateral ligaments are normal.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Signal abnormality involving the distal fibers of the ACL compatible with a sprain or partial thickness tear. No full thickness disruption.2. Edema at the tibial tuberosity apophysis suggests mild apophysitis.


Instruction: Generate impression based on findings.

Input: Visual complaints and unsteadiness with history of esophageal MALT. Per EPIC notes: "Transient binocular visual loss without return to baseline. The symptom is quite atypical. Due to the occipital region pain, scalp tenderness, and jaw pain, it raises the possibility of a temporal arteritis, although with this amaurosis fugax would usually be monocular. It is possible to have posterior ischemic optic neuropathy (PION) that cannot be detected on funduscopic examination." MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild, scattered, nonspecific cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. 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, and scalp soft tissues are grossly unremarkable. There is moderate left maxillary sinus mucosal thickening, mild right maxillary and left sphenoid sinus mucosal thickening, and fluid within the right sphenoid sinus.MRA: There is no evidence of significant steno-occlusive intracranial lesions. The bilateral opthalmic arteries appear to be intact, at least proximally. There is no evidence of cerebral aneurysms.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant steno-occlusive intracranial lesions. In particular, the bilateral opthalmic arteries appear to be intact, at least proximally. 3. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Acute right arm weakness and numbness. No evidence of acute ischemic or hemorrhagic lesion on the scan.There is enlarged suprasellar cistern and pituitary gland appear to be relatively thinner than normal indicating possible empty sella.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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: No evidence of acute ischemic or hemorrhagic lesion.MR suggestion of an empty sella.


Instruction: Generate impression based on findings.

Input: Breast cancer and brain metastases treated with surgery and CyberKnife treatments. There are postoperative findings related to right frontal lesionectomy. There is confluent high T2 signal and susceptibility effect surrounding the resection cavity, but no evidence of associated abnormal enhancement. However, there is an irregularly enhancing lesion in the left cerebellar hemisphere that measures up to 20 mm with extensive surrounding vasogenic edema. There is also an irregularly enhancing lesion in the left cerebellar hemisphere that measures up to 10 mm with mild surrounding vasogenic edema and a punctate focus of enhancement in the superior right cerebellar hemisphere. In addition, there is an enhancing lesion in the right occipital lobe that measures up to 5 mm. There are a few punctate foci of nonspecific cerebral white matter T2 hyperintensity without associated enhancement. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Postoperative findings related to right frontal lesionectomy, without evidence of recurrent tumor in this area. 2. Multiple enhancing intracranial lesions are compatible with metastases, the largest of which is located in the left cerebellar hemisphere with associated extensive vasogenic edema, but no herniation.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic breast cancer. Signs and symptoms: Worsening pain. Nonenhanced Lumbar MRI:Examination demonstrates less than 50% compression fracture of the superior endplate of T12 with resultant mild kyphotic deformity. There is T2 STIR hyperintensity and T1 hypointensity of the T12 marrow space suggestive of edema. Finding is concerning for a metastatic lesion. The finding has remained stable since prior CT of abdomen from 4-13-15. There is mild ventral bulge of the superior aspect of T12 vertebra into the spinal canal resulting in subtle mass effect and posterior displacement of the cord however without spinal stenosis or neural foraminal compromise and no detectable signal abnormality of the cord.Large focus of marrow signal replacement within the vertebral body of L1, tiny focus in the body of L2, diffusely in of vertebral bodies of L3 and L4 as well as small focus in the inferior S2 vertebral body also suspected of osseous metastatic lesions. There is no detectable extraosseous spread of tumor and no evidence of spinal canal compromise or stenosis. No evidence of neural foraminal compromise at any level.Nonenhanced thoracic MRI:Examination demonstrates diffuse patchy foci of marrow signal replacement involving both the vertebral bodies, pedicles and the articulating facets at multiple levels and consistent with diffuse metastatic lesions. There is normal signal intensity and caliber of the thoracic cord.There is no convincing evidence of extraosseous spread of tumor into the spinal canal or perispinal soft tissues on this nonenhanced exam areaNo evidence of spinal stenosis or neural foraminal compromise at any level. Mild degenerative disease is however noted.

Output: 1.Nonenhanced MRI of lumbar spine demonstrate diffuse metastatic lesions of the lumbosacral spine as detailed. Stable less than 50% compression fracture of T12 with a slight kyphotic angulation compared to prior exams. No spinal stenosis or neural foraminal compromise at any level. Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina. No detectable extraosseous spread of tumor on this nonenhanced exam.2.Nonenhanced thoracic MRI demonstrate diffuse patchy foci of marrow signal changes consistent with metastatic disease however without fracture or malalignment and no detectable extraosseous spread of tumor. No spinal stenosis or neural foraminal compromise at any level. Normal signal intensity and caliber of thoracic cord.


Instruction: Generate impression based on findings.

Input: 66-year-old female with RC weakness, persistent pain status post injury and PT. Evaluate rotator cuff. ROTATOR CUFF: There is complete tear of the supraspinatus tendon with 2 to 3 cm retraction of the proximal tendon fibers. There is intermediate signal intensity within the infraspinatus tendon indicating moderate tendinopathy, the possibility of a small focal tear at the insertion site cannot be excluded within the limitations described above. The remaining rotator cuff muscles and tendons appear grossly normal.SUPRASPINATUS OUTLET: Moderate osteoarthritic changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a high riding humeral head secondary to the aforementioned complete tear of the supraspinatous tendon. Mild degenerative changes affect the glenohumeral joint. The glenoid labrum appears grossly normal. There is a small amount of fluid in the joint without frank effusion.BICEPS TENDON: The long head of the biceps tendon appears grossly normal.ADDITIONAL

Output: 1. Complete tear of the supraspinatus tendon with retraction and associated high riding humeral head. Moderate tendinopathy of the infraspinatus tendon with the possibility of a small focal tear at its insertion not entirely excluded as evaluation is slightly limited secondary to motion artifact. 2. Degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: Reason: eval for labral tear vs rotator cuff tear History: shoulder pain from sports months s/p fall ultimte frisbee ROTATOR CUFF: Normal appearing rotator cuff tendons and muscles. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Rounded deformity of the posterior humeral head, consistent with Hill-Sachs deformity. Tear and irregularity of the anterior from labrum, consistent with cartilaginous Bankart lesion. Contrast remains within the glenohumeral joint without communication with subdeltoid or subacromial bursa.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Findings representing Hill-Sachs deformity and cartilaginous Bankart lesion.


Instruction: Generate impression based on findings.

Input: Subarachnoid hemorrhage. Subarachnoid hemorrhageClinical question: R Pcomm aneurysm coilingSigns and Symptoms: R PComm aneurysmOPERATORS: Greg ChristoforidisFLUOROSCOPY TIME: 40.9 minutesFrontal: 1406.64 mGyLateral: 1785.82 mGyPROCEDURES: 1) cerebral angiogram 2) Intracranial cerebral aneurysm coil embolization with balloon assistance. 3) 3-D reconstructions of intracranial right internal carotid artery 4) Expert CT of the head without contrast. CT head: The ventriculostomy tip is located in the frontal horn of the right lateral ventricle. There is subarachnoid blood present and ventriculomegaly with intraventricular blood.Right common carotid artery: No stenosis at the carotid bifurcation on the basis of NASCET criteria. There is no evidence for carotid dissection. There is an atherosclerotic web at the right common carotid bifurcation.Right internal carotid artery: There is opacification of the right anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. The right A1 segment is small and the right A2 segment only partially opacifies. There is a 5mmx8mmx6mm aneurysm present at the origin of the right PCOMA which incorporates the origin of the PCOMA at its base.The carotid siphon and cavernous carotid have an irregular wall with mild areas of narrowing.Left common carotid artery: No evidence for carotid stenosis on the basis of NASCET criteria. There is no evidence for carotid dissection. There is mild vessel irregularity at the left common carotid bifurcation.Left internal carotid artery: There is opacification of the left anterior, middle and posterior cerebral arteries and partial opacification of the right anterior cerebral artery. The ACOMA is medium sized. Venous and parenchymal phases were within normal limits. No evidence for aneurysm, AVM or AV fistula. There is an infundibulum at the origin of the left posterior communicating artery which is fairly large and partly opacifies the right PCA.The distal cavernous segment is irregular.Left subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Left vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the basilar artery and both posterior cerebral arteries. There is inflow of unopacified blood into the posterior cerebral arteries and into the basilar artery.Right subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Right vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the basilar artery and both posterior cerebral arteries.There is transient reverse filling of the left vertebral artery and the posterior communicating arteries.Intraprocedural angiograms:Serial arteriograms performed during aneurysm coiling demonstrate serial occlusion of the aneurysm using balloon remodeling. The balloon remained across the neck of the aneurysm throughout the procedure.Final RICA arteriogram :At the end of the procedure there is no opacification of the aneurysm with preservation of the PCOMA and anterior choroidal artery and no thromboembolic events.Right common iliac artery: No contraindications to closure device. There are atherosclerotic changes along the right common, external and internal iliac arteries.

Output: 1.8mm multilobulated right posterior communicating artery aneurysm.2.Subarachnoid hemorrhage. There is a small amount of intraventricular blood present.3.Ventriculomegaly with ventriculostomy in the frontal horn of the right lateral ventricle.4.Embolic coil occlusion of right PCOMA aneurysm using MRI (up to 3T) compatible coils.5.Findings were discussed with Dr Yamini.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, pain and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The [Dictate right or left here] elbow was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, 21 gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 20 mL of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and the patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute 59 seconds.

Output: Successful fluoroscopic injection of contrast into the right elbow.


Instruction: Generate impression based on findings.

Input: Reason: stroke History: slurred speech12/29/194372 yearsMale MRI of the brainThere are foci of encephalomalacia present in the right centrum semiovale and right basal ganglia. There is associated slitlike susceptibility effect in the right basal ganglia.On susceptibility imaging there is some decreased signal along the right hemispheric cortical vein vasculature.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right internal carotid artery is very small. There is diminished signal in the right middle cerebral artery vasculature.There is mild narrowing at the mid basilar artery with approximately 50% stenosis on the basis of WASID criteria.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is 65% stenosis at the proximal left internal carotid artery. There is a high-grade stenosis (>90%) at the proximal right internal carotid artery associated with a diminutive right internal carotid artery cervical segment. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from the innominate artery. The right ophthalmic artery appears larger than the left ophthalmic artery.

Output: 1.High-grade stenosis at the origin of the right internal carotid artery associated with string sign. Please note on the prior CTA from 2/15/2014 it appeared that the right internal carotid artery at that time was occluded. There is collateralization to the right anterior and middle cerebral arteries via the circle of Willis and the right ophthalmic artery. There is diminished blood flow to the right middle cerebral artery relative to the left middle cerebral artery indirectly suggested based on the MRA and susceptibility imaging.2.67% stenosis at the origin of the left internal carotid artery3.No evidence for acute ischemic cerebral infarction.4.Findings are compatible with encephalomalacia in the right centrum semiovale probably in part related to ischemia. This is new since the 2/16/2014 MRI exam but was present on the 3/22/2014 CT exam.5.Findings are suggestive of prior hemorrhagic infarction in the right basal ganglia. This is new since the 2/16/2014 MRI exam.


Instruction: Generate impression based on findings.

Input: 67-year-old male presents with left shoulder pain. ROTATOR CUFF: The rotator cuff muscles and tendons appear normal. There is perhaps mild tendinosis of the supraspinatus tendon.SUPRASPINATUS OUTLET: Moderate degenerative changes affect the acromioclavicular joint. Small amount of fluid is present within the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. The labrum appears normal. There is a small amount of fluid within the joint, however, no frank effusion is present.BICEPS TENDON: The long head of the biceps tendon is intact. ADDITIONAL

Output: Moderate osteoarthritis of the acromioclavicular joint with a small amount of fluid present within the subacromial bursa. The rotator cuff is intact.


Instruction: Generate impression based on findings.

Input: 20-year-old male with blunt force trauma to the knee 4 weeks ago. Persistent lateral knee pain and effusion. Evaluate for meniscal or chondral damage. MENISCI: The medial and lateral menisci are morphologically normal.ARTICULAR CARTILAGE AND BONE: There is abnormal marrow signal along the medial tibial plateau anteriorly and posteriorly as well as within the medial femoral condyle posteriorly. There is a joint effusion about the knee extending to the suprapatellar space. The articular cartilage is morphologically normal forLIGAMENTS: There is laxity of the lateral collateral ligament with surrounding intermediate signal intensity representing at least a partial thickness tear. There is discontinuity of a portion of the posterior cruciate ligament with surrounding fluid signal compatible with a at least a partial-thickness tear. The medial collateral ligament appears normal. The anterior cruciate ligament appears normal.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Findings compatible with at least a partial thickness tear of the posterior cruciate ligament and lateral collateral ligament.2. Bone marrow contusion pattern along the medial femoral condyle and medial tibial plateau.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (2/24/15), ultrasound images of right breast and right axilla (2/24/15), images from ultrasound guided biopsy and postprocedural right mammographic images (2/24/15), breast MRI (3/3/15), images from MRI guided biopsy of right breast with post procedural right mammographic images (3/11/15) performed at Midwest Center for Advanced Imaging. DIGITAL MAMMOGRAPHIC IMAGES (2/24/15):The breast parenchyma is composed of scattered fibroglandular elements. A triangular marker is placed at lower outer quadrant of right breast, denoting the palpable lump.There are four round masses aligned anteroposteriorly in the right lower inner quadrant, with total measurement 40 x 18 mm. Immediately posterior to these masses, there is a focal asymmetry measuring 20 x 16 mm. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST AND RIGHT AXILLA (2/24/15):Multiple masses abutting each other are present at 3:30 to 4:00 position in the right breast. Total measurement is reported as 38 x 21 x 15 mm. A few normal appearing lymph nodes are seen in the right breast.IMAGES FROM ULTRASOUND GUIDED BIOPSY AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (2/24/15):Core biopsy was performed under ultrasound guidance with appropriate needle placement. Postprocedural right mammographic images show a marker clip placed at the posterior portion of the multiple masses in the right lower inner quadrant.Per outside radiology report, the pathology results were solid papillary, possible invasive carcinoma.BREAST MRI (3/3/15):Breast MRI was performed with a protocol outlined in the outside radiology report. Multiple enhancing masses are seen at lower inner quadrant, middle to posterior depth in the right breast, consistent with proven carcinoma. There is a posteriorly extending non-mass enhancement from these masses. Total measurement of these lesions is 68 x 22 x 27 mm (AP x LR x CC). No abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in either axillary region.IMAGES FROM MRI GUIDED BIOPSY OF RIGHT BREAST WITH POST PROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (3/11/15): MR guided biopsy was performed for the area of non-mass enhancement at posterior lower inner quadrant in the right breast. Postprocedural mammographic images show a marker clip placed at far posterior lower inner quadrant in the right breast, approximately 43 mm posterior from the marker clip placed at ultrasound-guided biopsy.Per outside radiology report, the pathology results showed invasive ductal carcinoma and ductal carcinoma in situ.

Output: Biopsy proven carcinoma in the lower inner quadrant in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Thyroid nodules RIGHT LOBE MEASUREMENTS: 7.2 x 2.4 x 2.1 cmLEFT LOBE MEASUREMENTS: 6.9 x 2.6 x 1.9 cmISTHMUS MEASUREMENTS: 7 mmRIGHT LOBE: Again noted heterogeneous echotexture without any focal lesions.LEFT LOBE: Heterogeneous echotexture without any focal lesions, unchanged.ISTHMUS: Previously described isthmic subcentimeter cystic lesions are unchanged.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes are unchanged.OTHER: No significant abnormality noted.

Output: Diffuse enlarged thyroid with two subcentimeter cystic isthmic nodules without any significant change.


Instruction: Generate impression based on findings.

Input: Worsening dizziness and tinnitus: 4 mm schwannoma on the left side. There is an unchanged enhancing nodule within the left internal auditory canal that measures up to 4 mm. No new mass lesions are identified. There is fluid signal within the left mastoid air cells. The bilateral inner ear structures are intact. There is an unchanged 10 mm wide probable Thornwaldt cyst in the nasopharynx. The skull and extracranial soft tissues are otherwise unremarkable.

Output: No significant interval change in the subcentimeter left internal auditory canal probable vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: Headache.IMAGE ACQUISITIONS: 5-mm contiguous axial images of the brain without contrast infusion. Low-attenuation lesion in the peripheral aspect of right cerebellar hemisphere or in the extra-axial space adjacent to the right cerebellar hemisphere measures approximately 19 x 12 mm transverse by AP. This could represent an arachnoid cyst but is in an atypical location for arachnoid cyst. Consider follow-up MRI of the brain before and after gadolinium to definitively exclude cystic mass.There are moderate chronic ischemic/degenerative changes of cerebral white matter. There is no hydrocephalus. There are no subdural fluid collections. Left parieto-occipital scalp swelling is noted. There is no depressed calvarial fracture.

Output: 1.No acute intracranial hemorrhage.2.Moderate chronic ischemic/degenerative changes.3.Posterior fossa cystic appearing lesion. Consider MRI for further evaluation.


Instruction: Generate impression based on findings.

Input: 41 years, Female, multiple sclerosis, evaluate for progression of demounting disease. Again seen are multiple T2/FLAIR hyperintense lesions involving the subcortical and periventricular white matter with distribution and morphology consistent with known demyelinating disease. Multiple infratentorial lesions in the brainstem, cerebellar peduncles, and bilateral cerebellar hemispheres are also noted. Compared to 9/26/2006, no new lesion is identified allowing for slight differences in technique. There is no intracranial mass or mass effect. There is mild global parenchymal volume loss including thinning of the corpus callosum, similar to prior. Multiple T1 hypointense lesions are also seen similar to prior. No diffusion abnormality. No evidence of intracranial hemorrhage. No extra-axial collections. No hydrocephalus. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Multiple T2/FLAIR hyperintense supra- and infratentorial lesions consistent with known chronic demyelinating disease. Compared to 9/26/2006, no new lesions are appreciated. No abnormal enhancement to suggest active demyelination. Mild global parenchymal volume loss including thinning of the corpus callosum again seen.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with low back pain. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable. No evidence of bone marrow edema is seen.The visualized spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Otherwise unremarkable. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. L4-5: Moderate to severe facet hypertrophy with ligamentum flavum thickening. Mild loss of disc T2 signal with preservation of disc height and no significant bulge or herniation. No spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. Loss of disc height and disc T2 signal intensity. Mild disc bulging with a superimposed right foraminal disc protrusion. No significant spinal canal stenosis. Moderate, right more than left, bilateral foraminal narrowing A Tarlov cyst is evident within the left S2 neural foramen.

Output: 1.Posterior limb and hypertrophy is seen becoming most severe at the L3-4 and L4-5 levels.2.Mild disc degeneration is noted at L4-5 with moderate disc degeneration at L5-S1. No significant spinal canal stenosis is seen. However the neural foramina are moderately narrowed at L5-S1.


Instruction: Generate impression based on findings.

Input: Reason: eval labrum History: pain ROTATOR CUFF: Intermediate signal intensity in the mid to distal aspect of the supraspinatus tendon along with slight thickening suggests tendinopathy. There is no frank tear or evidence of communication to the subacromial subdeltoid bursa. The remainder of the tendons and musculature of the rotator cuff are unremarkable.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: A tear extends from the posterior superior labrum to the anterior superior labrum terminating at the base of the long head of the biceps, without extending into the biceps tendon.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.SLAP (superior labrum anterior posterior) tear as above.2.Thickening and increased signal intensity of the supraspinatus tendon is compatible with tendinopathy.3.No frank tear of the rotator cuff.


Instruction: Generate impression based on findings.

Input: Metastatic head and neck cancer treated with 2 cycles of pembrolizumab. There is a punctate focus of enhancement in the right middle temporal gyrus subcortical white matter. There is also a mildly prominent vessel in the right inferior temporal gyrus region. The brain parenchyma otherwise appears unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. 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: Unchanged nonspecific punctate focus of enhancement in the right middle temporal gyrus subcortical white matter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Thoracic or lumbosacral neuritis or radiculitis, unspecified. Thoracic or lumbosacral neuritis or radiculitis, unspecifiedClinical question: disc herniationSigns and Symptoms: LLE radiculopathy Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disc desiccation present in the lower lumbar spine. There is a T1 hyperintense lesion present within the L2 vertebral body measuring 23 x 17 mm sagittal dimensions. There is a 15 x 12 mm T1 hyperintense lesion within the L1 vertebral body. Both of these lesions have suppressed signal on the inversion recovery images. They most likely represent vertebral body hemangiomas.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present this level associated with mild loss of disc space height and disc desiccation. There is mild ligamentum flavum hypertrophy present at this level. The fat at the lateral recesses bilaterally is not effaced. The fat surrounding the exiting nerve roots within the neural foramina is not effaced.At L4-5 there is no significant compromise to spinal canal or neural foramina. There are endplate reactive changes present at this level with Schmorl's nodes and T2 signal hyperintense signal. There is a disc bulge present this level associated with mild loss of disc space height and disc desiccation. There is mild ligamentum flavum hypertrophy present at this level. The fat at the lateral recesses bilaterally is not effaced. The fat surrounding the exiting nerve roots within the neural foramina is not effaced.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present this level associated with mild loss of disc space height and disc desiccation. There is mild ligamentum flavum hypertrophy present at this level. The fat at the lateral recesses bilaterally is not effaced. The fat surrounding the exiting nerve roots within the neural foramina is not effaced. There is a small subchondral cyst along the left facet joint at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a partially imaged cystic lesion in the left kidney which is inadequately evaluated on this exam.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.There are multilevel degenerative changes present in the lumbar spine with findings suggesting more subacute degenerative change at L4-5.3.There is a partially imaged cystic lesion in the left kidney which is inadequately evaluated on this exam.


Instruction: Generate impression based on findings.

Input: Metastatic RCC with worsening pain Again noted is a large destructive enhancing mass of the right sacrum consistent with known metastatic disease. The mass is centered in the sacral wing which involves S1-S3 and crosses the sacroiliac joint to involve a small portion of the right ilium. The mass also extends into the left sacral wing with focal involvement of the left ilium. Additionally, there is soft tissue involvement anterior to the sacrum with signal abnormalities noted within the piriformis muscle. The mass obliterates the right S1 and S2 neural foramen and partially invades the right S3 neural foramen and sacral canal. It is difficult to determine if there has been slight interval increase due to technical differences between MR and CT but overall the mass appears similar in extent. It measures approximately 13 cm in the greatest transverse dimension and approximately 10 cm in the greatest craniocaudal dimension.Multiple other lesions noted throughout the pelvis with the next largest present in the left posterior acetabulum/ischium, measuring approximately 2.3 x 3.8 cm. Additional foci of disease are noted in the left iliac wing (series 8 image 7/50), the L5 vertebral body (series 8 image 9/50), the left superior acetabulum (series 8 image 24/50) and the subtrochanteric portion of the left femur (series 8 image 42/50).There is severe degenerative disc disease of the lower lumbar spine.

Output: Metastatic disease within the bones of the pelvis, left proximal femur, and lower lumbar spine as described above. The largest mass within the right sacrum appears comparable to the prior CT exam although direct comparison is limited given technical differences between MRI and CT.


Instruction: Generate impression based on findings.

Input: 64-year-old female with mesothelioma status post HIPEC (06/2016) ABDOMEN:LIVER, BILIARY TRACT: Slitlike T2 hyperintense focus with hypointense nodularity in the inferior right lobe of the liver is new since the prior exam. Perihepatic disease has been resected since the prior MR with residual disease studding the surface of the liver. Implant at the dome of the liver is increased in size since prior CT.Reference measurement on the lateral right lobe is provided. There is a subhepatic peritoneal mass that is increased in size when compared to the prior exam.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland nodule is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Focus of peritoneal disease along the right abdominal wall. Nodules noted in the greater curvature of the stomach and gastrosplenic ligament are new/increased in size. Trace perisplenic fluid.BONES, SOFT TISSUES: Rightward curvature of the lumbar spine with degenerative changes centered at L3-L4.Right paralabral cyst anterior to the to the right hip joint, increased in size. Right paralabral cyst in the gluteus minimus is unchanged in size. OTHER: No significant abnormality noted.PELVIS:UTERUS/ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference right lower quadrant soft tissue implant and not significantly changed in size. The posterior pelvic soft tissue implant is slightly increased to stable in size since the prior examination. BONES, SOFT TISSUES: Rightward curvature of the lumbar spine with degenerative changes centered at L3-L4.Right paralabral cyst anterior to the to the right hip joint, increased in size. Right paralabral cyst in the gluteus minimus is unchanged in size. Heterogenous enhancement in the proximal femoral diaphysis is not evaluated well and likely unchanged.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/1/2016 09:18:26)VENTRAL BODY WALL COMPLEX CYSTIC LESION: 7.5 x 1.3 cm (Image 45, Series 6); 9.3 x 1.5 cm on prior (8/9/2016) (Image 94, Series 3).POSTERIOR PELVIC SOFT TISSUE IMPLANT: 3.1 x 3.7 cm (Image 60, Series 18); 3.4 x 3.0 cm on prior (8/9/2016) (Image 127, Series 3).RIGHT LOWER QUADRANT SOFT TISSUE IMPLANT: 4.3 x 4.3 cm (Image 63, Series 18); 4.1 x 3.4 cm on prior (8/9/2016) (Image 127, Series 3).RIGHT SUBHEPATIC NODULE: 2.2 x 2.8 cm (Image 234, Series 10).

Output: 1.Interval increase in size and number of peritoneal/mesenteric and subcapsular metastatic foci as above.


Instruction: Generate impression based on findings.

Input: 22 years, Female, etiology of left frontal intraparenchymal hemorrhage. Again seen is intraparenchymal hemorrhage in the left frontal lobe similar to CT head dated 5/10/2016 allowing forslight differences in technique. There is minimal adjacent subarachnoid hemorrhage and minimal leptomeningeal enhancement which is likely reactive. No suspicious enhancement to suggest underlying lesion. No abnormal flow-voids in this region. There is relatively mild surrounding vasogenic edema. There is local mass effect and minimal rightward subfalcine herniation. No uncal herniation. Ventricles remain normal in size. There is mild cerebellar tonsillar ectopia.MR venogram demonstrates patency of the major dural venous sinuses without evidence of thrombosis. No appreciable evidence of cortical vein thrombosis.

Output: Left frontal intraparenchymal hematoma with minimal adjacent subarachnoid hemorrhage and minimal adjacent leptomeningeal enhancement which is likely reactive. No suspicious underlying lesion or vascular malformation is appreciated. Major venous sinuses are patent.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified disorders of muscleClinical question: history of old stroke, possible new strokeSigns and Symptoms: as above MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of signal hyperintensity on T2 and FLAIR MRI are present in the left thalamus and ponsThere are small foci of susceptibility effect in signal loss present in the basal ganglia thalami and pons. The largest one is located in the right thalamus and can be identified on T2-weighted imaging root measures approximately 5 x 7 mm axial dimensions.The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small.. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There are multiple microhemorrhages present in the basal ganglia, thalami and brainstem was pattern is suggestive of hypertensive microhemorrhages. 2.There is a 1cm old hemorrhagic focus in the right thalamus. 3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for intracranial cerebrovascular occlusive disease.5.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: For numbering purposes, a total of 5 lumbar type vertebral bodies are identified. Alignment is anatomic. There are no fractures or subluxations. Vertebral body heights and intervertebral disc spaces are preserved. There is bone marrow signal heterogeneity and scattered foci of T1 hyperintensity in the lumbar vertebral bodies, suggestive of fat or hemangiomas. There are additional areas of low T1 and low T2 signal such as in the anterior L2 vertebral body, inferior midportion of the L3 vertebral body, and inferior aspect of the L4 vertebral body. No associated STIR hyperintensity or enhancement is seen. There is no definite evidence of osseous metastatic disease, however possibility of these lesions representing sclerotic, possibly metastatic lesions is not entirely excluded. There is no evidence of epidural tumor or compression fracture. The conus is normal in signal and morphology and terminates at T12-L1 level. No abnormal enhancement of the cauda equina is identified. Multiple subcentimeter cystic-appearing structures are noted in bilateral kidneys.T12/L1: No evidence of neural foraminal or spinal canal stenosis.L1/2: No evidence of neural foraminal or spinal canal stenosis.L2/3: There is mild disc bulge and facet joint arthropathy, with no significant spinal canal or neural foraminal stenosis.L3/4: There is a disc bulge with moderate facet joint arthropathy, with partial effacement of the lateral recesses and mild bilateral neural foraminal stenoses. No significant central spinal canal stenosis. There is mild enhancement associated with facet arthropathy at this level, likely related to degenerative changes.L4/5: There is a disc bulge with left posterior annular fissure and mild left neural foraminal stenosis. No spinal canal or right neural foraminal stenosis is identified. Mild facet joint arthropathy noted at this level.L5/S1:No significant spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.

Output: 1.No definite evidence of metastatic disease in the lumbar spine. However there are several small nonspecific foci of low T1 and T2 in the lumbar spine vertebral body, as described above. These are nonspecific, however the possibility that these may represent sclerotic metastatic disease is not entirely excluded. Consider bone scan or follow-up MRI as clinically appropriate.2.No evidence of significant spinal canal stenosis.3.Scattered neural foraminal stenoses, as described above.


Instruction: Generate impression based on findings.

Input: 48 year old male patient with newly diagnosed prostate cancer. Staging examination. PELVIS:PROSTATE:Prostate Size: 5.5 x 2.7 x 3.7 cm.Peripheral Zone: There is a region of signal abnormality in the left apex measuring approximately 1.4 x 1.0 cm (image 11, series 1001); this region of signal abnormality is larger than expected when correlated with biopsy results. This appearance could be related to local prostatitis with underlying foci of tumor. Linear T2 signal abnormality within the left apex anteriorly is also non-specific and may be represent localized inflammation or tumor (image 14, series 1001). Central Gland: There are BPH nodules.Seminal Vesicles: No definite involvement.Extracapsular Extension: No definite extraprostatic 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.Region of signal abnormality within the left apex which is larger than would be expected when correlating with biopsy results; this appearance could be related to local prostatitis with underlying foci of tumor. Additional non-specific focus of signal abnormality as described above.2.No definite extraprostatic extension.


Instruction: Generate impression based on findings.

Input: Spina bifida with hydrocephalus. Assessment of Chiari malformation. Brain:Findings related to previous suboccipital decompressive craniectomy are present. Since the previous examination, new, severe dilatation of the ventricular system has occurred, including the fourth ventricular outflow tracts. Fourth ventricular dilatation is more focally pronounced along the inferior aspect of the ventricle and results in downward displacement of the cervicomedullary junction and obex into the upper cervical spinal canal. The cerebellar tonsils are posteriorly pushed rather than inferiorly displaced through foramen magnum. This is suggestive of obstruction at the level of the median foramen. There is also severe inferior displacement and thinning of the floor of the third ventricle (hypothalamus) which is now partially behind the dorsum sellae which shows pressure thinning. There is postchiasmatic splaying of the optic tracts by the dilated and third ventricle. This ventricular dilatation is associated with periventricular white matter T2 hyperintensity indicating transependymal CSF flow. Given the bilateral, symmetric nature of the ventricle dilatation, there is no midline shift. The sulci are relatively compressed. There is no space-occupying brain lesion, otherwise. The major intracranial vessels are patent.The CSF flow study shows pulsatile flow in the CSF spaces above and below the foramen magnum but not through it. Whole Spine:The above-described new dilatation of the ventricular system is associated with marked progression of the cervicothoracic syrinx (hydromyelia and syringomyelia) which is now associated with expansion of the spinal cord. The abnormality reaches to the lower T11 vertebral level. The tip of the conus medullaris is at the mid L2 level. The conus has normal morphology.There is a mild sigmoid-shaped scoliosis (rightward convex in the thoracic spine with compensatory lumbar and cervical curvatures). This is not associated with morphologic abnormality of the vertebrae.

Output: Since August 2013, there has been significant progression of dilatation of the ventricular system as well as the cervicothoracic syrinx. This is suggestive of obstruction at the level foramen magnum.


Instruction: Generate impression based on findings.

Input: History of metastatic gallbladder cancer with rising bilirubin, jaundice and ascites. Evaluate for intraductal obstruction. ABDOMEN:LIVER, BILIARY TRACT: T2-weighted moderately hyperintense liver masses extending from the gallbladder fossa and involving the right hepatic lobe. Tumor/lymphadenopathy extends through the porta hepatis. These findings have progressed from the prior study. There is severe narrowing at Klatskin's point (series 501/27) and decompression of the common hepatic and common bile duct. This results in severe intrahepatic biliary ductal dilatation. The dominant lesion measures approximately 6.0 x 5.2 cm (series 501/26) at the junction of the anterior and posterior segment.Large gallstone in a decompressed gallbladder. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild right-sided hydroureteronephrosis to the level of the pelvic mass likely related to mass effect, increased from the prior study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is normal in caliber. Large volume ascites. The large heterogeneous pelvic mass with central cystic component is partially evaluated and is best seen on the coronal images. It measures approximately 12.2 x 11.7 cm (series 401/12).BONES, SOFT TISSUES: Anasarca.OTHER: Large bilateral pleural effusions with adjacent consolidation/atelectasis.

Output: 1.Findings compatible with gallbladder carcinoma invading the hepatic parenchyma with tumor/lymphadenopathy infiltrating the porta hepatis resulting in severe intrahepatic biliary ductal dilatation centered about Klatskin's point.2.Large volume ascites and bilateral pleural effusions.3.Pelvic mass is partially imaged.