Instruction: Generate impression based on findings.

Input: For the purposes of numbering there are 5 lumbar type vertebral bodies. Vertebral body heights are maintained. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. There is grade 1 anterolisthesis of L5 on S1, grade 1 retrolisthesis of L3 on L4, grade 1 retrolisthesis of L2 on L3, and minimal retrolisthesis of L1 on L2. The visualized intra-abdominal and paraspinal contents are unremarkable.Degenerative changes are seen, with individual levels as below:T12/L1: There is no spinal canal or neural foraminal narrowing.L1/2: There is a mild disc bulge. No significant spinal canal narrowing. There is mild bilateral neural foraminal narrowing.L2/3: There is disc bulge with minimal spinal canal narrowing and mild bilateral neuroforaminal narrowing, right greater than left. There is mild facet hypertrophy.L3/4: There is a disc bulge with mild spinal canal narrowing. There is mild bilateral neuroforaminal narrowing, right greater than left. There is facet hypertrophy.L4/5: There is a disc bulge and bilateral facet arthropathy. No significant spinal canal narrowing. There is severe right and moderate to severe left neural foraminal narrowing.L5/S1: There is bilateral L5 spondylolysis with grade 1 anterolisthesis of L5 on S1. Advanced bilateral facet arthropathy. No spinal canal narrowing. Moderate to severe bilateral neural foraminal stenosis.

Output: 1. Multilevel degenerative changes. No high grade spinal canal stenosis.2. There is bilateral L5 spondylolysis with grade 1 L5-S1 spondylolisthesis. Additional levels of spondylolisthesis as above.3. Moderate to severe neural foraminal stenosis at L4-5 and L5-S1 bilaterally as detailed above. 4. Advanced facet arthropathy in the lower lumbar spine.


Instruction: Generate impression based on findings.

Input: Male 82 years old Reason: IPMN, re-evaluate size History: IPMN, re-evaluate size ABDOMEN:LIVER, BILIARY TRACT: Several tiny T2 hyperintensities within the liver likely represent cysts.SPLEEN: No significant abnormality noted.PANCREAS: Again seen is a cystic lesion in the uncinate process measuring approximately 0.9 cm (series 3, image 27) unchanged from prior study where it measured 0.9 cm. This likely represents an IPMN. The pancreatic duct is mildly prominent measuring up to 4 mm but is unchanged compared to prior studies.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.

Output: 1.Again seen is a cystic focus in the uncinate process of the pancreas not significantly changed compared to prior studies and likely representing an IPMN.2.Stable mild prominence of the pancreatic duct.


Instruction: Generate impression based on findings.

Input: 37 years, Male, Reason: Eval grade II astrocytoma. Pt has NOT had RT. Please compare to most recent scan as well as back to postop scan. History: grade 2 astrocytoma.. Again seen are postsurgical changes of left frontal craniotomy for tumor resection. Compared to examinations from 9/10/2014 and 5/24/2013, there is gradually progressive increase in T2 hyperintensity surrounding the left superior frontal gyrus resection cavity extending to the left frontal horn. There is also a new nodular focus of enhancement measuring approximately 6 x 6 x 11 mm along the lateral aspect of the resection cavity, not present on prior study from 9/10/2014.No significant intracranial mass effect. Remainder of the brain parenchyma is unremarkable. No new sites of tumor. There is unchanged ex vacuo dilatation of the left frontal horn. Ventricles are otherwise normal in size. No evidence of acute ischemia or hemorrhage. Calvarium and extracranial soft tissues are also unremarkable.

Output: Compared to prior examinations from 9/10/2014 and 5/24/2013 there is evidence of gradual increase in T2 hyperintensity surrounding the left superior frontal gyrus resection cavity and extending to the left frontal horn. There is also interval development of a new 6 x 6 x 11 mm enhancing nodule along the lateral aspect of the resection cavity. These findings are concerning for gradual tumor progression, especially in the absence of radiation therapy.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with right-sided weakness, concern for ischemia. A small focus of T2 hyperintensity and susceptibility is seen within the left paracentral lobule. T2 hyperintensity and encephalomalacia is also evident more inferiorly along the left postcentral gyrus. In the adjacent left corona radiata, there is a subcentimeter triangular region of T2 hyperintensity with corresponding hyperintense signal on diffusion but no convincing ADC correlate.Elsewhere in the brain, a few scattered very small foci of T2 hyperintensity are seen within the cerebral white matter, a nonspecific finding. No evidence of significant parenchymal edema or mass effect is seen. No evidence of acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricular system is normal in size and morphology.

Output: 1.Lesions within the left paracentral lobule and left postcentral gyrus are most compatible with small areas of chronic cortical infarction.2.A small region of diffusion signal abnormality within the left corona radiata does not show convincing ADC correlation and may therefore represent T2 shine through artifact from a chronic ischemic insult. This could also, however, reflect late subacute nearly resolved ischemia.


Instruction: Generate impression based on findings.

Input: 21-year-old male with a history of Rosai Dorfman and status post chemotherapy. RIGHT LOBE MEASUREMENTS: 1.5 x 1.2 x 5.2 cmLEFT LOBE MEASUREMENTS: 1.6 x 1.3 x 4.3 cm.ISTHMUS MEASUREMENTS: 3.8 mmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: Anterior, slightly hypoechoic round mass measuring 0.5 cm in diameter likely represents small thyroid nodule.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Bilateral lymphadenopathy right greater than left. The largest measures 1.2 x 0.5 x 2.0 cm.OTHER: No significant abnormality noted.

Output: Bilateral lymphadenopathy right greater than left.


Instruction: Generate impression based on findings.

Input: One month old male with large soft tissue mass on right head and history of sepsis. Examination of intracranial content demonstrates normal morphology and density of brain parenchyma. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits. There is complete opacification of the left middle ear cavity and mastoid air cells. These findings represent otitis media. Right mastoid air cells and middle ear cavity cavity are well pneumatized and are unremarkable.Bony density of calvarium demonstrates some periosteal thickening in the right posterior parietal in region of large soft tissue abnormality of the scalp that was noted on clinical exam. No definitive evidence of abnormal enhancement is detected. No definitive evidence of any cavity formation is present. Although possibility of infection cannot be entirely ruled out possibility an old sub periosteal hemorrhage should also be considered. No definitive evidence of any edematous changes of the adjacent subcutaneous fat is detected. There is no evidence of any abnormality of the inner table of the skull or the marrow space. Further evaluation with an infused MRI is recommended.

Output: 1.Unremarkable CT examination of intracranial content.2.Left otitis media.3.Large low-density mass like lesion involving right posterior parietal scalp with irregularity of the outer cortex and periosteum of the parietal lobe as detailed above.4.Further evaluation with an infused MRI of brain is recommended.


Instruction: Generate impression based on findings.

Input: 65-year-old woman with history of colon cancer and seizures. MR brain attempted on 11/28/2016, not completed due to developing seizure. There is a punctate focus of diffusion restriction in the anterior limb of the left internal capsule (4/17) in the vascular distribution of an MCA perforator branch. There is no associated signal abnormality on T2 or FLAIR images. No evidence of surrounding edema or enhancement. There are no additional areas of diffusion restriction.A few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. The brain parenchyma is otherwise unremarkable for age and the medial temporal lobes appear normal.On postcontrast images, there are no foci of abnormal enhancement. There is no intracranial mass or mass effect. The sella is partially empty. The ventricles are within normal limits in size and configuration. The major flow-voids are preserved. There is a punctate focus of susceptibility artifact in the left occipital lobe without edema or enhancement, likely calcification or hemosiderin deposition.There is mild mucosal thickening of the right maxillary sinus, otherwise the paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1.No evidence of intracranial metastasis or acute hemorrhage.2.Punctate diffusion signal abnormality in the anterior limb of the left internal capsule which could represent an acute or subacute small vessel infarct of a left MCA perforator branch. This finding is of questionable clinical significance.


Instruction: Generate impression based on findings.

Input: Weakness. There is restricted diffusion and high T2 signal diffusely within the left caudate nucleus and putamen, as well as smaller gyriform areas of high T2 signal and restricted diffusion in the left anterior temporal lone, left superior frontal lobe, left occipital lobe, left cerebellar hemisphere, and right hippocampus and parietal lobe. There is a background of diffuse cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or mass. There is mild diffuse cerebral volume loss. 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 nonspecific fluid within the bilateral mastoid air cells. There is mild diffuse paranasal sinus mucosal thickening. There are bilateral lens implants.

Output: Acute infarcts in multiple bilateral cerebral hemisphere vascular territories, most extensively involving the left basal ganglia, as well as in the left cerebellar hemisphere, superimposed upon a background of probable chronic small vessel ischemic white matter disease.


Instruction: Generate impression based on findings.

Input: 64-year-old male with concern for reactive arthritis. Evaluate for sacroiliitis. BONE MARROW: There is evidence of marrow replacement.SOFT TISSUES: The soft tissues, including the pelvic musculature appears normal. JOINTS: The sacroiliac joints appear normal and symmetric bilaterally with no evidence of narrowing, ankylosis or subchondral erosions. The hip joints appear normal bilaterally.ADDITIONAL

Output: No MRI findings suggest sacroiliitis.


Instruction: Generate impression based on findings.

Input: Reason: right C6-7 and left C7-T1 neural foraminal lesions History: weakness Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the right C6-7 neural foraminal lesion. Following needle removal images obtained demonstrate no complications.

Output: Right C6-7 neural foraminal lesion lesion fine needle aspiration under CT guidance.


Instruction: Generate impression based on findings.

Input: Clinical question: leg dystonia and memory and personality change. Signs and Symptoms: As above Pre and post enhanced brain MRI:Negative diffusion weighted series.There is a slight prominence of high convexity bilateral parietal cortical sulci for patient's stated age of 41.The signal intensity and anatomical morphology of the brain otherwise remains within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Post contrast images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Signal void of major intracranial arterial branches are identified and unremarkable.Signal intensity of intracranial venous sinuses is within normal and with normal pattern of enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.Pre- and post enhanced total spine MRI:Examination of cervical spine demonstrate normal signal intensity and caliber of cervical cord without abnormal enhancement.There is normal signal intensity and anatomical alignment of vertebral column without detectable abnormal enhancement.No significant degenerative disc disease, no spinal stenosis or neural foraminal compromise at any level is detected. Unremarkable perispinal soft tissues.Formation of the thoracic spine demonstrate normal signal intensity and anatomical alignment of vertebral column without abnormal enhancement. There is mild exaggeration of thoracic kyphosis. No significant degenerative disease or spinal canal compromise at any level is detected. There is also no convincing evidence of neural foraminal compromise at any level.The signal intensity and caliber of the thoracic cord is within normal and without detectable enhancement of the cord or the meninges.Examination of lumbosacral spine demonstrate normal anatomical alignment and signal intensity of vertebral column and without abnormal enhancement. No appreciable significant degenerative disease and no spinal stenosis or neural foraminal compromise at any level.Normal signal intensity and caliber of the lower most visualized thoracic spine and thoracic cord, conus and the cauda equina and without detectable abnormal enhancement.Unremarkable paraspinal soft tissues.

Output: 1.Brain MRI demonstrate slight symmetrical bilateral prominence of high convexity parietal cortical sulci for patient's stated age without detectable signal abnormality or enhancement. Unremarkable pre and post enhanced brain MRI otherwise as detailed.2.Pre- and post enhanced total spine MRI is unremarkable.


Instruction: Generate impression based on findings.

Input: 60 years, Male, recent diagnosis of multiple sclerosis. New INO. Looking for progression of disease. Brain: There is moderate burden of T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter with morphology and distribution compatible with known demyelinating disease. Relatively larger lesion is present in the posterior left frontal lobe. There are also multiple infratentorial lesions in the brainstem and cerebellar hemispheres. Lesions are also noted in the dorsomedial midbrain and upper pons including the region of the medial longitudinal fasciculus, particularly on the left which may explain patient's internuclear ophthalmoplegia.There is mild to moderate burden of T1 hypointense lesions. There is also mild parenchymal volume loss with mild thinning of the corpus callosum for age. There is no intracranial mass, mass effect, midline shift or herniation. No hydrocephalus.Cervical Spine: There are multiple T2 hyperintense lesions throughout the cervical cord with morphology and distribution consistent with known demyelinating disease. Relatively most prominent lesions are present at the C2 level involving the bilateral posterior aspects of the cord, right greater than left, as well as at the left ventrolateral C3-C4 level. There are additional small scattered lesions. Mild volume loss is present involving the dorsal cervical cord associated with the C2 lesions.Vertebral body heights and alignment in the cervical spine are normal. Minimal degenerative changes include small disc osteophyte complex, eccentric to the right at the C4-C5 level. There is no significant spinal canal stenosis at any level. Neural foramina are suboptimally evaluated due to motion degradation, but there does appear to be mild to moderate multilevel neural foraminal stenosis related to facet arthropathy and uncovertebral hypertrophy, relatively worse at the right C4-C5 level.

Output: 1. Multiple supra- and infratentorial lesions as described above with morphology and distribution consistent with known demyelinating disease. No prior examinations are available for comparison and addendum can be issued if made available.2. Multiple demyelinating lesions in the cervical cord as described above, comparison of which is not available.


Instruction: Generate impression based on findings.

Input: Right upper quadrant pain, retained stone on outside hospital study ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense focus in the left hepatic lobe, likely benign. The hepatic and portal veins are patent. Cholelithiasis. The common bile duct measures up to 11 mm. No evidence of choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonspecific enlarged porta hepatis lymph node measures 2.7 x 2.0 cm (series 601, image 27). Enlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Mildly dilated common bile duct without evidence of choledocholithiasis.2.Cholelithiasis.3. Nonspecific lymphadenopathy as described above.


Instruction: Generate impression based on findings.

Input: Low back pain with radiculopathy Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is disk desiccation and disk height loss. There is large disk extrusion with inferior migration to the lower S1 level. Extruded disc components appear contiguous without definite evidence of sequestration. There is effacement of the right lateral recess. No significant central canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Large L5-S1 disk extrusion with inferior migration to the lower S1 level. There is effacement of the right lateral recess which may be impinging on the traversing right S1 nerve root. No significant central spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Male; 34 years old. Reason: Concern for a dominant stricture History: PSC/pruritus ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Mild periportal increased signal intensity which may represent periportal edema versus inflammation is similar to prior exam. Multifocal areas of intrahepatic biliary stricturing and associated dilatation are redemonstrated, similar to prior exam. Again, the common duct is attenuated throughout its course, including a short focal stenosis at the ampulla. A short segment stenosis just distal to the confluence of the right and left intrahepatic duct is not significantly changed. The distal right and left intrahepatic ducts are again poorly visualized proximal to Klatskin's point, similar to prior exam. No new focal mass.Geographic T2 hypointense signal and heterogenous enhancement is likely related to chronic liver disease, similar to prior exam.SPLEEN: Stable moderate splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable prominent subcentimeter in short axis perihilar lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Multifocal intra-and extrahepatic biliary duct strictures are consistent with patient's history of primary sclerosing cholangitis and not significantly changed since prior study. No new focal mass.


Instruction: Generate impression based on findings.

Input: Male 60 years old Reason: hx of prostate cancer under active surveillance History: prostate cancer PELVIS:PROSTATE:Prostate Size: 4.0 x 5.7 x 5.2 cmPeripheral Zone: No significant abnormality noted.Central Gland: Enlarged and heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious lesion is identified.


Instruction: Generate impression based on findings.

Input: Strong family history of breast cancer, personal history of multiple benign breast biopsies, evaluate for high risk lesions There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a homogeneously enhancing benign morphology mass in the 2 o'clock position of the right breast, posterior depth, measuring 17 x 10 x 11 mm. This mass is a biopsy proven fibroadenoma and is unchanged in size. A biopsy clip is noted medially. There are 2 stable homogeneously enhancing benign morphology masses in the left breast, mid depth, measuring 9 x 7 x 7 mm in the 12 o'clock position and 6 x 5 x 5 mm in the 10 o'clock position. A biopsy clip is noted adjacent to the mass in the 10 o'clock position. No abnormal enhancement is noted in either breast. There are no abnormal lymph nodes.

Output: Stable benign morphology masses without MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: There is grade 1 anterolisthesis of L3 on L4. There is increased T2 signal intensity in the bilateral L3 pars, which raises concern for a pars fracture. There is also increased T1 signal in the bilateral pars, which may be related to associated fatty change. There is disc desiccation at L3-L4 through L5-S1. The conus is normal in signal and morphology and terminates at the L2 level. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: No significant spinal canal or neuroforaminal narrowing.L1/2: No significant spinal canal or neuroforaminal narrowing.L2/3: No significant spinal canal or neuroforaminal narrowing.L3/4: There is a left paracentric disc extrusion with 1.5 cm of cranial migration. No sequestration. There is resultant partial effacement of the left lateral recess. There is moderate left neuroforaminal narrowing with possible impingement of the L3 nerve root and mild right neuroforaminal narrowing. There is mild facet arthrosis. There is minimal spinal canal narrowing at this level.L4/5: There is minimal central disc protrusion without significant spinal canal or neuroforaminal narrowing. L5/S1:No significant spinal canal or neuroforaminal narrowing.

Output: 1.Grade 1 anterolisthesis of L3 on L4 with left paracentric disc protrusion and cranial migration of left paracentric disc extrusion with resultant partial effacement of the left lateral recess, moderate left neural foraminal narrowing, and mild right neuroforaminal narrowing. No significant spinal canal or neural foraminal stenosis is seen in the remainder of the lumbar spine.2.Findings of possible pars fractures at L3, which can be better evaluated on CT.


Instruction: Generate impression based on findings.

Input: 67 year-old female with seizure today. No history of seizure. History of CVA and encephalopathy, mental retardation. There is no evidence of intracranial hemorrhage, mass or edema. Extensive carotid calcification. Dystrophic calcifications within the bilateral basal ganglia. Multiple hypodensities in periventricular distribution consistent with extensive small vessel disease, age indeterminate. Multifocal old cerebellar strokes. No evidence of supratentorial cortical stroke. If there is clinical concern for acute ischemia an MRI may be considered. Prominent sulci with proportionally enlarged ventricles.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Liver lesion thought to be hemangioma. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size, measuring 20.9 cm in craniocaudal dimension. Left hepatic dome lesion measuring 2.5 x 2.5 cm (series 6/11). The lesion has a lobular contour and is hyperintense on T2-weighted imaging. There is peripheral nodular discontinuous enhancement on postcontrast imaging which gradually fills in.No additional suspicious liver lesion. No biliary ductal dilatation. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Note is made of focal subsegmental consolidation in the right lower lobe.

Output: Left hepatic dome 2.5 cm lesion is compatible with a benign hemangioma.Focal subsegmental consolidation in the right lower lobe, likely related to prior infection/inflammation.


Instruction: Generate impression based on findings.

Input: 40 years Female (DOB:10/5/1975)Reason: interval change History: Lhermitte'sPROVIDER/ATTENDING NAME: ANTHONY T REDER ANTHONY T REDER MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of patchy T2 and FLAIR hyperintense lesions located in the periventricular white matter as well as the T2 and FLAIR hyperintense foci in the left cerebral peduncle, the left superior cerebellar peduncle and along the anterior medial medulla. There are a few punctate lesions present in the right cerebellar hemisphere which were also present on the prior exam. The lesion along the medulla appears to have increased in extent and now extends down into the cervical spinal cord. The other lesions appear to be relatively stable.Findings raise the question of possible lesion in the left optic nerve at the canalicular segment. It is not clear whether this was present on the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There are patchy ill-defined lesions located within the cervical spinal cord at the C1 level, the C3 to level, the C3-C4, C5, C6, C7 and the visualized upper thoracic levels. These lesions appear to be predominantly along the near midline aspects of the cervical spinal cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.There is a disc bulge at T1-T2.The vertebral artery flow voids appear to be intact.

Output: 1.Since the prior exam the lesion located in the medulla has extended inferiorly into the upper cervical spinal cord.2.There are multiple lesions scattered in the supratentorial and infratentorial brain as well as the cervical spinal cord as detailed above which are concerning for demyelinating process.


Instruction: Generate impression based on findings.

Input: Hb-SS disease without crisis [282.61] / Unspecified disorder of eye movements [378.9], Reason for Study: ^Reason: etiology of abnormal eye movements, hyperreflexia History: abnormal eye movements, hyperreflexia (HbSS patient) C-Spine:The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal.T-Spine and L Spine:There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the L1-L2 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass.

Output: Normal Cervical, Thoracic and Lumbar spine MRI.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The imaged spinal cord displays normal signal and morphology with the conus terminating at L2 . There is no evidence of filar thickening or fibrofatty infiltration and there is normal anterior translation of the conus upon prone positioning. The paravertebral soft tissues are unremarkable. There is a large amount stool in the colon.

Output: No evidence of tethered cord.


Instruction: Generate impression based on findings.

Input: Back pain, history of tethered cord repair. Prior lipomyelomeningocele. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. There are postsurgical changes in the lower lumbar spine related to lipomyelomeningocele repair and tethered cord release. Deficiency involving the posterior elements likely reflects combination of surgical change and dysplasia. Conus is low lying terminating at the mid to lower L4 level. There is an intradural lipoma along the posterior aspect of the distal cord measuring up to 11 x 13 in the axial plane and approximately 5.4 cm in the craniocaudal dimension. No other masses within the lumbar spinal canal. There is no evidence of syrinx or other signal abnormality within the cord. There are degenerative changes primarily consisting of moderate facet arthropathy in the lower lumbar spine at the L4-L5 and L5-S1 levels, particularly on the right with small adjacent synovial cysts. There are minimal disc bulges as well as a tiny central protrusion at the L4-L5 level. There is no significant spinal canal stenosis at any level. There is minimal narrowing of the bilateral L4-L5 neural foramina. Neural foramina are otherwise patent.

Output: Postsurgical changes related to prior lipomyelomeningocele repair and tethered cord release. Conus terminates at the inferior L4 level and is associated with an intradural lipoma in its posterior aspect. There is absence of ventral motion of the conus on the prone sequences which can be seen with re-tethering in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of unspecified site [C79.9] / Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: hx of metastatic melanoma with know brain mets s/p WBRT History: as above Previously seen multifocal various sized supra and infra tentorial enhancing lesions are again seen but with significant size reduction since prior scan. For example, the right frontal middle frontal gyrus lesion was 13.5mm x 9.2mm, now 7.4mm x 3.5mm; the left inferior frontal gyrus par opercularis lesions was 17.1mm x 18mm, now 10.4mm x 13.5mm.There is no new enhancing lesion seen on this scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Overall interval decrease in size of multiple enhancing metastatic lesions as described above.2. There is no evidence of new enhancing lesion on this scan.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate intracranial process. Signs and symptoms: Weakness Non-enhanced CT brain:The examination demonstrates an extra-axial high density mass in the basal cistern measuring approximately 13.8 mm x 14.5-mm on sagittal reformatted image 26. On axial image 7 this mass measured 8 mm in the AP axis and 12.5 mm in transverse axis. The mass is in contact with dorsum sella and minimal apparent extension into the sella. The appearance of the lesion is suggestive of a meningioma considering its location and density on CT. Other differential diagnosis of pituitary macroadenoma, craniopharyngioma and very less likely aneurysm should be considered. This finding requires further dedicated MRI examination of pituitary region for better evaluation. This finding is not associated with any associated adjacent brain parenchyma abnormality.There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift.There are small foci of low attenuation in the subcortical white matter of bilateral cerebral hemispheres which are nonspecific however it could represent minimal small vessel disease. The cortical sulci and ventricular system are more pronounced than is expected for patient's stated age of 69. Similar observation of the folia of the cerebellum is also made.Calvarium is intact. Mastoid air cells, middle ear cavities and visualized paranasal sinuses are unremarkable.

Output: 1.No evidence of acute intracranial finding.2.Minimal small vessel disease of indeterminate age.3.Well demarcated high-density mass in the basal cistern with minimal extension into the sella as described. Differential diagnosis of meningioma, craniopharyngioma, pituitary macroadenoma should be considered. Follow-up with a dedicated MRI of pituitary region is recommended.


Instruction: Generate impression based on findings.

Input: Reason: assess for meniscal tear, ligamentous History: L. knee locking, giving away MENISCI: The lateral meniscus appears intact. The medial meniscus appears intact. No fluid-filled tear is evident.ARTICULAR CARTILAGE AND BONE: There is partial-thickness articular cartilage degeneration along the medial facet of the patella. Otherwise no full-thickness or near full-thickness articular cartilage defects are identifiedLIGAMENTS: The cruciate and collateral ligaments otherwise appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Articular cartilage degeneration affecting the patellofemoral articulation. No evidence of a meniscal tear.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for acute abnormality. Signs and symptoms: Worsening chronic neck pain with soft tissue inflammation at the base of neck. Nonenhanced cervical MRI:Examination demonstrates no evidence of fracture or malalignment.Normal signal intensity and caliber of cervical cord.Unremarkable foramen magnum.C2-C3 is unremarkable.C3-C4 is unremarkable.C4-C5 is unremarkable.C5-C6 demonstrate mild degenerative changes, tiny right median disc protrusion (axial T2 series 701 image 10) results in subtle flattening deformity of the ventral aspect of the cord. No detectable signal abnormality of the cord. No convincing evidence of spinal stenosis or neural foraminal compromise.C6-C7 demonstrate advanced disc disease and significant loss of disc height, moderate (left greater than right) neural foraminal compromise and no central spinal stenosis.C7-T1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.Nonenhanced thoracic MRI:Examination demonstrates no detectable fracture or malalignment.The signal intensity of vertebral column is unremarkable.The signal intensity and caliber of thoracic cord is unremarkable.Examination at T7-T8 demonstrate a right lateral small disc protrusion resulting in subtle flattening deformity of right lateral aspect of the cord without detectable cord signal abnormality, spinal stenosis or neural foraminal compromise.At T8-T9 there is also evidence of a right lateral disc protrusion without mass effect on the cord, spinal stenosis or neural foraminal compromise and with normal signal intensity of the cord.Unremarkable images at other levels and without intravenous or spinal stenosis or neural foraminal compromise. No detectable perispinal soft tissue abnormalities.

Output: 1.Nonenhanced MRI of cervical spine demonstrate advanced degenerative disc disease at C6/C7, tiny right perineum disc protrusion at C5-C6, no spinal stenosis or neural foraminal compromise at any level and no detectable paraspinal soft tissue abnormalities. There is normal signal intensity and caliber of cervical cord.2.Nonenhanced MRI of the thoracic spine demonstrate normal signal intensity of the vertebral column, cord and the perispinal soft tissues. No spinal stenosis or neural foraminal compromise at any level. Small right lateral disc protrusions at T7-T8 and T8-T9 levels as detailed.


Instruction: Generate impression based on findings.

Input: 26-year-old male with recurrent dislocation of the patella. Evaluate for loose ligaments of the patella or internal derangement. MENISCI: There is branching linear signal abnormality within the posterior horn of the medial meniscus which extends to the tibial and femoral articular surface consistent with a complex tear with both the vertical and horizontal component which extends into the body of the meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a near full-thickness articular cartilage fissure along the knee medial facet of the patella, centrally. There is also a near full-thickness to full-thickness articular cartilage fissure along the lateral facet of the femoral trochlea, centrally. There is increased signal abnormality within the medial aspect of the patella consistent with the stated history of transient patellar dislocation. The medial retinaculum appears intact. Findings suggestive of mild femoral trochlear dysplasia. There are medial and lateral compartment osteophytes.LIGAMENTS: There is complete rupture of the ACL. The PCL appears intact. The MCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact. The Insall-Salvati ratio is 1.5 consistent with patella alta. ADDITIONAL

Output: 1. Rupture of the ACL.2. Complex tear of the medial meniscus.3. Findings suggestive of patellofemoral instability as described above.4. Articular cartilage fissures as described above.


Instruction: Generate impression based on findings.

Input: VHL with pre-existing brain and spine hemangioblastomas. Brain: There are multiple subcentimeter enhancing lesions in the posterior fossa, including the medulla and cerebellum, some of which display associated edema. There is no evidence of intracranial hemorrhage or acute infarct. There is unchanged mildly prominent sulcus in the superior let parietal lobe. The supratentorial brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is diffuse paranasal sinus mucosal thickening. The retropharyngeal lymph nodes appear unchanged.Thoracic Spine: There is an unchanged enhancing lesion in the posterior spinal cord at the T10-11 level that measures up to 5 mm, with extensive surrounding edema. There are punctate enhancing lesions at the T2 and T6 levels. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. There are multiple bilateral complex renal cystic lesions. There are also multiple pancreatic cystic lesions.

Output: 1. No significant interval change in the posterior fossa hemangioblastomas.2. No significant interval change in the spinal cord hemangioblastomas.3. Multiple bilateral renal cyst lesions, some of which may represent renal cell carcinoma. Please refer to the prior body MRI for additional details.4. Multiple pancreatic cystic lesions. Please refer to the prior body MRI for additional details.


Instruction: Generate impression based on findings.

Input: Has left vocal cord paralysis, elevation of left hemidiaphragm, and left injection pharyngoplasty. History of polymyositis. There are findings related to left thyroplasty and pharyngoplasty. The neck musculature otherwise appears to have normal bulk and signal characteristics. There is no evidence of mass lesions or significant lymphadenopathy in the neck. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable.

Output: Findings related to left thyroplasty and pharyngoplasty, but no evidence of mass lesions or inflammatory process in the neck.


Instruction: Generate impression based on findings.

Input: Female 36 years old with left shoulder pain. ROTATOR CUFF: There is thickening of the supraspinatus tendon and a small interstitial tear measuring 2 mm in AP dimension (series 7, image 22 and series 5, image 14). The infraspinatus, teres minor and subscapularis tendons are intact.There is a small amount of fluid in the subacromial subdeltoid bursa and extending to the acromioclavicular joint.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Within the limits of a non arthrogram exam, the glenoid labrum is grossly intact. There is cystic change beneath the spinous tendon insertion otherwise, bone marrow signal intensity is within normal limits. The articular cartilage is intact.BICEPS TENDON: The biceps tendon is normal in appearance and situated within the biceps groove. ADDITIONAL

Output: 1.Supraspinatus tendinopathy and small interstitial tear.2.Fluid within the subacromial subdeltoid bursa may be seen in bursitis.


Instruction: Generate impression based on findings.

Input: Progressive multiple sclerosis. Worsening lower extremity weakness. Cervical: Artifacts and slight differences in technique make assessment difficult however compared to 10/13/2012, there appears to be increase in patchy T2 signal abnormality in the cervical cord at the C2 level as well as in the mid to lower cervical cord extending into the thoracic cord. Vertebral body heights are maintained. There is minimal retrolisthesis of C5 on C6. Alignment is otherwise maintained. There is mild spinal canal stenosis at the C6-C7 level. No high-grade spinal canal stenosis. There is mild to moderate left C4-C5, moderate left greater than right C5-C6, and moderate left and mild right C6-C7 neural foraminal stenosis related to uncovertebral hypertrophy.Thoracic: No recent thoracic MRI is available for comparison but compared to 10/13/2012, there appears to be interval increase in patchy areas of T2 hyperintensity in the upper, mid, and distal thoracic cord. Although slight differences in technique limit comparison, overall findings are suspicious for progression. There is T2 hyperintensity involving the ventrolateral aspects of the cord suggesting Wallerian degeneration along the lateral corticospinal tracts. Artifacts on the post gadolinium sequences limits assessment, but there is suggestion of mild enhancement in the distal thoracic cord, sagittal series 19 image 11.Vertebral body heights and alignment in the thoracic spine are normal. No significant spinal canal or neural foraminal stenosis is appreciated. Bone marrow signal is benign.

Output: Although artifact and differences in technique limit comparison, there is overall suggestion of progression of demyelinating disease in the cervical and thoracic cord compared to 10/13/2012. There is also suggestion of mild enhancement in the lower thoracic cord which may be related to recent active demyelination.


Instruction: Generate impression based on findings.

Input: Female 59 years old Reason: eval biliary system, assess hepatic vessel patency History: s/p OLT, elevated AP ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged and demonstrates signal drop out on in phase images consistent with iron deposition. Postoperative changes compatible with orthotopic liver transplant. No focal liver lesion within the limitations of this noncontrast study. No biliary dilatation. Expected vessel flow voids in the main portal vein.SPLEEN: Mild splenomegaly at 13.6 cm. Splenic varices noted, increased compared to prior study.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: Postsurgical changes with blooming artifact in the anterior abdominal wall.

Output: 1.Status post orthotopic liver transplant. Hepatomegaly with iron infiltration throughout the liver. 2.Within the limitations of this noncontrast study the main portal vein is patent.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, history of progressive glioblastoma, follow-up examination. A resection cavity is redemonstrated involving the right anterior temporal lobe, a portion of the right insula and frontal operculum, and a portion of the right inferior frontal lobe. The size and morphology of the resection cavity are unchanged.Enhancement along the ependyma of the right frontal lobe appears slightly more prominent than on the immediate prior examination of 7/10/2015. This remains improved, however, when compared to the examination of 4/17/2015.Enhancement along the medial aspect of the resection cavity, which is contiguous with the ependymal enhancement discussed above, has not significantly changed. Enhancement along the septum pellucidum is also not significantly changed compared to the immediate prior study, but is improved relative to the 4/17/2015 exam.A small region of enhancement along the ependyma of the right lateral ventricular body appears slightly longer than on the prior examination, now measuring up to 9 mm in length, previously 7 mm. A second small area of ependymal enhancement along the right ventricular atrium is unchanged.Curvilinear enhancement at the superior lateral margin of the right ambient cistern has progressively diminished in size, particularly when compared to 4/17/2015. No entirely new areas of pathologic enhancement are detected.The degree of T2 signal abnormality surrounding the resection cavity and extending into the right frontal white matter has not significantly changed. Mild periventricular T2 hyperintensity along the left frontal horn is also unchanged as are a few additional scattered small foci of white matter T2 hyperintensity. The ventricular system is stable in size and morphology.

Output: Redemonstrated are findings related to tumor resection and treatment. No large or significant interval changes are seen, though there are some mild interval changes of uncertain clinical significance. For example, ependymal enhancement along the frontal horn and body of the right lateral ventricle may be slightly more prominent than on the prior examination. However, in other areas, enhancement has progressively decreased. These fluctuating imaging findings are difficult to interpret as they could reflect fluctuations in disease status, treatment related findings, or even technical differences between scans.


Instruction: Generate impression based on findings.

Input: Female, 75 years old. Right shoulder pain and weakness ROTATOR CUFF: There is moderate to severe thinning of the supraspinous tendon compatible with chronic attritional tearing that has progressed compared to the prior study. Increased signal intensity replacing the distal fibers of the supraspinatus tendon likely represents a combination of tendinosis and tearing. There may be a focal full-thickness tear affecting the anterior fibers of the supraspinatus tendon at their insertion, but this is equivocal. There is mild fatty atrophy of the supraspinatus muscle. Mild edema type signal within the muscle on fat suppressed T2 sequences may reflect denervation injury or a strain. There is thickening and increased signal intensity of the infraspinatus tendon representing tendinosis that has progressed from the prior study. There are also cystic structures along the myotendinous junction more proximally. Mild to moderate fatty atrophy of the infraspinatus muscle appears to have progressed from the prior study. There is also edema type signal within the infraspinatus muscle on fat suppressed T2 sequences which may reflect denervation injury or strain. The teres minor tendon and muscle are intact. There is increased signal intensity within the subscapularis tendon involving the majority of the thickness of the tendon with sparing of the bursal surface fibers indicating a high-grade partial-thickness tear. There also appears to be incomplete insertional tearing of the subscapularis tendon. Subscapularis tendon tearing has progressed when compared to the prior study. There is mild atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. There is a small amount of fluid in the joint but no large effusion. Given the limitations of a nonarthrogram study, the glenoid labrum appears normal for age.BICEPS TENDON: There is medial dislocation of the biceps tendon from the bicipital groove which is new when compared to the prior study.

Output: 1.Progression of partial thickness tearing of the supraspinatus, infraspinatus, and subscapularis tendons with equivocal focal full-thickness tear of the anterior fibers of the supraspinatus tendon at their insertion.2.Osteoarthritis and other findings as above, including medial dislocation of the biceps tendon.


Instruction: Generate impression based on findings.

Input: There is herniation of the anterior right medial orbitofrontal gyrus through a bony defect in the right fovea ethmoidalis, measuring up to approximately 15 mm. There is a small amount of cerebrospinal fluid along with the herniated brain. There is deformity of the right gyrus rectus. There is no midline shift. There is no evidence of acute infarction or intracranial abscess. There is an enlarged partially empty sella. There are postoperative findings related to functional endoscopic surgery, including bilateral uncinectomy and ethmoidectomy. There is diffuse mucosal thickening is present in the remaining ethmoid air cells, maxillary sinuses and frontal sinuses. There is also diffuse mild mucosal enlargement of the bilateral nasal turbinates. There is fluid in the nasal cavity and nasopharynx likely attributable to intubation. The orbits are unremarkable.

Output: 1. Findings compatible with a small ethmoidal meningoencephalocele.2. Postoperative findings related to endoscopic sinus surgery with diffuse paranasal sinus mucosal thickening and diffuse turbinate hypertrophy.3. Enlarged and partially empty sella, which may be associated with pseudotumor cerebri.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out stroke. Signs and symptoms: As above. Nonenhanced brain MRI:No evidence of acute ischemic stroke on diffusion weighted series.Examination demonstrates several small final flair hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres as well as minimally in the left basal ganglia. Although findings are nonspecific this appearance is often result of microvascular ischemic changes. This finding demonstrate no evidence of hemorrhagic component.The overall anatomical morphology as well as the signal intensity of brain parenchyma is otherwise within normal limits on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces for patient's stated age.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses is within normal.Images through the orbits are unremarkable.Paranasal sinuses and mastoid air cells remain well pneumatized.Nonenhanced brain MRA:Patent bilateral intracranial vertebral arteries and bilateral pica branches. Patent and unremarkable basilar artery, superior cerebellar and posterior cerebral arteries.Patent and unremarkable bilateral internal carotid arteries, bilateral anterior and middle cerebral arteries and their branches are patent and unremarkable bilateral posterior communicating arteries.

Output: 1.Nonenhanced brain MRI demonstrate no evidence of an acute ischemic stroke. Findings of mild chronic small vessel ischemic strokes only in the subcortical and periventricular white matter and minimally in the left basal ganglia as detailed. Unremarkable exam otherwise.2.Unremarkable nonenhanced brain MRA.


Instruction: Generate impression based on findings.

Input: 72-year-old female with an enlarging meningioma for operative planning. Redemonstrated is evidence of craniotomy at the parietal vertex. Nonspecific dural thickening and a small fluid collection subjacent to the craniotomy are stable.Tumor centered on the posterior interhemispheric falx in the parietal region is approximately unchanged in size relative to the most recent examination, with approximate dimensions of 60 x 30 mm in length and width. There is no evidence of contrast within the superior sagittal sinus at the level of the parasagittal meningioma, which is not significantly changed in the interval. Encephalomalacia and ill-defined T2 signal abnormality affecting the bilateral parietal lobes and the left occipital lobe are unchanged. Scattered small foci of T2 hyperintensity within the cerebral hemispheres and brainstem are also unchanged. No new lesions are detected. No new pathologic enhancement is identified. The ventricles are stable in size and morphology.Fluid signal in the right mastoid air cells and middle ear cavity is again demonstrated.

Output: 1. Limited evaluation for operative planning related to a parasagittal meningioma.2. Extensive post treatment changes in the brain are not significantly changed since 8/1/2016.


Instruction: Generate impression based on findings.

Input: 50 years Female (DOB: 6/20/1966)Reason: Worsening MS symptoms on Rituximab History: Severe disability, worsening swallow, neck flexion weaknessPROVIDER NAME: ADIL JAVED ADIL JAVED MRI brain:There is redemonstration of a moderate degree of periventricular and subcortical white matter lesions. Many of these are perpendicularly oriented to the lateral ventricles. There is T2 and FLAIR signal hyperintensity present within the corpus callosum which was also present on the prior exam. When compared to the previous exam from July there is no compelling evidence suggesting progression or change when compared to the previous exam. Additional lesions in the brainstem are present which were also present on the prior exam and is also not significantly changed relative to the prior exam. These lesions are hypointense on T1-weighted imaging. There is no associated contrast enhancement with these lesions. Previously noted contrast enhancing lesion in the right parietal periventricular and subcortical white matter no longer enhance.Incidental note is made of a developmental venous anomaly in the right frontal lobe.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There are patchy T2 hyperintense lesions within the cervical spinal cord. There is no associated contrast enhancement with these lesions.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is loss of disc space height, desiccation and uncovertebral osteophytes associated with a disc bulge and some encroachment of the neural foramina bilaterally with encroachment of exiting nerve roots within the 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.

Output: 1.There are extensive periventricular and subcortical white matter lesions as well as lesions in the brainstem compatible with patient's diagnosis of demyelinating disorder. There is no significant interval change when compared with previous exam from July.2.There are multiple patchy lesions identified in the cervical spinal cord which are unchanged compared to the prior exam.3.There are degenerative changes present in the cervical spine worse at C5-6 where there is encroachment of exiting nerve roots within the neural foramina


Instruction: Generate impression based on findings.

Input: Choking, voice change, coughing spells, and right side facial numbness. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a small right maxillary sinus retention cyst. There is plagiocephaly.Internal Auditory Canals: The bilateral cranial trigeminal nerves are intact. The bilateral Meckel caves and cavernous sinuses are unremarkable. There is no evidence of mass lesions.

Output: No evidence of intracranial or skull base mass and no evidence of acute infarct.


Instruction: Generate impression based on findings.

Input: 16 years, Male, pineal germinoma status post biopsy, third ventriculostomy with a Ommaya placement, chemotherapy, and radiation therapy.. Compared to MRI brain dated 9/30/2015, there is minimal decrease in size of enhancing pineal mass measuring approximately 10 x 14x 12 mm in the AP, transverse, and craniocaudal dimensions, previously 11 x 16 x 13 mm. Cystic components involving the bilateral thalami without enhancement are not significantly changed. Endoscopic third ventriculostomy is noted which appears patent, as evidenced by flow-void on the sagittal T1 sequence.No new mass or new focus of enhancement is appreciated. No abnormal leptomeningeal enhancement. Right transverse frontal Ommaya catheter is again seen with its tip at the right foramen of Monro. Ventricular system is within normal limits in size without evidence of hydrocephalus. No diffusion abnormality. Major flow-voids are preserved. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: Compared to MRI brain dated 9/30/2015 there is minimal decrease in size of enhancing pineal mass. No significant change in cystic component involving the thalami.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified disorders of liver Abdominal pain, right upper quadrant Backache, unspecifiedClinical question: pain in neck and spineSigns and Symptoms: pain in neck and spine Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is reversal of normal cervical curvature present which is a nonspecific finding and could be related to patient positioning though could also be related to muscle spasm.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a small disc bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right jugulodigastric node measures 11 mm in thicknessMRI 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 enhancing lesions are appreciated in the thoracic spine.

Output: 1.No abnormal lesions are identified in the cervical or thoracic spinal cord.2.No compromise of the cervical or thoracic spinal canals. There is a minor disc bulge present at C6-7.


Instruction: Generate impression based on findings.

Input: Male, 69 years old. Biceps tendon rupture Evaluation is limited by patient motion artifact.ROTATOR CUFF: Although we see no full-thickness fluid-filled rotator cuff tear, the supraspinatus and infraspinatus tendons appear slightly thinned, likely reflecting chronic attritional tearing. The supraspinatus and infraspinatus muscles appear normal. The teres minor and subscapularis tendons and muscles are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is no frank fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint, and there is a moderate-sized joint effusion. Foci of intermediate signal intensity within the subscapular recess likely represents synovitis. There is degeneration and fraying of the inferior and posterior labrum. The anterior labrum is partially detached from the glenoid. Small cysts along the glenoid likely reflect additional tearing of the labrum.BICEPS TENDON: There is fluid in the biceps tendon sheath, likely representing a combination of fluid from the glenohumeral joint and synovitis. Otherwise, the proximal biceps tendon appears normal.

Output: 1.Osteoarthritis of the glenohumeral joint with a joint effusion and labral degeneration and tearing.2.Fluid and possible synovitis within the biceps tendon sheath, but the tendon of the long head of the biceps otherwise appears intact.3.Thinning of the supraspinatus and infraspinatus tendons may represent chronic attritional tearing, but we see no full-thickness rotator cuff tear.4.Mild osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: Acquired deformity of head.IMAGE ACQUISITIONS: 1 mm contiguous axial CT sections of brain and skull base. Postoperative status post suboccipital craniectomy and cranioplasty for Chiari decompression are again noted. There has also been left parietal craniotomy. There is a very small amount of nonspecific extra axial fluid deep to the inferior aspect of the right suboccipital cranioplasty flap. As on previous scans, cerebellar tonsils extend through the foramen magnum. Brain parenchymal attenuation is normal. There is no hydrocephalus.Postoperative change is again noticed that status post multilevel cervical laminectomy. There is a linear hyperdense structure within the spinal canal at the C5 level. This appears to be within the substance of the spinal cord. Comparison with a previous MRI of the cervical spine dated 01/31/2008 suggests possible subtle low signal intensity in this region on gradient echo axial images. It would be helpful to follow-up with a repeat MRI of the cervical spine to determine whether this calcified or ossified structure is new since there are no prior CTs of the cervical spine.

Output: 1.Normal postoperative changes status post suboccipital cranioplasty and left parietal craniotomy.2.It would be helpful to compare with the previous CT scan of the cervical spine if there is a prior outside exam. Otherwise, a follow-up MRI of the cervical spine would be helpful to discern determine whether there is new signal change in the substance of the cervical spinal cord at C5, corresponding with calcified or ossified structure within the substance of the cord at the C5 level.


Instruction: Generate impression based on findings.

Input: Reason: Assess the collateral ligaments of the THUMB MCP and flexor Pollicis longus tendon for rupture History: pain and swelling LIGAMENTS: There is partial thickness tearing of the proximal fibers of the ulnar collateral ligament extending to involve it's mid substance fibers. There is no evidence of a Stener lesion. The radial collateral ligament appears intact.TENDONS: The flexor and extensor tendons appear intact. BONES: No bone marrow signal abnormality is identified.ADDITIONAL

Output: Partial thickness tearing of the ulnar collateral ligament without evidence of a Stener lesion.


Instruction: Generate impression based on findings.

Input: Gallbladder nodularity seen on prior CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a suspicious lesion. Left hepatic lobe simple cyst is noted.The gallbladder may contain sludge. No gallstones are seen. There is a punctate cystic focus in the gallbladder body (series 501/28), likely focal adenomyomatosis. Also of note is a persistent narrowing/thickening at the mid body of the gallbladder which has been present dating back to 9/11/2014. There is no discrete differential enhancement of this region to suggest an underlying lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Severe chronic hydroureteronephrosis of the left kidney with marked cortical thinning.Mild right hydroureteronephrosis, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant urinary diversion is partially imaged. No evidence of obstruction or bowel inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dating back to 9/11/2014 there has been persistent minimal thickening and narrowing of the mid body of the gallbladder without a discrete mass lesion evident. This may constitute sequela from prior and/or chronic inflammation. Chronic severe left-sided hydroureteronephrosis.


Instruction: Generate impression based on findings.

Input: A 50 year old male with hypertension, hypothyroidism, asthma, with moderately reduced left ventricular systolic function and frequent PVC's. Left VentricleThe left ventricle is mildly dilated with low normal systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 237 ml (normal range 142+/-34), the LV end systolic volume index is 51 ml/m2 (normal range 25+/-9), the LVESV is 120 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 119 g (normal range 164+/-36). There is no late gadolinium enhancement to suggest the presence of underlying replacement fibrosis, infiltration, or inflammation. However, the native myocardial T1 times are mildly increased (~1100ms) suggesting the presence of mild underlying interstitial fibrosis. No myocardial iron overload. No intracavitary thrombus.Left AtriumThe left atrium is moderately dilated (130ml).Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 197 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 68 ml (normal range 54+/-17). No fatty infiltration, regional wall motion abnormality or focal aneurysm noted. No MRI evidence of ARVD.Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with low normal `systolic function, the LVEF is 50%.2. There is no late gadolinium enhancement to suggest the presence of underlying replacement fibrosis, infiltration, or inflammation. However, the native myocardial T1 times are mildly increased (~1100ms) suggesting the presence of mild underlying interstitial fibrosis.3. The right ventricle is normal in size with normal systolic function, the RVEF is 65%. No fatty infiltration, regional wall motion abnormality or focal aneurysm noted. No cardiac MRI evidence of ARVD.4. The left atrium is moderately dilated and the right atrium is mildly dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 56-year-old female with history of chronic abdominal pain and question of pancreatic divisum on outside endoscopic ultrasound (2014). ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense cysts scattered throughout the liver.SPLEEN: Peripheral T2 hyperintensities are likely benign lesions.PANCREAS: A single main pancreatic duct is visualized. There is normal pancreatic duct compliance. No pancreatic divisum is identified as clinically queried. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense cysts lateral kidneys. A T2 hypointense cortical lesion is noted in the interpolar left kidney. A subcentimeter proteinaceous cyst is noted in the left lower pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post duodenectomy of the third portion of the duodenum with duodenojejunostomy in the right upper quadrant. This is better depicted on prior upper GI.BONES, SOFT TISSUES: Degenerative change at L4-L5 and L5-S1.OTHER: No significant abnormality noted.

Output: 1. No evidence of pancreatic divisum as clinically queried.


Instruction: Generate impression based on findings.

Input: 43-year-old female with history of Crohn's. Abdominal pain and loose stools. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is wall thickening involving approximately 13 cm of the terminal ileum. Hyperenhancement of this affected segment (sparing the distal 4 cm of the terminal ileum), suggestion of fibrofatty proliferation in the adjacent mesentery, and prominent right lower quadrant mesenteric lymph nodes suggest active inflammatory disease. There is no significant proximal dilatation to suggest stricturing. No evidence of fistula or sinus tract. No angulated bowel loops to suggest an adhesive disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings compatible with active, acute Crohn's disease involving the distal 13 cm of the terminal ileum.


Instruction: Generate impression based on findings.

Input: Male, 51 years old, with low back pain for one year following motor vehicle accident. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are slightly heterogeneous but benign.Both facet joints are degenerated at L4-5. On the right, there is a facet effusion and evidence of edema within the right L5 pedicle and superior articulating facet, and within the right L4 pedicle and inferior articulating facet. There is a 1 mm focus of bright T2 signal within the right L5 pars interarticularis. However, no definite pars fracture is seen.The visualized distal spinal cord, conus and cauda equina nerve roots are within normal limits. No epidural abnormalities are suspected.L1-2 through L3-4: Unremarkable. L4-5: Moderately advanced facet degeneration as discussed above. Ligamentum flavum thickening. Mild disc bulging. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. L5-S1: Moderately advanced facet degeneration. Bulging disc with a small right paracentral protrusion. No significant spinal canal or foraminal stenosis.

Output: 1.Moderately advanced facet degeneration at L4-5 and L5-S1. At L4-5 on the right, there is a facet effusion and evidence of edema affecting the pedicles and articulating facets. A small focus of intense T2 signal within the right L5 pars interarticularis could represent edema, a small cystic space or perhaps microtrabecular injury. These findings could potentially be posttraumatic, though osteoarthritic degeneration frequently produces identical findings.2.No other definite evidence of any post-traumatic lumbar spine abnormality is seen. No significant spinal canal or foraminal stenosis is detected.


Instruction: Generate impression based on findings.

Input: There are post-treatment findings in the nasopharyngeal region. There has been interval decrease in the enhancing lesion in the superior right parasagittal posterior nasopharynx, with mild asymmetric prominence on that side, but no discretely measurable tumor. There is no evidence of skull base invasion or intracranial extension. The pre-vertebral, parapharyngeal, and masticator spaces are intact. There is no significant lymphadenopathy in the neck. The parotid and submandibular glands are unremarkable. There is a possible punctate right vocal cord cyst. There is degenerative spondylosis in the cervical spine, which is most pronounced at C4/5. There are secretions and mucosal thickening in the left sphenoid sinus.

Output: 1. No measurable residual nasopharyngeal carcinoma and no evidence of significant cervical lymphadenopathy.2. Findings suggestive of acute left sphenoid sinusitis.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified Altered mental status, unspecifiedClinical question: r/o acute findingsSigns and Symptoms: altered mental status There is diffusion restriction present along the splenium of the corpus callosum as well as the thalami bilaterally and symmetrically.There are subdural effusions present bilaterally.. Exam is mildly degraded by patient motion.There is some retropharyngeal soft tissue thickening present. This finding has been present on prior soft tissues of the neck studies.There is mild patchy T2 signal hyperintensity present within the brain stem.The patient is status post cholecystectomy and head and neck surgery.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 some mucosal thickening in the sphenoid sinuses. The visualized portions of the mastoid air cells demonstrate partial opacification of the right mastoid air cells and to a lesser degree left mastoid air cells.. The visualized portions of the orbits are intact.

Output: 1.Diffusion restriction symmetrically within the splenium and thalami is present. This can be seen with the encephalitis, influenza as well as warning cues encephalopathy (thiamine deficiency) in the appropriate clinical setting.2.There are small subdural effusions present intracranially as etiology is uncertain on the basis of this exam..


Instruction: Generate impression based on findings.

Input: Right extremity weakness. BRAIN:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The adenoids are mildly enlarged.CERVICAL SPINE:Sagittal alignment is anatomic accounting for straightening which can be positional. The vertebral bodies are preserved in height. There is no suspicious marrow lesion. There is no significant degenerative disease and the spinal canal and neural foramina are not stenotic. The cervical spinal cord is of normal morphology and signal. Following contrast injection, there is no abnormal spinal cord, leptomeningeal or osseous enhancement.

Output: 1.Brain: No evidence of intracranial hemorrhage, mass, or acute infarct. 2.Cervical spine: No significant degenerative disease or other cervical spine abnormality.


Instruction: Generate impression based on findings.

Input: Other nontraumatic intracerebral hemorrhage [I61.8], Reason for Study: ^Reason: evaluate 2/2 cause of bleed History: hemorrhage There are 2 burr holes, one on the right frontal and another on the right temporal occipital area.Large right frontal intracerebral hematoma (45.3 mm x 55 and 5 mm x 63.6 mm) with surrounding edema, internal fluid fluid level and mass effect is seen. Midline shift towards left side is also seen, about 4 mm, at the level of foramen of Monro.Susceptibility lesions on surrounding sulci indicating associated subarachnoid hemorrhages.There is no evidence of contrast enhancement on the hematoma.There is no evidence of abnormal enhancement except thin, non nodular meningeal enhancement around the right frontal temporal parietal area which could be related to prior surgery or related to current hematoma related meningeal irritation.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Large right frontal ICH, surrounding SAH with mass effects and midline shift toward left side as described above.2. No evidence of abnormal enhancement except right hemispheric meningeal enhancement.


Instruction: Generate impression based on findings.

Input: Chairi decompression in 2015: vision and hearing issues, a very stiff neck and "constant cracking" in neck. There has been interval evolution of postoperative findings related to Chiari decompression surgery, with no residual pseudomeningocele at the surgical bed. The cerebellum appears unchanged in configuration, with minimal linear hypointense bands extending to the overlying dura, which may represent adhesions. The neo-foramen magnum is patent, with a robust transit of cerebrospinal fluid flow. The spinal cord appears to be normal. There is minimal unchanged multilevel degenerative spondylosis, without significant spinal canal or neural foraminal stenosis. The vertebral body heights are intact. However, there is partial congenital fusion of the C6 and C7 vertebrae. The bone marrow appears to be unremarkable.

Output: Expected interval evolution of postoperative findings related to Chiari decompression surgery. No evidence of syrinx.


Instruction: Generate impression based on findings.

Input: Evaluate right internal carotid artery for aneurysm as mentioned in previous MRI brain report. There is no evidence of significant steno-occlusive lesions in the cervical arteries. The study is not optimized to assess the intracranial arteries, although no aneurysm at the origin of the mildly tortuous right ophthalmic artery is apparent.

Output: 1.No convincing right ophthalmic artery aneurysm. Finding on previous examination may have been attributable to mild tortuosity of vessel or enhancement in the adjacent cavernous sinus.2. No significant steno-occlusive disease in the neck.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of seizures, new vertigo and tinnitus. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, heterotopia, or infarct. The brain parenchyma, including the hippocampi, appears unremarkable. There is a left cerebellar developmental venous anomaly, Otherwise, there is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. No evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: 12-year-old female with elbow clicking, please evaluate for CAD. History of right elbow orthopedic surgery. Examination is limited by patient bilateral motion and additional artifact related to patient's prior surgery and internal fixation.LEFT:LIGAMENTS: The ligaments of the left elbow appear grossly intact without abnormality.TENDONS: The tendons of the left elbow appear grossly intact without abnormalityARTICULAR SURFACES AND BONE: A small irregularity that likely correlates to an osteochondral defect of the posterior radial articulation of the humerus is visualized.SURROUNDING STRUCTURES: No significant abnormality noted. The soft tissues of the left elbow appear intact.ADDITIONAL

Output: 1. Small osteochondral defect along the posterior radial articulation of the left humerus.2. Postsurgical change and developing degenerative changes of the right elbow as outlined above.


Instruction: Generate impression based on findings.

Input: Gait disturbance, up going toe. Evaluate for spinal canal stenosis. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment of the cervical spine is grossly maintained. Bone marrow signal is within normal limits. No abnormal signal in the cervical cord. There are degenerative changes, as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a right paracentral protrusion which mildly indents the right ventral aspect of the cord. The dorsal thecal sac is preserved at this level. No significant neural foraminal stenosis.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: There is a right paracentral disc protrusion at the right C3-C4 level which mildly indents the right ventral cord. Dorsal thecal sac is preserved at this level. There is no significant spinal canal or neural foraminal stenosis in the remainder of the cervical spine.


Instruction: Generate impression based on findings.

Input: Resected surgery for a right frontal lobe anaplastic oligodendroglioma (WHO grade III). There are recent postoperative findings related to subtotal right frontal tumor resection with a small amount of hemorrhage in the region of the surgical cavity and along the right lateral ventricle choroid plexus and overlying extradural fluid collections that measure up to 7 mm in width. There is residual heterogeneously enhancing tumor along the posterior and superior margins that measures up to 20 mm in thickness. There is also a small amount of enhancement along the anterior medial margin. There appear to be small areas of restricted diffusion along the surgical margin, which may be related to the effects of blood products, but no acute territorial infarct. There is persistent extensive surrounding vasogenic edema and up to approximately 10 mm of midline shift to the left, as well as subfalcine herniation and partial effacement of the right lateral ventricle. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Recent postoperative findings related to subtotal right frontal tumor resection with evidence of residual tumor along the surgical margins, particularly posteriorly and superiorly, as well as persistent extensive vasogenic edema and approximately 10 mm of midline shift.


Instruction: Generate impression based on findings.

Input: Cavernous malformation surveillance.. There is an unchanged lesion centered in the right cerebral peduncle that measures up to approximately 15 mm with circumferential susceptibility effect that contains a loculated area of intrinsic T1 hyperintensity as well as patchy enhancement. There appears to be at least one developmental venous anomaly associated with the lesion, but there is no surrounding vasogenic edema. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A lesion centered in the right cerebral peduncle is unchanged and likely represents a cavernous malformation associated with at least one developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: History of newly diagnosed prostate cancer. Staging examination. PELVIS:PROSTATE:Prostate Size: 3.4 x 5.3 x 5.5 cmPeripheral Zone: In the right mid gland/apex peripheral zone medially there is a 7 x 6 mm focus of T2 weighted hyperintensity with associated restricted diffusion suggestive of carcinoma. Additional punctate foci of T2 hypointensity in the left peripheral zone mid gland.Central Gland: Changes of age.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral left greater than the right external iliac/femoral lymph nodes measuring less than 1 cm in short axis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.7 mm focus in the right mid gland/apex peripheral zone likely corresponds to the patient's known carcinoma.2.Nonspecific left greater than right external iliac/femoral lymph node enlargement.


Instruction: Generate impression based on findings.

Input: 81-year-old male with history of parotid ACC. Status post chemo/RT Images at the level of the skull base and cavernous sinuses and including paranasal sinuses are unremarkable. Opacification of right mastoid air cells is a new finding since prior study.Postoperative changes of right-sided parotidectomy is again identified. This finding remains stable since prior study and no evidence of recurrence of tumor at the surgical site is detected.No evidence of any masses or pathologic adenopathy in the soft tissues of the neck is detected. Images at the level of the apices of the lungs demonstrate minimal scarring on the left also stable since prior. No metastatic lesion is detected.Bony density of area of exam is negative for metastatic lesions.CT of brain with infusion.This examination demonstrates an enhancing lesion measuring approximately 12.5 mm x 9.3-mm in transaxial dimension within the right cerebellopontine angle. Multiple prior studies were reviewed which failed to demonstrate this finding. This lesion is not associated with any definitive bony changes and is at least partially at the level of the right internal auditory canal which also appears normal in size and morphology. This finding may represent choroid plexus at the level of the right foramina of Luschka, however due to lack of its visualization on prior examination possibility of tumor cannot be excluded and an MRI examination of brain with infusion is recommended to exclude this possibility.This examination is otherwise negative and in particular no evidence of metastatic disease to the brain parenchyma, leptomeninges or the calvarium is detected. Also as noted above there is evidence of interval development of opacification of mastoid air cells on the right side. Small vessel disease again identified.

Output: 1.No evidence of recurrence of disease in the neck.2.Extra-axial right CP angle enhancing lesion which may represent choroid plexus of the fourth ventricle at the level of foramina of Luschka however to exclude possibility of tumor an MRI is recommended. This finding was not identified on any of the prior studies.


Instruction: Generate impression based on findings.

Input: 62 year old male, status post lung transplant, need for evaluation for pericardial disease/constriction. Left VentricleThe left ventricle is normal in size and global function. The overall LV ejection fraction is 58%. The LVEDV is 59 ml (normal range 142+/-34), the LV end diastolic volume index is 30 ml/m2 (normal range: 74+/-15), the LVESV is 25 ml (normal range 47+/-19) and the LV end systolic volume index is 12 ml/m2 (normal range 25+/-9). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is presence of interventricular dependence with paradoxical septal motion, this appears to be most prominent during inspiration. The native T1 myocardial relaxation time is approximately [1010]ms. These values are [within normal limits], suggestive of [no]underlying diffuse fibrosis or infiltration.Left AtriumThe left atrium is dilated. Right VentricleThe right ventricle is normal in size and decreased in function. The overall RV ejection fraction is 30%. The RVEDV is 83 ml (normal range 142+/-31), RV end diastolic volume index is 42 ml/m2 (normal range 82+/-16), the RVESV is 58 ml (normal range 54+/-17), and the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is dilated.Aortic ValveThe aortic valve is trileaflet, 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 trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a large circumferential pericardial effusion.Extracardiac FindingsLarge bilateral pleural effusions. Ascites is present. 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. Left ventricle is normal in size and global function. The overall LV ejection fraction is 58%. 2 There is interventricular dependence with paradoxical septal motion. This may be related to RV pressure overload, however there appears to have a respirophasic component (most prominent with inspiration) which suggests the pericardial process is contributing, with the significant pericardial effusion it is difficult to isolate the contribution from any possible pericardial constriction.2. Right ventricle is normal in size and decreased in function. The overall RV ejection fraction is 30%.3. There is a large circumferential pericardial effusion. The pericardium thickness is not grossly thickened.4. See extracardiac findingsI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 69-year-old male with history of end-stage renal disease and hypertension presents with a new onset headache for three weeks. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are unchanged. There is mild to moderate periventricular and subcortical cerebral white matter T2 hyperintensity, which has slightly progressed. There is a persistent cavum septum pellucidum, a normal anatomic variant. There is no restricted diffusion. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is deformity of the right lamina papyracea. There is a small retention cyst in the right maxillary sinus.

Output: Nonspecific cerebral white matter abnormality may represent chronic small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 74 years old, with progressive supranuclear palsy, IRB approved brain MRI. 2 repeat axial FLAIR sequences were obtained. Redemonstrated is thinning of the mid brain and volume loss.

Output: Repeat axial FLAIR sequences redemonstrate thinning of the midbrain and volume loss.


Instruction: Generate impression based on findings.

Input: There is acute right medial pontine ischemia. There is no evidence of acute intracranial hemorrhage. Periventricular and subcortical white matter hypodensities of a mild to moderate degree are present. Chronic right cerebellar encephalomalacia. Redemonstration of dominant left vertebral artery. Patient is status post trans-sphenoidal pituitary surgery. Pituitary lesion is slowly increasing in size over several prior studies. There is infiltration into the left cavernous sinus with the lesion surrounding the left cavernous internal carotid. The lesion also abuts the right medial cavernous internal carotid. There appears to be CSF between the optic chiasm and the lesion.No evidence of intracranial mass, mass-effect, or hydrocephalus. There is mild opacification of the maxillary sinuses. The imaged mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable.

Output: 1.Acute right medial pontine ischemia.2.Slowly increasing pituitary lesion as above.3.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 4.Right cerebellar encephalomalacia.Findings discussed with Dr. Mendelson on 3/23/2015 at 10:30AM.


Instruction: Generate impression based on findings.

Input: Asymptomatic female presents for routine screening mammography. Family history of breast carcinoma in her mother (diagnosed at age 48), aunt (diagnosed at age 60), and two cousins. Two standard digital views of both breasts with tomosynthesis were performed and reviewed with the aid of R2 CAD. The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C), unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Numerous bilateral benign calcifications are similar to prior studies and are likely related to milk of calcium given the presence of cysts on MRI.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram.