Instruction: Generate impression based on findings.

Input: Male; 53 years old. Reason: Eval liver lesions masses, HCC screen compare seg VII hepatic lesion without washout, eval patent vessels, coronary calicifications History: cirrhosis, ascites, PVT ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Mild perihepatic ascites, slightly decreased since prior exam. Arterially enhancing lesion in segment VII posterior to the IVC measures 13 x 10 mm, unchanged (series 1001/349). No washout on delayed contrast phase. No additional enhancing lesions. Stable attenuation of the extrahepatic main portal vein measuring up to 3 mm. Extensive venous collaterals are noted throughout the upper abdomen.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable nonenhancing cystic lesion in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis with stable compression fractures of lower thoracic vertebral bodies.OTHER: No significant abnormality noted.

Output: Stable arterially enhancing segment VII hepatic lesion without washout. The lesion does not meet the criteria for hepatocellular carcinoma. However, continued surveillance is recommended.


Instruction: Generate impression based on findings.

Input: Status post ACL reconstruction, with ACL tear (not fixed), biceps avulsion, injury September 2015. Right knee instability. Evaluate right knee for healing of posterolateral corner. Due to the patient's body habitus, the high-resolution knee coil could not be used. An alternative coil was used instead which results in slightly suboptimal image quality.MENISCI: The menisci appear intact.ARTICULAR CARTILAGE AND BONE: I see no articular cartilage defects. Evaluation of the lateral femoral condyle is limited by metal susceptibility artifact resulting from an orthopedic screw. There is also a surgical tunnel within the fibular head. A couple of small ossicles are noted proximal to the fibular styloid likely representing ununited fracture fragments, the larger ossicle perhaps representing an old avulsion of the popliteofibular ligament.LIGAMENTS: The patient has undergone lateral collateral ligament reconstruction. The graft extends from the surgical tunnel in the fibular head toward the artifact created by the orthopedic screw which protrudes slightly from the lateral femoral condyle. Although the most proximal fibers of the graft are difficult to evaluate due to the metal susceptibility artifact, I suspect that it is intact. There is intermediate signal intensity surrounding the graft and extending superiorly beyond the orthopedic screw along the undersurface of the lateral retinaculum and iliotibial band that I suspect represents scarring. The iliotibial band itself appears thickened, but can be followed to its insertion on Gerdy's tubercle. The posterior fibers of the lateral retinaculum and adjacent lateral deep crural fascia also appear thickened with abnormal signal intensity, particularly in the vicinity of the aforementioned orthopedic screw, which I suspect represents a combination of chronic tearing and adjacent scar tissue. The distal tendon of the biceps femoris can be followed to its insertion on the fibula; it appears thickened at its insertion on the fibula, with mildly increased signal intensity, perhaps representing prior insertional injury and subsequent scarring, but I see no fluid-filled disruption currently. The medial collateral ligament appears intact. The posterior cruciate ligament appears intact. A structure resembling of the anterior cruciate ligament is noted extending from the distal femur to the proximal tibia; however, it appears thinned and may represent only one of the two bundles, with the other bundle being chronically torn and no longer visible. Alternatively, this may reflect scar tissue that has formed along a completely disrupted ACL, but I suspect this is less likely.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Surgical changes of LCL reconstruction as described above. Although detailed evaluation is limited by metal susceptibility artifact, I suspect that the graft is intact. There is, however, what I believe to be the extensive adjacent scar tissue, and perhaps chronic tearing of the adjacent lateral retinaculum. Other findings as above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of unspecified nature of bone, soft tissue, and skinClinical question: 3 month f/u eval schwannoma for change The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.The patient is status post posterior fusion with the lateral mass screws on the left side at C2, C3 and C4 and on the right side at C2 and C4. There are associated interconnecting rods. The patient is status post right-sided laminotomy at this level.At C2-3 there is a 9 x 7 mm axial dimension ring-enhancing lesion within the right neural foramen this was not clearly present on the prior exam from March.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is mild facet hypertrophy at this level - right more than left.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild facet hypertrophy present at this level.At C5-6 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with moderate bilateral neural foramina encroachment of exiting nerve roots. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level. There is loss of disk space height at this levelAt C6-7 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with bilateral neural foramina encroachment (right worse than left) and some mild narrowing of the spinal canal . There is encroachment of right-sided exiting nerve roots. There is loss of disk space height at this level.At C7-T1 there is no significant compromise to the spinal canal. There are small uncovertebral osteophytes present at this level mildly narrowing the neural foramina.The vertebral artery flow voids appear to be intact.There is redemonstration of some signal changes in the visualized portions of the pons which can be better visualized on the MRI of the brain from 2/4/2015

Output: 1.Since previous examination a nodule has developed in the right neural foramen at C2-3. The possibility that this represents recurrence or residual tumor cannot be excluded.2.The patient is status post surgery at C2-3 as detailed above.3.There are some degenerative changes present in the cervical spine which remains stable since prior exams. This appears to be worse at C5-6 and C6-7 where there is encroachment of exiting nerve roots bilaterally at C5-6 and on the right side at C6-7.4.Signal changes in the brainstem are better evaluated on the MRI of the brain from 2/4/15.


Instruction: Generate impression based on findings.

Input: 79-year-old female patient with history of IPMN in the uncinate process of the pancreas. Please evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense nonenhancing lesions within the liver compatible with simple cysts. Peripherally located perfusion anomalies noted on postcontrast imaging. No suspicious liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion in the pancreatic neck that communicates with the main pancreatic duct measures 1.9 x 0.8 cm (series 6 image 22), previously 1.9 x 0.9 cm. Prominent main pancreatic duct measures to 4 mm in diameter, similar to prior.ADRENAL GLANDS: Left adrenal lesion currently measures 2.3 x 1.6 cm (series 4 image 17), previously 2.4 x 1.6 cm.KIDNEYS, URETERS: Bilateral subcentimeter renal cysts are again noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Arterial enhancing T2 hyperintense duodenal mass currently measures 2.7 x 2.2 cm (series 4 image 25), previously 2.9 x 2.4 cm. This is compatible with patient's known carcinoid tumor.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in duodenal mass compatible with patient's known carcinoid tumor.2.Pancreatic IPMN is unchanged.3.Left adrenal lesion unchanged.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1] / Hyperlipidemia, unspecified [E78.5] / Cardiomyopathy, unspecified [I42.9], Reason for Study: ^Reason: question of ischemic stroke History: left sided clumsiness and weakness Brain MRIThere are scattered restricted diffusion lesions on the right pre central and post central gyri indicating possible acute/subacute ischemic infarction.There is no evidence of hemorrhagic conversion of those lesions.Scattered high signal lesions on FLAIR/T2 images on the left centrum semiovale and left occipital lobe are non-specific.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. 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.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No intracranial arterial luminal stenosis. No intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The right vertebral artery appears to be hypoplastic. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Multiple acute/subacute ischemic infarction on the right pre-central and post-central gyri without evidence of hemorrhagic conversion.2. No evidence of intra and extra cranial arterial luminal stenosis.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, 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 right wrist 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 a 25-gauge needle.Under fluoroscopic guidance, a 22-gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 4 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 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 and 6 seconds.

Output: Successful fluoroscopic-guided right wrist arthrogram.


Instruction: Generate impression based on findings.

Input: History prostate cancer.Additional history per Epic:PSA 4.5 ng/ml and recent biopsy with 5 mm of Gleason 3+4=7 (left base), clinical stage T1c. PELVIS:PROSTATE:Prostate Size: 5.3 x 4.3 x 4.5 cm.Peripheral Zone: Areas of intrinsic T1 shortening within the left greater than the right peripheral zone likely reflect blood products from prior biopsy and somewhat limit evaluation. There is an area of decreased T2 and ADC signal and associated mild early enhancement within the left mid gland/base measuring approximately 7 x 10 mm (series 401, image 16) which is suspicious for neoplasm.Central Gland: Several well-circumscribed nodules compatible with benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Blood products from recent biopsy somewhat limit evaluation, but no gross evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right-sided hydrocele.

Output: 1.Blood products from recent biopsy which somewhat limits evaluation.2.Signal abnormality within the left mid gland/base suspicious for neoplasm.


Instruction: Generate impression based on findings.

Input: Patient fell, pain along medial aspect, check meniscus MENISCI: A complex single abnormality is observed in the anterior horn of the lateral meniscus with a distinct vertical extension projected towards both the superior and inferior articular surfaces. A small 4-mm adjacent para-meniscal cyst is also identified. Otherwise the lateral meniscus is unremarkable and well anchored posteriorly. The medial meniscus demonstrates a mild globular signal within the body which is associated with irregular fraying upon the inferior articular surface and towards the apex. No discrete linear component is observed in the posterior component is otherwise unremarkable.ARTICULAR CARTILAGE AND BONE: A focal subchondral cyst is observed lung the lateral tibial plateau adjacent to the tibial spine. No additional cartilaginous abnormalities are observed other than mild signal abnormality without focal lesions in the patellar cartilage. Marrow signals otherwise unremarkableLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: A complex tear within the anterior horn of the lateral meniscus in a more minimal globular signal involving the medial meniscus; see detail provided. Mild degenerative changes


Instruction: Generate impression based on findings.

Input: There is an extra-axial enhancing mass arising within the left cerebellopontine angle cistern extending into the internal auditory meatus that measures 13 x 17 x 12 mm, previously 13 x 15 x 11 mm. There is decreased enhancement within the tumor centrally. There is no significant mass effect on the adjacent brainstem. There is no evidence of intracranial hemorrhage or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intraparenchymal 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 skull and scalp soft tissues are unremarkable. There is a small mucous retention cyst within the left maxillary sinus. The midline structures and craniocervical junction are within normal limits.

Output: Interval post-treatment effects in the left vestibular schwannoma with perhaps slight increase in size. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, primarily in the frontal lobes, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Cerebellar tonsils are borderline low with preserved normal rounded morphology. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Specifically no lesions are seen along the courses of the cranial nerves, cavernous sinuses, or orbital apex. Major flow-voids are preserved.Sella is grossly within normal limits. Mild mucosal thickening involving the right maxillary sinus. Mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Small skin nodule is seen at the right cheek which can be better assessed on examination.Orbits: No abnormal mass or abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1. Brain MRI is essentially unremarkable for age. There are scattered foci of T2/FLAIR hyperintensity in the supratentorial white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes.2. Orbit MRI is within normal limits.3. Mild right maxillary sinus mucosal thickening.


Instruction: Generate impression based on findings.

Input: History shortness of breath. LUNGS AND PLEURA: Interstitial fibrosis consisting of inter and intralobular reticulation, volume loss and traction bronchiectasis, with little honeycombing but a few areas of ground glass opacity.MEDIASTINUM AND HILA: Scattered upper limits normal sized mediastinal lymph nodes, not unexpected in interstitial lung disease.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: 25 x 18 mm heterogeneous right adrenal lesion could be an adenoma a follow-up CT or MRI might be advisable.Right renal cyst.

Output: 1. Moderate to severe interstitial lung disease in a pattern most consistent with NSIP.2. Right adrenal lesion possibly an adenoma, see above.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for deterioration of lumbar radiculopathy/stenosis. Signs and symptoms: Back pain and radicular pain. Nonenhanced lumbar MRI:T11-T12 these unremarkable and unchanged since prior exam.T12-L1 demonstrate moderate degenerative disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. There is no spinal stenosis however mild right neural foraminal compromise is noted. Is progression of disease since prior study.L1-L2 demonstrate mild disc disease and loss of disc height, asymmetric mild right facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise. No significant change since prior exam.L2-L3 demonstrates advanced disc disease and loss of disc height with evidence of progression since prior exam. There is asymmetric diffuse shallow bulging disc on the left and far laterally, asymmetric (L>R) moderate facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. There is significant left neural foraminal and left lateral recess compromise at this level and no central spinal stenosis in AP axis. Since prior exam there is interval significant decreased size of the large left lateral disc protrusion.L3-L4 demonstrate mild disc disease moderate bilateral (L>R) facet hypertrophic changes with resultant significant left neural foraminal compromise, no spinal stenosis and patent right neural foramen. There is interval progression of disease at this level and left neural foraminal compromise is a new finding. Also new since prior exam is mild chronic compression deformity of the superior endplate of L4.L4-L5 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum and facet hypertrophic changes and including widening of the facet spaces with fluid signal intensity (effusion). There is interval progression of degenerative changes at this level. Mild compromise of AP axis of the canal without convincing evidence of central spinal stenosis. There is moderate left lateral recess compromise and no significant neural foraminal compromise.L5/S1 demonstrate mild disc disease, large left lateral and far lateral disc protrusion in combination with asymmetric hypertrophic changes of posterior elements on the left results in significant left neural foraminal and left lateral recess compromise. No central spinal stenosis and patent to right neural foramina.

Output: 1.Degenerative changes of the discs and the posterior elements with evidence of mild interval progression since prior exam as detailed.2.No evidence of clinically significant central spinal stenosis at any level.3.There are however multilevel neural foraminal and lateral recess compromise secondary to degenerative disease and disc protrusions as detailed per level above.


Instruction: Generate impression based on findings.

Input: Female, 41 years old, with intractable epilepsy. Functional localization requested for presurgical evaluation. During the visual stimulation portion of the examination, the patient experienced one of her typical seizure episodes with involuntary movement of the right arm, disorientation and headache. The symptoms lasted less than 5 minutes, and after a short delay, the patient was fully recovered and able to proceed with the remainder of the exam. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical activation maps as expected along the bilateral calcarine sulci.All tested language paradigms produce reliable language related cortical activation. Language is left dominant. Multiple foci of cortical activation are observed mapping to the left inferior frontal gyrus (primarily pars opercularis and pars triangularis) which likely reflect the putative Broca's area. Foci of activation in the left posterior temporal lobe are seen variable on all language paradigms, though the sentence completion paradigm produces the most robust activation. A focus of activation is seen along the left superior temporal sulcus which is typical of the putative Wernicke's area. However, foci are also seen more posteriorly in the superior temporal gyrus and the middle temporal gyrus, which could reflect additional sites of Wernicke's processing or sites of accessory language processing.

Output: 1.Technically successful fMRI for sensorimotor and language cortical mapping.2.Sensorimotor cortical activation maps as expected along the pre- and post-central gyri. Visual cortical activation maps as expected along the calcarine sulci.3.Language is left dominant. Cortical activation related to Broca's and Wernicke's areas maps to the customary locations as above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Thoracic or lumbosacral neuritis or radiculitis, unspecified LumbagoClinical question: evaluate for stenosisSigns and Symptoms: lumbar 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 disk dessication present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a small right lateral disk protrusion extending into the inferior aspect of the right neural foramen. This protrusion is associated with T2 signal hyperintensity. The disk protrusion abuts the nerve roots at the right lateral recess along their lateral aspect.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge and mild facet and ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge at this level. There also endplate reactive changes which are bright on T2 and low signal on T1.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a T2 hyperintense lesion in the parenchyma of the right kidney. This could represent a cyst.

Output: 1.No compromise to lumbar spinal canal or neural foramina. There are mild degenerative changes in the lumbar spine present. A right lateral disk protrusion at L5-S1 extending to the neural foramen but abutting the nerve roots at the right lateral recess along their lateral aspect.2.There is a T2 hyperintense lesion in the parenchyma of the right kidney. This could represent a cyst. An ultrasound would help confirm this.


Instruction: Generate impression based on findings.

Input: Left neck mass x 2 years. Additional history from the electronic medical record: history of posterior neck schwannoma resection who presents for evaluation of left neck mass. The patient has had a left neck mass for at least 4 years. Recently, over the last 3-4 months, it has been growing in size. C-spine MR on 2/2016 demonstrated a 5 cm cystic/solid mass in the left neck which measured 1.3 cm on imaging on 10/2009. The patient underwent a CT on 3/15/2016 which demonstrated a 5 cm left neck mass, possibly representing a schwannoma or paraganglioma. There is a T2 hyperintense, tubular structure in the left neck abutting the left internal jugular and left common carotid artery measuring 1.9 x 1.4 x 4.9 cm. This lesion demonstrates minimal peripheral enhancement, with what appears to be a more nodular enhancing component along the superior and posterior aspect of the lesion, which measures 15 mm in diameter. There is otherwise no significant lymphadenopathy according to radiological criteria. The salivary glands, upper aerodigestive tract, and thyroid appear unremarkable. The imaged intracranial contents are unremarkable. There is mild bilateral maxillary sinus mucosal thickening. The orbits are unremarkable. The cervical spine is unremarkable. However, there appears to be focal volume loss of the right spinal cord at the C2 level.

Output: 1. A left neck tubular cystic structure along the carotid sheath with what may represent a nodular solid component posteriorly and superiorly may represent a partially cystic peripheral nerve sheath tumor.2. Apparent focal volume loss of the right spinal cord at the C2 level may represent myelomalacia. Correlation with dedicated imaging of the cervical spine may be useful.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 85 years Male (DOB:7/25/1931)Reason: hx of spinal stenosis, AV malformation, AVN of thoracic cord, and elevated PSA presenting with bilateral leg weakness History: bilateral leg weakness PROVIDER/ATTENDING NAME: GRACE E BERRY SERVICES ANCILLARY MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal lesions are identified in the thoracic spinal cord.There are degenerative changes present in the cervical spine associated with narrowing of neural foramina and the spinal canalLumbar spine:Five lumbar type vertebral bodies are presumed to be present. The conus medullaris on sagittal imaging is grossly intact.There is a superior endplate compression of L4 and inferior endplate compression of L3.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet and ligamentum flavum hypertrophy present. There is some disc desiccation and a disc bulge at this level. Overall this has not significantly progressed when compared to the prior exam to extent of visualization. There is some effacement of the fat at the right lateral recess which remains stable compared to the prior exam.At L4-5 there is mild anterior subluxation of L4 on L5 by approximately 5 mm. Previously this was slightly less. There is narrowing of the facet joints at this level. The facet joints appear narrowed on the current exam versus the prior exam. Additionally ligamentum flavum is much thinner on the current exam compared to the previous exam from 2005. Since the prior exam spinal stenosis has regressed compared to previous exam. The patient is status post laminectomy at this level.At L3-4 there is a disc bulge present associated with mild ligamentum flavum hypertrophy and facet hypertrophy. There is triangulation of the thecal sac at this level which has progressed since the prior exam. Overall there is a mild degree of spinal stenosis at this level.At L2-3 there is a broad-based right lateral disc protrusion present which was also present on the prior exam but appears to have progressed. There is now some encroachment of the nerve roots of the right lateral recess at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are multiple renal cysts present these can also be identified on the recent abdomen CT from 11/27/2015.

Output: 1.There are degenerative changes present in the lumbar spine associated with mild spinal stenosis at L3-4 which has progressed since the 2005 exam.2.The patient status post laminectomy at L4-5 where there is mild subluxation. Previous exam spinal stenosis at this level has been alleviated.3.There are endplate compressions present at the L3-4 disc level. These have developed since the previous exam.4.No marrow replacing lesions are appreciated within the lumbar spine.5.Although no lesions are appreciated within the thoracic spinal cord, motion artifact may obscure more subtle abnormalities including arteriovenous malformation.6.There are degenerative changes present in the cervical spine associated with narrowing of neural foramina and the spinal canal.7.Examination is degraded by artifact due to patient motion which will obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Male, 58 years old. Pain. MENISCI: The medial and lateral menisci are intact, without evidence of tear. ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the patellar cartilage. Focal irregularity along the medial patellar facet, compatible with partial-thickness tearing/defects.LIGAMENTS: The cruciate and collateral ligaments are unremarkable. The medial patellar retinaculum is not well seen and may be torn. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Joint effusion with possible associated inflammatory changes.2.Possible tear of the medial patellar retinaculum.


Instruction: Generate impression based on findings.

Input: Left hip pain There is mild osteoarthritis of the left hip. Evaluation of the labrum is limited due to lack of intra-articular contrast however we suspect there is a superior labral tear present. There is mild osteoarthritis of the right hip, possibly with a labral tear as well. Evaluation of the lower lumbar spine is limited given the presence of metallic susceptibility artifact from lumbar fusion. Orthopedic screws are also evident within the right sacrum and ilium. Mild osteoarthritis also affects the pubic symphysis. Mild enthesopathic changes are also noted at the origins of the hamstring muscles although there is no discrete fluid-filled tear.Scattered foci of near fluid signal intensity within the anterior subcutaneous fat of the pelvis likely relate to prior subcutaneous injections.

Output: Mild osteoarthritis of the hip with additional findings described above.


Instruction: Generate impression based on findings.

Input: 33 years Female (DOB:9/1/1982)Reason: CCM yearly surveillance History: yearly surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The CSF spaces are appropriate for the patient's stated age with no midline shift. A small focus of signal loss is present in the left paracentral lobule adjacent to the marginal ramus of the cingulate sulcus measuring several millimeters in size. It appears be associated with a very small developmental venous anomaly. It is unchanged since the prior exam.Multiple foci of signal loss and susceptibility weighted imaging are present with the lesions identified in the subcortical white matter of the frontal lobes, parietal lobes and right cerebellar hemisphere. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A lesion in the left paracentral lobule suspicious for a cerebral cavernous malformation is stable compared to the prior exam.2.There are multiple punctate lesions in the subcortical white matter which were also present on the prior exam and are nonspecific and too small to characterize further. It is conceivable that these are related to cavernoma or microhemorrhages from other cause.


Instruction: Generate impression based on findings.

Input: 54-year-old woman with right clavicle lesion identified on MRI. There is a poorly defined lucent lesion within the mid to distal clavicular diaphysis, which perhaps represents the lesion seen on outside MRI. We see no cortical penetration or soft tissue mass. Mild osteoarthritis affects the acromioclavicular joint.

Output: Poorly defined lucency within the clavicular diaphysis is nonspecific, but in a 54-year-old woman the possibility of metastatic disease should be considered.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, history of epilepsy, planning examination for laser ablation. T2-weighted images show no evidence of any significant or concerning signal abnormality. The periventricular signal alteration seen on FLAIR images on the prior examination are not well appreciated on today's exam. On postcontrast images, no enhancing lesions are seen. Brain parenchymal morphology is within normal limits. The ventricular system is normal in size and morphology.

Output: Selected sequences for presurgical planning which show no significant intracranial abnormalities.


Instruction: Generate impression based on findings.

Input: 33 years Female (DOB:12/5/1982)Reason: eval ischemia History: weaknessPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI MRI of the brainNo diffusion weighted abnormalities are appreciated.There is several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 fetal origin of the posterior cerebral arteries bilaterally associated with small P1 segments. The anterior communicating artery is also small. The left vertebral artery is slightly larger than the right vertebral artery.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 no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left vertebral artery is larger than the right vertebral artery.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.There is no evidence for acute cerebral infarction.2.There is no evidence for intracranial aneurysm.3.There is no evidence for extracranial cerebrovascular occlusive disease.4.There is no evidence for intracranial cerebrovascular occlusive disease.5.Several punctate subcortical white matter lesions are too few to establish a pattern and likely of little clinical significance.


Instruction: Generate impression based on findings.

Input: Acute onset weakness left-sided and slurred speech. Extensive areas of hypoattenuation are seen in the periventricular and subcortical white matter consistent with small vessel ischemic disease, age indeterminant. No definite acute cortical stroke is present. However, further evaluation with MRI is recommended if clinical concern acute ischemia is present. Circumscribed low density lesions are seen in the bilateral basal ganglia and right peri-atrial white matter consistent with lacunar infarcts. No intracranial hemorrhage is seen. Subarachnoid space is prominent suggestive of parenchymal volume loss. 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. Extensive small vessel ischemic disease, age indeterminant. 2. No evidence of acute cortical stroke. MRI is more sensitive for detection of acute ischemia.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:4/5/1944)Reason: 2 temporary episodes of loss of vision in R eye, brief episode of temporal pain History: 2 temporary episodes of loss of vision in R eye, brief episode of temporal painPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 small air-fluid level in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.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 size. There is fetal origin of the posterior cerebral arteries bilaterally with moderate-sized right P1 segment and a hypoplastic left P1 segment. The right vertebral artery is hypoplastic distally and predominantly supplies the right posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is approximately 40% narrowing at the origin of the right internal carotid artery. There is no significant stenosis along the course of the left vertebral artery. There is a stenosis at the origin of the right vertebral artery.The left common carotid artery originates from the innominate artery.

Output: 1.There is a stenosis at the origin of the right vertebral artery which is hypoplastic intracranially.2.There is no evidence for acute ischemic cerebral infarction.3.There is 40% narrowing at the origin of the right internal carotid artery.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Air-fluid level in the left maxillary sinus is nonspecific. The possibility of acute sinusitis, however, cannot be excluded. Please correlate with patient's clinical symptoms.


Instruction: Generate impression based on findings.

Input: Interval right temporal craniotomy changes are demonstrated related to partial resection of peripherally enhancing right medial temporal lobe lesion. Small amount of intrinsic T1 signal is noted within the resection cavity. Medial to the resection cavity, there is persistent T2 hyperintensity with peripheral rim enhancement related to residual tumor in the posterior right parahippocampal gyrus. Gradient susceptibility related to hemosiderin deposition is demonstrated within the surgical cavity. There is no diffusion restriction to suggest acute or subacute ischemia. No midline shift is appreciated. No intra-axial or extra-axial fluid collections are visualized. Mild scattered patchy mucosal thickening is demonstrated within the paranasal sinuses. Small amount of fluid is again seen in the right mastoid air cells. Extracranial fluid collection at the craniotomy site measures approximately 7 mm in thickness.

Output: 1. Interval postsurgical changes related to subtotal resection of medial right temporal lobe mass are demonstrated.2. Mild scattered patchy paranasal sinus mucosal thickening with small amount of fluid in the right mastoid air cells.


Instruction: Generate impression based on findings.

Input: Male, 48 years old, with left shoulder arthritis. Evaluate the glenoid. No fracture is evident. Severe osteoarthritis affects the glenohumeral joint with bone on bone apposition. Multiple subcentimeter subchondral lucencies penetrate the articular surface of the humeral head and glenoid, representing erosions. A large joint effusion is also noted (better seen on the patient's prior MRI). These findings raise the possibility of an underlying chronic inflammatory arthritis. Fluid is also seen distending the biceps tendon sheath.Please note that rotator cuff tearing and tendinosis seen on the prior MRI are not well visualized on the current CT study.A large, normal variant os acromiale is again noted. Moderate osteoarthritis affects the acromioclavicular joint.Note is made of a patulous esophagus with a dependent fluid level. If there is clinical concern for a motility disorder, further evaluation with an esophagram may be considered.The remaining bony and soft tissue structures are within normal limits.

Output: Severe arthritic changes at the shoulder joint as described above with multiple small erosions and a large joint effusion suggesting osteoarthritis with an underlying chronic inflammatory arthritis.


Instruction: Generate impression based on findings.

Input: Right nasopharyngeal mass. There is a midline subcentimeter cystic lesion in the nasopharynx. There is also mild asymmetric thickening of the mucosa within the right fossa of Rosenmuller, but no evidence of a discrete tumor. There is no evidence of retropharyngeal or cervical lymphadenopathy. Indeed, a right lateral retropharyngeal lymph node measures 4 mm in short axis. The skull base and prevertebral space appear to be intact. The thyroid and major salivary glands are unremarkable. The imaged intracranial structures and orbits are unremarkable.

Output: 1. Mild asymmetric thickening of the mucosa within the right fossa of Rosenmuller is nonspecific, but could represent early nasopharyngeal carcinoma versus inflammation, for example.2. A midline subcentimeter cystic lesion in the nasopharynx may represent a retention cyst of Thornwaldt cyst.


Instruction: Generate impression based on findings.

Input: Male, 76 years old, with GBM status post resection. A wide left temporoparietal craniotomy is again seen. Extracranial soft tissue swelling has improved, though there is a persistent extradural fluid collection along the craniotomy measuring up to 13 mm in thickness.A large hemosiderin stained resection cavity is redemonstrated within the anterior left temporal lobe at the site of prior tumor resection. The size and morphology of the cavity have not significantly changed. The fluid within the cavity shows progressive suppression on FLAIR imaging which indicates some interval clearing of proteinaceous and hemorrhagic debris.On postcontrast images, there is a thin rim of nonspecific likely postoperative enhancement surrounding a majority of the resection cavity with thick dural enhancement laterally, also likely procedure related. At the posterior inferior margin of the cavity, there is a new nodular area of enhancing tissue (see image 59 series 12) which corresponds to an area of restricted diffusion on the immediate postoperative examination and to a lesser degree on the present study as well. Of note, this area of enhancement does not correlate to enhancing tumor on the preoperative examination. rCBV mapping shows predominantly low blood volume corresponding to this tissue excluding sulcal vascularity.Somewhat more superiorly, however, amorphous enhancement along the left temporal horn (see image 71 series 12) has increased in prominence. Subtle increased rCBV is seen correlating with this lesion.T2 hyperintensity within the parenchyma surrounding the resection cavity has substantially improved. This abnormal signal involves the tissues immediately surrounding the cavity including the left periatrial white matter and the left insula and internal/external capsules. A small locule of presumed blood product is evident within the left operculum immediately above the resection cavity. Since the prior examination, generalized left cerebral mass effect has almost completely resolved. The left lateral ventricle has regained a near normal caliber. Scattered nonspecific small foci of T2 hyperintensity are demonstrated in the periventricular regions.

Output: 1.Findings are redemonstrated related to a large tumor resection in the left anterior temporal lobe. Since the prior examination, abnormal T2 signal extending out from the resection cavity, and associated mass effect, have substantially improved.2.A majority of the resection cavity is surrounded by thin, likely procedure related enhancement. At the posterior inferior margin of the cavity, there is a new nodular area of enhancement which demonstrates low rCBV. This tissue correlates to restricted diffusion on the immediate postoperative study, and there is no enhancing tissue at this site on the preoperative examination. Given these findings, the possibility that this tissue represents subacute procedure-related parenchymal injury should be considered. Continued follow-up will be necessary to exclude progressive tumor.3.Somewhat more superiorly, amorphous enhancement extending from the posterior cavity margin along the left temporal horn is more conspicuous, and this region does correlate with elevated rCBV. As there was enhancing tumor at this site on the preoperative study, this finding is concerning for mild growth of residual tumor, though again a component of surgical change may also be considered.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with metastatic breast cancer and back pain. Innumerable enhancing marrow space lesions are evident at every level of the visualized lumbosacral spine. Multiple lesions abut or slightly encroach upon the epidural space but without significant compromise of the spinal canal or neural foramina.The right lateral aspect of the L4 vertebral body is compressed with approximately 50% loss of height. Elsewhere, vertebral body heights are preserved allowing for scattered Schmorl's node deformities. Trace retrolisthesis of L5 relative to L4 and S1 is seen. Otherwise, spinal alignment is anatomic.The visualized distal spinal cord, conus and nerve roots of the cauda equina are normal in caliber and free of pathologic enhancement.L1-2: Facet arthropathy. Ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Facet arthropathy. Ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L3-4: Facet arthropathy. Ligamentum flavum thickening. Mild disc bulging. Mild generalized spinal canal stenosis. Mild left foraminal narrowing. L4-5: Facet arthropathy. Ligamentum flavum thickening. Mild disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing. L5-S1: Facet arthropathy. Disc bulging and osteophytic ridging. Narrowing of the lateral recesses but no significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing.

Output: Diffuse osseous metastatic disease is seen involving all levels of the visualized lumbosacral spine. Although a number of lesions abut and minimally encroach upon the epidural space, no significant tumor related spinal canal or foraminal compromise is identified. The right lateral aspect of the L4 vertebral body is compressed with approximately 50% loss of height.


Instruction: Generate impression based on findings.

Input: C1-C2 epidural abscess post resection. There are are postsurgical changes of occipitocervical fusion extending from occiput to the C4 level, with hardware better assessed on prior CT. Erosive changes involving the occipital condyles, C1 and C2 vertebrae also better seen on prior CT. There is development of T2 hyperintensity involving the ventral medulla at the cervicomedullary junction with parenchymal volume loss. The ventral aspect of medulla abuts the odontoid process tip which may be related to scarring. Remainder of the cervical cord demonstrates no signal abnormality.Mild degenerative changes are seen with uncovertebral hypertrophy resulting in mild left neural foraminal stenosis at the C5-C6 level. Spinal canal and neural foramina are otherwise patent.There is abnormal enhancement at the medial atlantoaxial joint including surrounding the atlantodental interval, which is mildly widened similar to prior CT. Abnormal enhancement involving the C1 and C2 vertebrae as well as occipital condyle also noted. No abnormal epidural or paraspinous fluid collections. There is enhancement involving the midline posterior paraspinous soft tissues compatible with postsurgical scarring.There is high signal involving the left vertebral artery which is diminutive. Prior study demonstrated diminutive caliber but preserved flow-void.

Output: 1. There is extensive abnormal enhancement surrounding the medial atlantoaxial joint favored to represent granulation tissue related to prior infection. There is mild widening of the atlantodental interval appearing similar to prior CT. Occiput to C4 posterior fusion hardware remains in place. Osseous changes involving the occipital condyle, C1 and C2 vertebrae are better seen on CT. No abnormal fluid collections or abscess to suggest worsening infection.2. Development of T2 hyperintensity and volume loss involving the ventral medulla near the cervicomedullary junction compatible with sequela of prior parenchymal injury. 3. High signal involving the left cervical vertebral artery which is diminutive. Prior MRA demonstrated diminutive caliber but preserved flow-void. Finding may be related to worsened stenosis or occlusion and can be better assessed with follow-up CTA or MRA if clinically indicated.


Instruction: Generate impression based on findings.

Input: Rising bilirubin. Evaluate for hepatic injury or biliary obstruction. History of Crohn's disease status post ileal resection and stricturoplasty. ABDOMEN: Limited evaluation due to lack of intravenous contrast. LIVER, BILIARY TRACT: TIPS catheter noted. Cirrhotic liver morphology without a discrete lesion on limited non-enhanced study. Small volume perihepatic ascites. Distended gallbladder without gallstones or significant wall thickening..SPLEEN: The spleen measures 12.9 cm in craniocaudal dimension without a focal lesion. Small volume of perisplenic ascites.PANCREAS: The pancreas is normal in morphology and signal intensity without pancreatic ductal dilatation or focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Markedly dilated small bowel loop in the upper abdomen measuring up to 9.6 cm, not significantly changed from small bowel follow-through dated 11/19/2014. No proximal small bowel dilatation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large right and small left pleural effusion with bibasilar consolidation/atelectasis, see same day chest radiograph.

Output: 1.Distended gallbladder without cholelithiasis, choledocholithiasis or significant gallbladder wall thickening; may be seen in fasting state. No biliary ductal dilatation.2.Cirrhosis.3.Limited nonenhanced evaluation of the upper abdomen shows no additional significant abnormality. 4.Large right and small left pleural effusion with adjacent consolidation or atelectasis. Small volume ascites.5.Persistently dilated small bowel loop in the midabdomen is similar to prior small-bowel follow-through.


Instruction: Generate impression based on findings.

Input: 54 year old man with NASH cirrhosis, hypertension, diabetes and known coronary disease (50% LAD lesion on 2014 coronary angiography) who presents for vasodilator stress testing to evaluate for ischemia as part of a pre-transplant evaluation.MEDICATIONS: lasix, nadolol, insulin, spironolactone, omega 3 fatty acid First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 100 ml/m2 (normal range: 74+/-15), the LVEDV is 217 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 77 ml (normal range 47+/-19), the LV mass index is 65 g/m2, and the LV mass is 146 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 78 ml/m2 (normal range 82+/-16), the RVEDV is 174 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 62 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumTrivial pericardial fluid is present.Extracardiac FindingsNodular appearance to liver consistent with cirrhosis with exuberant gastroesophageal varices. Left renal cyst. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%).4. Normal RV size and systolic function (RVEF 64%).5. Mild main PA dilation.6. Nodular appearance to liver consistent with cirrhosis with exuberant gastroesophageal varices.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: There is a T2 hyperintense, enhancing lesion involving the right inferior medial aspect of the right parotid gland measuring up to 16 x 18 x 26 mm in the AP, transverse, and craniocaudal dimensions. There foci of low T2 signal within the lesion suspected to represent phleboliths. There is deep extension of part of the lesion through the stylomandibular tunnel. This lesion is present on prior MRI neck from 4/8/2015 without evidence of interval enlargement.There are no suspicious masses or evidence of pathologic enhancement elsewhere in the neck. There are scattered subcentimeter lymph nodes which are nonspecific. No pathologically enlarged or necrotic lymph nodes are seen. There is a small polyp or mucous retention cyst involving the right medial aspect of the maxillary sinus. Tiny nodules involving the left thyroid lobe and isthmus are noted. Multilevel degenerative changes are seen in the cervical spine. There is abnormal T2 cord signal involving the left aspect of the cord compatible with sequela of prior injury, and better assessed with dedicated cervical spine MRI..

Output: 1. Right parotid mass with T2 hyperintensity and enhancement is favored to represent a venous malformation. There are small round foci of low signal within the lesion suspected to represent phleboliths, which can be confirmed with CT.2. T2 hyperintensity involving the left aspect of the cervical cord is compatible with sequela of prior injury and also present on prior study.


Instruction: Generate impression based on findings.

Input: There is mild leftward curvature of the lower thoracic and lumbar spine. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. There is minimal loss of L1-L2 disc height. There is multilevel disc desiccation. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the lower L1 level. The paraspinal soft tissue structures are unremarkable.T11-T12: On sagittal images, there is no significant disc disease, neural foraminal narrowing or spinal canal stenosis.T12-L1: On sagittal images, there is no significant disc disease, neural foraminal narrowing or spinal canal stenosis.L1-L2: Small central disc protrusion. Extending about the level of the disc, there is some thickening of the posterior longitudinal ligament. No significant neural foraminal narrowing or spinal canal stenosis.L2-L3: Trace disc bulge no significant disc disease or neural foraminal narrowing.L3-L4: Facet hypertrophy. Disc bulge. Mild bilateral neural foraminal narrowing. No central canal stenosis.L4-L5: Facet hypertrophy. Trace disc bulge. Minimal bilateral neuroforaminal narrowing. No spinal canal stenosis.L5-S1: Facet hypertrophy. Left foraminal and far lateral disc protrusion likely encroaching the descending L5 nerve root. Moderate left neural foraminal narrowing. No spinal canal stenosis.

Output: Degenerative disc disease worst at L5-S1, where there is left foraminal and far lateral disc protrusion likely encroaching on the exiting L5 nerve root and moderate left neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: History of 2.5 x 2.6 cm pancreatic tail mass. History of lymphocytic Hodgkin's stage II A in 2000 and right renal cell carcinoma status post resection. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a focal suspicious lesion. Large gallstone within an otherwise normally distended unremarkable gallbladder. No intra or extrahepatic biliary ductal dilatation.SPLEEN: The spleen is normal morphology size, and signal intensity of the spleen which demonstrates heterogeneous early enhancement. No discrete lesion. Marked narrowing and probable thrombosis of the splenic vein.PANCREAS: There is mild to moderate interstitial edema involving the pancreatic body and tail compatible with pancreatitis. There is a focal masslike signal abnormality measuring 2.4 x 2.2 cm at the body tail junction with abnormal enhancement characteristics. The pancreatic tail duct is dilated measuring up to 3 mm. At the pancreatic tail near the splenic hilum there is a second masslike enlargement measuring 2.6 x 2.0 cm.There is heterogeneous perfusion of the pancreatic parenchyma.The pancreatic head and uncinate process is without diagnostic abnormality.The splenic vein is thrombosed. No peripancreatic fluid collections.Punctate cystic structure in the pancreatic body (series 4/15) does not definitively communicate with the main pancreatic duct, but may still represent a small sidebranch IPMN.Respiratory motion and peristalsis limits evaluation of the Secretin administration images. Within this limitation no additional abnormality is evident.ADRENAL GLANDS: There is a small enhancing mass in the right adrenal gland measuring 1.8 x 0.9 cm on image 44/series 3.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of tumor recurrence in the nephrectomy bed. No enlarged locoregional lymphadenopathy.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of mild pancreatitis involving the pancreas body and tail with suspicion for underlying masses at the pancreatic body/tail junction and pancreatic tail with intervening dilated pancreatic duct. There is thrombosis of the splenic vein. Differential considerations include metastatic renal cell carcinoma vs. Primary pancreatic neoplasm.2.Small enhancing right adrenal mass.3.Cholelithiasis without acute cholecystitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 3 week old full term baby girl born NSVD with no complications. Patient had a fever and presented with right arm rhythmic shaking lasting less than a minute concerning for seizure activity, evaluate for intracranial abnormality. LP performed at outside hospital with CSF notable for WBC 33, RBC 48, N18, L76, M6, Glucose 47, Protein 141. There are areas of mild ill-defined diffusion restriction particularly affecting the left temporal lobe but also scattered elsewhere through the brain bilaterally. Additionally, there is generalized fullness and edema of the left temporal lobe, parietal lobe, occipital lobe, thalamus, and insula, which correlate to the areas of restricted diffusion. No hemorrhage or fluid collection is identified. No structural abnormalities are present and the pattern of myelination is appropriate for patient's age. The brainstem and posterior fossa structures are within normal limits. 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.

Output: Findings compatible with encephalitis, likely viral.


Instruction: Generate impression based on findings.

Input: Anesthesia of skin [R20.0], Reason for Study: ^Reason: evaluate for acute ischemia History: left face and arm weakness38 years Male (DOB:2/5/1978)Reason: evaluate for acute ischemia History: left face and arm weaknessPROVIDER/ATTENDING NAME: JAMES AHN No evidence of acute ischemic or hemorrhagic lesion.There is localized thickening of the falx which protrudes towards left side (series 601, image 27) which likely indicate a small falx meningioma. The size of the lesion is measured about 4.3 mm x 15 mm.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Mucosal thickenings are seen on bilateral maxillary sinuses

Output: No evidence of acute ischemic or hemorrhagic lesion.Possible small falx meningioma.


Instruction: Generate impression based on findings.

Input: 55-year-old man with history of pancreatitis and IPMN, now with a lipase of 137 and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The gallbladder is normal. There is no intra hepatic biliary duct dilatation. The common bile duct is mildly prominent 8 mm but is unchanged from the prior exam.SPLEEN: Spleen is normal.PANCREAS: Two subcentimeter foci of increased T2 signal (series 501, images 29 and 31) communicate with the main pancreatic duct and are unchanged from the prior examination. The main pancreatic duct is prominent but stable from the prior exam. The pancreatic parenchyma appears normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a right upper pole renal cyst. The kidneys are otherwise normal and enhance symmetrically. Small amount of perinephric fluid is noted bilaterally, likely chronic.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted in the partially visualized small bowel and colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unchanged sidebranch IPMNs.2.No MR findings to explain acute abdominal pain.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: HA with exercise, eval for space occupying lesion History: as above Brain MRISignificant metallic artifacts from maxillofacial area degraded exam quality.There is no evidence of acute ischemic or hemorrhagic lesion although on limited examination coverage. 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 are normal.There is about 3mm downward placement of bilateral cerebellar tonsils through the foramen magnum. The paranasal sinuses and mastoid air cells are clear.Brain MRASignificant metallic artifacts degraded inflow enhancement signal intensities especially anterior aspects of circle of Willis.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate no evidence of intracranial aneurysm, no significant luminal stenosis.However, due to metallic artifacts, precise evaluation of intracranial arterial system is not possible. Thus, if clinically indicated, head CTA can be considered for further imaging evaluation.

Output: 1. Limited examination due to significant metallic artifacts.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.3. No evidence of intracranial arterial abnormality.Comment: head CTA can be considered for further imaging evaluation for intracranial arterial system if clinically indicated.


Instruction: Generate impression based on findings.

Input: HeadacheClinical question: Please evaluate craniocervical junctionSigns and Symptoms: Headache, dizzy, scintillations, scotomata The CSF spaces are appropriate for the patient's stated age with no midline shift. There is no evidence for Chiari malformation. The lateral ventricles are nondilated. A 3 millimeters cyst is present in the right choroid fissure.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 couple minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No obvious cause for the patient's headache is appreciated. A 3 mm cyst in the right choroid fissure is most likely incidental and of little clinical significance


Instruction: Generate impression based on findings.

Input: Images are somewhat limited by patient motion.There is redemonstration of an enhancing mildly T2/FLAIR hyperintense and T1 isointense mass in the right posterior frontal lobe measuring 2.0 x 2.2 cm (series 301, image 148). There is minimal localized mass effect and a medial halo of mild diffusion restriction. An additional smaller enhancing lesion in the left precentral gyrus measures 0.7 x 0.7 cm (series 301, image 132). The extent of surrounding T2/FLAIR hyperintensity appears similar to prior exam. This mass also demonstrates diffusion hyperintensity without significant increased signal on ADC. Linear enhancement along the medial right thalamus appears vascular.There is an additional left cerebellar enhancing focus which is not well visualized on the previous exam secondary to patient motion artifact measuring 4 x 4 mm on 1501/56. There is a questioned punctate focus of diffusion restriction in the inferior left cerebellum ventrally, without signal abnormality or enhancement.The ventricles and sulci are mildly prominent compatible with age-related volume loss, aside from the areas of sulcal effacement in the areas of the masses. Nonspecific nonenhancing punctate foci of T2/FLAIR hyperintensity are again seen elsewhere within the white matter. The cisterns remain patent. There is no midline shift. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. A left maxillary retention cyst is noted.

Output: 1. Delineation of an additional nodular enhancing focus in the lateral left cerebellum, also likely consistent with metastatic disease. This was not well visualized on prior exam secondary to patient motion.2. Otherwise, motion limited exam, with redemonstration of two lesions in the bilateral posterior frontal lobes with similar extent of surrounding vasogenic edema are most consistent with metastatic disease.3. Scattered nonenhancing nonspecific punctate foci of T2/FLAIR hyperintensity throughout the white matter, which could be compatible with chronic small vessel ischemic changes.4. A questioned focus of diffusion restriction in the ventral left inferior cerebellum not other signal abnormality, which could be artifactual or possibly represent a tiny developing metastasis versus lacunar infarct.


Instruction: Generate impression based on findings.

Input: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.

Output: MRA brain appears within normal limits. Please note examination is limited to MR angiogram of the head and conventional brain MRI sequences were not obtained. Prior brain MRI however from 10/10/2013 was within normal limits.


Instruction: Generate impression based on findings.

Input: Degenerative disc disease in the cervical spine with arm weakness. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is moderate loss of disc height at C5-C6, C6-C7, and C7-T1 as well as mild loss of disc height at C3-C4 with associated degenerative endplate changes. There is an area of increased T2 signal within the T1 vertebral body with associated mottled increased T1 signal suggestive of an atypical hemangioma. The spinal cord displays normal signal and morphology. At C2-C3, there is no significant spinal canal or neuroforaminal stenosis. At C3-C4, there is a posterior disc osteophyte complex, as well as ligamentum flavum hypertrophy resulting in moderate central canal stenosis and severe bilateral neuroforaminal stenosis. At C4-C5, there is a minimal posterior disc osteophyte complex, as well as left greater than right facet hypertrophy with mild right and moderate left neuroforaminal stenosis, but without significant spinal canal stenosis. At C5-C6, there is a mild posterior disc osteophyte complex, as well as facet hypertrophy and ligamentum flavum thickening resulting in mild spinal canal stenosis and mild bilateral neuroforaminal stenosis. At C6-C7, there is a posterior disc osteophyte complex, as well as facet hypertrophy resulting in mild spinal canal stenosis and moderate left and mild right neuroforaminal stenosis. At C7-T1, there is a small posterior disc osteophyte complex resulting in mild to moderate bilateral neuroforaminal stenosis and minimal spinal canal narrowing. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative cervical spondylosis most pronounced at C3-C4, where there is moderate central spinal canal stenosis, but no associated spinal cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Reason: evaluate sesamoid apparatus - rule out AVN History: pain at medial and lateral sesamoids left A skin marker was placed along the plantar aspect of the first MTP joint presumably corresponding to the patient's area of concern. Note is made of increased bone marrow signal abnormality within the medial sesamoid of the first MTP joint with corresponding decreased signal abnormality and T1-weighted images. These findings appear most consistent with a sesamoiditis. There is inflammatory change in the surrounding soft tissues. The lateral sesamoid is normal in appearance. No additional bone marrow signal abnormality is identified. The flexor and extensor tendons appear intact. There is a moderate amount of fluid within the first MTP joint with low signal intensity debris internally suggesting a synovitis. The remainder of the visualized soft tissues are unremarkable.

Output: Findings indicating a sesamoiditis affecting the medial sesamoid of the first MTP joint as well as a synovitis of the first MTP joint.


Instruction: Generate impression based on findings.

Input: History of cirrhosis and multiple liver lesions, evaluate for hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour compatible with cirrhosis with diffuse reticular T2 hyperintensity compatible with fibrosis. There are multiple subcentimeter nodules some of which demonstrate subtle arterial enhancement and others of which demonstrate subtle intrinsic T1 hyperintensity compatible with regenerative and siderotic nodules. An example arterially enhancing nodule in segment 8 measures 10 mm (series 901, image 382), unchanged. The previously described arterially enhancing anterior segment 3 lesion is not well-visualized on this examination. None of the lesions demonstrate definite washout on delayed images. The hepatic vasculature remains patent. No biliary ductal dilatation. There is once again trace perihepatic ascites.SPLEEN: Splenomegaly with spleen measuring up to 16.6 cm in the craniocaudal dimension, similar to prior.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver with multiple siderotic and regenerative nodules without suspicious features at this time.


Instruction: Generate impression based on findings.

Input: Female, 67 years old, with increasing seizures and headaches. Atrophy with diffuse abnormal T2 hyperintensity is again seen involving the right parietal, occipital and temporal lobes, appearing similar to the prior examination. In particular, the right hippocampus is atrophic but this finding is unchanged. The volume of the left cerebral hemisphere is preserved. Relatively mild patchy periventricular T2 hyperintensity is seen, also similar to prior. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. No parenchymal edema or mass effect is seen. The ventricular system is stable in size.

Output: 1.No significant interval change in the pattern of atrophy and associated gliosis involving the right parietal, occipital and temporal lobes. In particular, the right hippocampus is atrophic but this finding is also unchanged.2.No new intracranial findings are identified to account for the patient's worsening symptoms.


Instruction: Generate impression based on findings.

Input: 55-year-old male with a history of acute onset left arm weakness, prior c-spine imaging suspect for C5 cord compression. Patient motion severely limits evaluation of fine details, making evaluation for cord signal abnormality impossible. The cervical vertebral bodies are appropriate in overall alignment and height. There is straightening of the cervical curvature present. There is multilevel disk dessication present. At C2-3 there is a small disk bulge but no significant compromise to the spinal canal or neural foramina. At C3-4 there is a disk bulge present which causes effacement of spinal fluid ventral and posterior to the spinal cord and mild flattening of the spinal cord. There is some narrowing of the neural foramina at this level.At C4-5 there is a disk bulge present associated with effacement of spinal fluid ventral and posterior to the spinal cord and mild flattening of the spinal cord.At C5-6 there is a disk bulge but no significant compromise to the spinal canal or neural foramina. At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The left vertebral artery is very small. Partially visualized multifocal foci of encephalomalacia of the pons which has been characterized on prior Brain MRIs.

Output: 1.Patient motion severely limits evaluation of fine details, making evaluation for cord signal abnormality impossible.2.Redemonstrated are stable disk bulges at C3-4 and C4-5 with moderate spinal stenosis (worse at C3-4).


Instruction: Generate impression based on findings.

Input: 41 year old with history of right lumpectomy in 2007 for invasive ductal carcinoma. Patient received radiation and chemotherapy. Recent mammogram showed an area of asymmetry in the left upper outer quadrant. Mild parenchymal enhancement is noted bilaterally. Scattered fibroglandular elements are noted. Bilateral cysts, left greater than right are noted. Post-surgical distortion in the right outer breast is again seen. No suspicious enhancement is seen in either breast. At the area of concern from the mammogram, a few cysts are present, but no suspicious enhancing lesion is seen. Expected thin rim enhancement around the right breast lumpectomy site is present. There are a few scattered enhancing foci and a 3 mm skin lesion on the inferior left breast but none of these findings are uniquely suspicious. No abnormal axillary lymph nodes are identified in either axillary region. A probable sebaceous cyst is noted in the intermammary cleft.A high T2 signal lesion in the liver is likely a cyst or otherwise another benign lesion such as a hemangioma.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 86-year-old male with history of MI with profound short-term memory loss. Expansile mass is present within the sella, which was better characterized on prior brain MRI study, as a pituitary macroadenoma. There is no evidence of intracranial hemorrhage, mass or edema. 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: No acute abnormality or interval change.


Instruction: Generate impression based on findings.

Input: Female 67 years old Reason: evaluate etiology posterior lateral knee pain History: ?ganglion MENISCI: Although we see no discrete tear of the lateral meniscus there is diffuse increased signal intensity within the root of the posterior horn which could reflect mucoid degeneration and/or degenerative tearing. There are small cysts and mild edema-like signal in the underlying intercondylar eminence. There is also intrasubstance degeneration involving the body of the lateral meniscus. There is abnormal signal intensity within the body of the medial meniscus extending to the tibial articular surface likely representing degenerative tearing. Anterior and posterior horns appear intact.ARTICULAR CARTILAGE AND BONE: There is near-full-thickness to full-thickness degeneration of the articular cartilage femoral trochlea inferiorly extending along the anterior aspect of the lateral femoral condyle with cyst formation in the underlying subchondral bone. There is relatively mild degeneration of the cartilage of the patella particularly along the medial facet. There is also cyst formation along the posterior aspect of the medial femoral condyle with mild degeneration of the overlying articular cartilage.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Osteoarthritis most severely affecting the femoral trochlea.2.Tear of the body of the medial meniscus and increased signal intensity at the root of the posterior horn of the lateral meniscus which may reflect additional degeneration/degenerative tearing.3.Soft tissue edema including edema along the medial head of the gastrocnemius which may reflect rupture of prior Baker's cyst.4.Other findings as above.


Instruction: Generate impression based on findings.

Input: Recurrence of pain following relief of symptoms for approximately 8 months following vertebroplasty at L5 and RF ablation of metastatic renal cell carcinoma with painful compression fracture of L2. There are postoperative findings related to vertebroplasty of a compression fracture at L5 and RF ablation of metastatic renal cell carcinoma with compression fracture of L2. There has been interval increase in size of an intermediate T1 and high T2 signal lesion in the left posterior vertebral and pedicle of L2, resulting in marked spinal canal stenosis, in which the cauda equina nerve roots are compressed. There is no significant interval change in the treated L5 vertebra with mild loss of height and high T2 signal surrounding the cement. There is also no significant interval change in the L1 compression fracture with approximately 50 % loss of height. There is a probable small hemangioma in the T6 vertebral body. There are mild superior endplate depressions at T3 and T5. The rest of the vertebral body heights are intact and the alignment is unchanged. There are mild degenerative spondylitis changes in the lumbar spine without associated significant spinal canal or neural foraminal narrowing. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. The right kidney is absent.

Output: Postoperative findings related to vertebroplasty of a compression fracture at L5 and RF ablation of metastatic renal cell carcinoma with compression fracture of L2, with interval increase in size of tumor involving the eft posterior vertebral and pedicle of L2, which results in marked cauda equina nerve root compression. Otherwise, no significant interval change in the L1 and L5 compression fractures, as well as the mild superior endplate depressions at T3 and T5. Assessment for tumor is otherwise limited without contrast.


Instruction: Generate impression based on findings.

Input: 43 years Female (DOB:1/11/1973)Reason: r/o aneurysm History: new onset headache with pulsatile swishing in earsPROVIDER/ATTENDING NAME: SANDRA NAAMAN SANDRA NAAMAN MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. The temporal horn of the right lateral ventricle is larger than the temporal horn of the left lateral ventricle.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain: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. There is triplication of the anterior cerebral artery. The posterior communicating arteries are small. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm or arteriovenous malformation. Please note that MR angiography is as sensitive as conventional angiography in detection of dural arteriovenous fistula.3.Asymmetry in the size of the temporal horns of the lateral ventricles is a nonspecific finding which could relate to a small cyst in the temporal horn. This could also be considered a variation of normal. The underlying hippocampi appear to be similar in volume on visual inspection.


Instruction: Generate impression based on findings.

Input: 64 old female with witnessed partial seizure (new onset). Evaluate for bleed. Hypodense region in the left posterior parietal and left occipital lobes with no significant mass effect or volume loss concerning for a subacute infarct. MRI is recommended for further evaluation. Subcortical and periventricular white matter diffuse hypodensities consistent with small vessel ischemic disease of indeterminate age.There is no evidence of intracranial hemorrhage, mass or edema. 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- Left posterior parietal and occipital lobes hyperdense the concerning for subacute infarct. MRI is recommended for further evaluation.2- Small vessel ischemic disease of indeterminate age.These findings were communicated to Dr. Christopher Chapman via phone at 10:50am.


Instruction: Generate impression based on findings.

Input: Bladder cancer and hip pain The examination is limited by motion artifact.There is abnormal marrow signal intensity involving the acetabulum posteriorly which extends into the anterior column as well. These findings are concerning for metastatic involvement. Evaluation for soft tissue component is limited absent intravenous contrast. Abnormal marrow signal is also evident within the inferior pubic ramus relating to a nondisplaced fracture. There is a mild amount of soft tissue edema surrounding both of these sites.Osteoarthritis affects the hips with a small amount of joint fluid present on the right.

Output: Abnormal marrow intensity involving the right acetabulum consistent with malignant involvement. Abnormal signal intensity also involves the inferior pubic ramus where a nondisplaced, presumably pathologic fracture is present.


Instruction: Generate impression based on findings.

Input: Male, 21 years old, with syncope. Assess for structural lesions. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. An incidental, subcentimeter pineal cyst is detected.On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected.Signal intensity of the bone marrow is unremarkable. A small mucus retention cyst is noted in the right maxillary sinus.

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Hand tremors. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is a small left maxillary retention cyst. There is a right globe prosthesis and implant.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 9 years Female (DOB:7/29/2006)Reason: 9 yo with catatonia abnormal EEG activity. History: seizures, abnormal EEG activityPROVIDER/ATTENDING NAME: JAMES H TONSGARD JAMES H TONSGARD The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No intracranial mass lesions or other abnormalities are appreciated to explain the patient's EEG abnormalities.


Instruction: Generate impression based on findings.

Input: Reason: Hx of chronic pancreatitis, pancreatic pseduocyst History: Pancreatic pseudocyst. ABDOMEN:LIVER, BILIARY TRACT: Mild hepatic steatosis. Tiny punctate hepatic cysts in the right lobe of the liver. No suspicious focal hepatic lesion. No intrahepatic or extra hepatic biliary ductal dilatation. Post surgical changes of a cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas. Nonenhancing foci within the pancreas correlate with calcifications seen on outside CT. Pancreatic duct is mildly dilated measuring 4 mm. Multiple cystic lesions within the pancreas. The largest is multiloculated in the pancreatic body and measures approximately 1.6 x 3.8 x 2.1 cm (series 4 image 26, series 2 image 40), increased in size compared to outside CT. This lesion communicates proximally and distally with the pancreatic duct compatible with a main branch IPMN. Smaller pancreatic tail cystic lesions are also not significantly changed. These cystic lesions also appear to communicate with the pancreatic duct and likely represent side branch IPMN's. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Additional cystic lesion adjacent to the pancreatic head measures 1.9 x 1.9 x 1.8 cm (series 4 image 32, series 2 image 43) and correlates with duodenal diverticulum on outside CT. BONES, SOFT TISSUES: Postsurgical changes of a sternotomy, which results in artifact on some sequences.OTHER: No significant abnormality noted.

Output: 1.Multiple pancreatic cystic lesions that appear to communicate with the pancreatic duct, which is mildly dilated. The largest in the pancreatic body has increased in size compared to prior outside CT and communicates proximal and distally with the pancreatic duct compatible with a main duct IPMN. Smaller lesions in the tail are likely side branch IPMN's.2.Chronic pancreatitis.3.Duodenal diverticulum. 4.Discussed with Dr. Waxman.


Instruction: Generate impression based on findings.

Input: Female, 17 years old, with pain/pressure in the left buttock, status post discectomy May 2015. Spinal alignment is within normal limits. Vertebral body heights are maintained. Bone marrow signal intensity is within normal limits. The visualized spinal cord, conus and cauda equina demonstrate normal signal intensity and morphology. L1-2: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. L2-3: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. L3-4: Moderate facet hypertrophy. Mild disc bulging with a small right paracentral protrusion. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L4-5: Evidence of laminotomy on the left. Severe facet hypertrophy. Small defect in the left paracentral disc may reflect a prior treated herniation. There may be a tiny right paracentral protrusion with mild disc bulging and loss of disc T2 signal. No significant generalized spinal canal stenosis. Mild foraminal narrowing. L5-S1: Facet hypertrophy, severe on the left. Mild bulging disc. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing.

Output: 1.Evidence of laminotomy on the left at L4-5 compatible with the surgical history.2.Disc degeneration at L4-5 but without significant spinal canal stenosis or foraminal compromise.3.Relative mild disc disease at other levels. However, advanced facet arthropathy is seen at L4-5 and L5-S1.


Instruction: Generate impression based on findings.

Input: 74-year-old female history of CAD and S/P CABG presents with acute SOB evaluate for stroke On image 19, a small focal hypoattenuation adjacent to the right Sylvian fissure most likely due to technique difference from prior. If acute ischemic infarction is concerned, MRI exam is recommended.The images re-demonstrate chronic ischemic infarction in the right basal ganglia and the left thalamus as well as periventricular white matter small vessel disease. There is no evidence of intra-or extra axial fluid collection/hemorrhage, mass or edema.The ventricles and basal cisterns are normal in size and configuration for the patient's stated age.The calvaria and skull base are radiographically normal. Visualized paranasal sinuses and mastoid air cells are normally pneumatized. Calcified atherosclerotic disease of the vertebrobasilar system and internal carotid arteries is noticed.

Output: Small vessel ischemic disease and chronic ischemic infarction with no evidence of acute intracranial hemorrhage/ischemic change.