Instruction: Generate impression based on findings.

Input: Surgical planning: seizure. Per EPIC: brain lesion (unclear pathology), CVA during biopsy in 1990 with residual left sided weakness and seizure disorder. There are postoperative findings related to right frontal craniotomy with encephalomalacia and gliosis in the underlying right frontal lobe. There is a large area of encephalomalacia in the right basal ganglia, medial right temporal lobe, right midbrain, and right corona radiata with extensive susceptibility effect, Wallerian degeneration in the brainstem, and ex vacuo dilatation of the adjacent ventricles. There is linear high T2 signal in the left brainstem, which may also represent Wallerian degeneration. There is a punctate area of encephalomalacia in the left corona radiata. There are scattered foci of susceptibility effect in the right frontal lobe and overlying extra-axial space, which correspond to dystrophic calcifications demonstrated on CT. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. Postoperative findings related to right frontal craniotomy with encephalomalacia and gliosis in the underlying right frontal lobe, but no definite gross tumor. 2. Chronic hemorrhagic infarction involving the right basal ganglia, medial right temporal lobe, right midbrain, and right corona radiata.3. Punctate chronic lacunar infarct in the left corona radiata.


Instruction: Generate impression based on findings.

Input: 41 years, Female, Reason: evaluate left sided pelvic pain History: left sided pelvic pain radiating to back and left lower leg; normal pelvic ultrasound. PELVIS: UTERUS, ADNEXA: Left sided corpus luteum. The left uterine vessels are engorged relative to the right. Multiple nabothian cysts. Small submucosal lesion along the anterior aspect uterus measuring 1 cm. There is focal thickening of the junctional zone along the posterior aspect of the uterus measuring up to 1.4 cm, suggestive of adenomyosis.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: For findings in the lumbar spine, please see dedicated lumbar spine MRI.OTHER: No significant abnormality noted.

Output: 1.Thickening of the junctional zone is suggestive of adenomyosis.2.Focal 1 cm submucosal lesion may represent an adenomyoma or a submucosal fibroid.


Instruction: Generate impression based on findings.

Input: 82 years Female (DOB:12/27/1933)Reason: metastatic breast cancer with dural based met, s/p RT; please evaluate History: surveillance after RTPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The dural based plaque-like thickening of the dura adjacent to the upper clivus eccentric to the left side has decreased in thickness from 6 mm to 4 mm. And is decreased from 18 to 15 mm in widthThe marrow signal is heterogeneous with multiple foci of enhancement throughout the calvarium. These foci of enhancement are also present on the prior exam..No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is redemonstration of a defect along the right lamina papyracea probably related to old orbital medial blowout

Output: 1.There is continued regression of a meningeal-based lesion adjacent to the clivus.2.There is redemonstration of extensive osseous metastatic disease.3.No metastatic foci are identified within the brain parenchyma.


Instruction: Generate impression based on findings.

Input: 26 year old male with a history of non-ischemic cardiomyopathy status-post heart transplant in 11/2016 with a history of pericarditis now with persistently elevated white blood cell count and ECG changes. He is referred for cardiac MRI. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 164 ml (normal range 142+/-34), the LV end systolic volume index is 21 ml/m2 (normal range 25+/-9), the LVESV is 48 ml (normal range 47+/-19).There are no regional wall motion abnormalities present.. There is a focus of late gadolinium enhancement of the distal inferior/inferolateral wall that is not typical for infarction and may suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation times are normal. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 66%, the RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVEDV is 162 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 55 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a small pericardial effusion. The pericardium is upper normal in thickness. There is late gadolinium enhancement of the pericardium. Extracardiac FindingsSternal wires present. There is a right sided pleural effusion. 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. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 70%.There are no regional wall motion abnormalities present.. There is a focus of late gadolinium enhancement of the distal inferior/inferolateral wall that is not typical for infarction and may suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation times are normal. 2.The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 66%.3. There is a small pericardial effusion. The pericardium is upper normal in thickness. There is late gadolinium enhancement of the pericardium consistent with inflammation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headaches, immunosuppressed. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal scattered punctate foci of T2 hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and sulci are slightly prominent due to apparent mild cerebral volume loss. 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 mild mucosal thickening in the right maxillary sinus.

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


Instruction: Generate impression based on findings.

Input: Status post bilateral UAE for fibroids PELVIS:UTERUS, ADNEXA: Enlarged fibroid uterus again visualized but demonstrating overall interval decrease in size, now measuring 17.5 x 8.6 cm in sagittal plane, previously 21.2 x 10.8 cm. Internal necrosis and greater amount of T1 hyperintensity seen in several fibroids, likely reflecting internal hemorrhage. Reference intramural fibroid located in uterine body posteriorly demonstrates internal necrosis and liquefaction and now measures 5.8 x 5.2 cm on image 163 series 10, previously measured 6.7 x 6 cm. Previously alluded to largest discrete fibroid anteriorly now demonstrates extensive necrosis and measures 6.2 x 4.6 cm, previously measured 9.4 x 7.5 cm. Persistent avid enhancement visualized in multiple additional smaller uterine fibroids bilaterally. Deformity of endometrial stripe secondary to numerous fibroids seen. Again seen fluid containing tubular structure in left adnexa, likely hydrosalpinx, improvement in size noted. Simple appearing 3.1 cm right adnexal cyst visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Decreased size of fibroid uterus as described with evidence of internal necrosis in the largest leiomyomas, reflecting posttreatment sequela; please see above.2. Left-sided hydrosalpinx decreased in size.


Instruction: Generate impression based on findings.

Input: Persistent knee pain MENISCI: There is obliquely oriented tearing of the posterior horn of the lateral meniscus which extends to the tibial articular surface. This tearing extends into the body and there is abnormal morphology and signal intensity of the anterior horn indicating additional tearing.There is abnormal signal intensity within the posterior horn of the medial meniscus indicating the presence of an undersurface tear. The anterior horn and body of the medial meniscus are intact.ARTICULAR CARTILAGE AND BONE: There is severe loss of the articular cartilage of the lateral compartment with areas of full-thickness loss particularly along the lateral femoral condyle anteriorly as well as the nonweightbearing portion posteriorly. Similar articular cartilage loss is seen along the tibial plateau and there is degenerative subchondral edema evident within the lateral compartment.There is moderate articular cartilage thinning of the medial compartment but no discrete full-thickness tear is appreciated.There is severe articular cartilage loss of the patellofemoral compartment with areas of full-thickness loss involving both the medial and lateral facets. The articular cartilage of the femoral trochlea also appears thinned. There is degenerative marrow changes in the undersurface of the patella particularly inferiorly.There are large tricompartmental osteophytes.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tear of the lateral meniscus with mild undersurface tearing of the medial meniscus.2. Severe articular cartilage loss of the lateral and patellofemoral compartments with more moderate changes noted medially.


Instruction: Generate impression based on findings.

Input: Clinical question: Aphagia, status post TPA. Signs and symptoms: Aphagia Previously noted on MRI examination from 11 -- 16 left thalamic infarct is again identified with no evidence of hemorrhagic transformation. Subtle mass effect by the edema of the stroke on the third ventricle is noted. There is however no evidence of hydrocephalus. No evidence of hemorrhage is detected. No evidence of new findings. Cortical sulci, ventricular system and all CSF cisterns remain within normal.

Output: Subacute nonhemorrhagic left thalamic stroke.


Instruction: Generate impression based on findings.

Input: There is redemonstration of a saccular aneurysm arising from the basilar tip measuring approximately 4 x 5 mm, not significantly changed.The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis. No additional aneurysms are identified.

Output: Aneurysm arising from the junction of the basilar tip measuring approximately 4 x 5 mm, not significantly changed when allowing for differences in technique.


Instruction: Generate impression based on findings.

Input: Status post right CCM resection Non-infused CT of brain:Examination demonstrate a foci of increased density measuring approximately 30 x 14.6-mm in trans-axial dimensions in the right basal ganglia. There are no prior CT examination for comparison. This finding is believed to represent patient's known cavernous malformation at this site. There is evidence of surgery and with extension of surgical tract to the right lateral aspect of this lesion. Although the above finding could represent patient's known cavernoma and does not particular area appeared like acute hemorrhage possibly itself subtle associated hemorrhage cannot be ruled out. The configuration of right frontal horn is identical to prior MRI exam which demonstrated extension of tumor into the right caudate nucleus and bulge into the right frontal horn.Postoperative changes of a right anterior frontal craniotomy and resultant air within the anterior cranial fossa bilaterally and minimal epidural collection under the craniotomy flap. There is no evidence of subarachnoid hemorrhage or definitive acute parenchymal hemorrhage. Ventricular system remains within normal size and unchanged since prior exam. There is no midline shift.

Output: 1.Postoperative changes of right frontal craniotomy for partial resection of right basal ganglial cavernoma.2.High density material within the right basal ganglia as measured could represent residual cavernoma. No definite postoperative hemorrhage is detected however high density of the mass can obscure small amount of hemorrhage.3.There is no evidence of hydrocephalus or midline shift.4.Residual air and minimal epidural hemorrhage under the craniotomy flap.


Instruction: Generate impression based on findings.

Input: 61-year-old female with worsening back and leg pain. Evaluate for disc pathology.Epic: Pain is localized to the low back and groin, no radiation, no weakness The vertebral column alignment is within normal limits. The vertebral body heights are preserved with mild disc narrowing at L3-L4 and L4-L5. Disc desiccation is present at these levels as well as at L2-L3 and L5-S1. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. There is developmental narrowing of the distal lumbar spinal canal due to shortened pedicles. The paravertebral soft tissues are unremarkable. Degenerative changes are seen in the cervical spine as described below:From T12-L1 through L2-L3, there is facet arthropathy and ligamentum flavum thickening without stenosis.At L3-L4, there is a mild disc bulge with mild bilateral facet arthropathy and ligamentum flavum thickening. There is overall mild central spinal canal stenosis as well as mild right and mild-moderate left foraminal narrowing.At L4-L5, there is a diffuse disc bulge associated with a moderate degree of ligamentum flavum hypertrophy. There is fluid present within the facet joints. The fat at the lateral recesses is effaced bilaterally at this level. There are some mild crowding of the nerve roots within the thecal sac at this level. The exiting nerve roots within the neural foramina are surrounded by fat.At L5-S1, there is a stable diffuse disc bulge associated with disc desiccation. There is bilateral ligamentum flavum thickening with narrowing of the lateral recesses. There is overall mild to moderate central spinal canal stenosis as well as moderate right and mild left foraminal narrowing.

Output: Stable degenerative changes in the lumbar spine with moderate spinal stenosis at L4-5 and the mild-to-moderate spinal stenosis at L5-S1.


Instruction: Generate impression based on findings.

Input: 43 years Female (DOB:3/22/1973)Reason: 43 yo with HIV and AMS eval for infection vs lymphoma History: alteredPROVIDER/ATTENDING NAME: DANA P EDELSON DANA P EDELSON The CSF spaces are appropriate for the patient's stated age with no midline shift. There is subtle diffuse periventricular and ill-defined signal hyperintensity without associated contrast enhancement. There is some associated involvement of the cerebral peduncles and internal capsules and some scattered involvement in the cerebellum and rest of the brainstem.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 partial opacification of the right sphenoid sinus and some mucosal thickening in the maxillary sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is diffuse marrow replacement present.

Output: 1.There is subtle signal change within the periventricular white matter and internal capsule with some lesser associated involvement of the brainstem and cerebellum. This is nonspecific. One possibility is that this represents HIV infection. No focal lesions are appreciated to suggest lymphoma.2.Diffuse marrow replacement is suspected to be related to HIV status.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for loose body, calculate TT/TG History: Pain, lateral patella dislocation MENISCI: There is intermediate signal intensity within the free edge of the posterior horn of the lateral meniscus extending along its tibial articular surface suggesting an undersurface tear. The anterior horn appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is asymmetry of the trochlear facets with a relatively small medial facet suggesting mild dysplasia. The bone marrow signal intensity is within normal limits. There is a slight lateral patellar tilt.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Borderline tibial tubercle to trochlear groove distance and other findings as described above that may be associated with patellofemoral instability.2. Small undersurface tear/fraying of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: 69 year-old female with altered mental status, dysarthria, pronator drift. Evaluate for acute stroke. There is no CT evidence of acute territorial ischemia. There are patchy areas of hypodensity within the subcortical, deep, and periventricular white matter that are nonspecific, however most commonly small vessel ischemic disease of indeterminate age. If there is a high index of suspicion for acute infarct, MRI would be more sensitive.The ventricles and sulci are mildly prominent, likely due to age-related volume loss. There is no acute intracranial hemorrhage or extraaxial collection. There is no midline shift or basal cistern effacement.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are clear.There is moderate atherosclerotic calcification of the intracranial vessels.

Output: 1.No CT evidence of acute territorial ischemia. MRI would be more sensitive for acute infarction if there is strong clinical suspicion for acute infarct. 2.Moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness, elevated CPK Exam is limited by poor fat suppression artifact due to patient's size.There is mildly increased T2/STIR signal scattered throughout the posterior musculature of the thigh. There is no abnormal fluid collection identified.The underlying bone marrow signal is normal. There is no osseous abnormality.

Output: Mild diffuse edema on the posterior musculature of the thigh consistent with a component of mild myositis.


Instruction: Generate impression based on findings.

Input: Evaluate left facial mass concerning for left sinonasal malignancy. There is a heterogeneous and infiltrative mass centered in the left sinonasal region, completely obliterating the left maxillary sinus and much of the left nasal cavity and ethmoid sinuses, with extension into the inferior and medial extraconal orbit, abutting the left inferior rectus muscle, and into the overlying left facial subcutaneous tissues with surrounding fat stranding and into the retromaxillary space. There is also compression of the left nasolacrimal duct, with dilatation of the lacrimal sac. Overall, the mass measures up to approximately 7 cm. There are secretions and mucosal thickening in the left frontal sinus and right ethmoid sinuses. The right orbit and paranasal sinuses are unremarkable. There is no significant cervical lymphadenopathy. The salivary glands appear to be grossly intact. There is no evidence of gross intracranial tumor. There is no evidence of acute cerebral infarction, hemorrhage, or ventriculomegaly. There is minimal nonspecific periventricular T2 hyperintensity.

Output: An aggressive mass centered in the left sinonasal region with extension into the extraconal orbit, the overlying left facial subcutaneous tissues, and the retromaxillary space is compatible with a malignant neoplasm.


Instruction: Generate impression based on findings.

Input: Lung cancer with history of a brain metastasis that received SBRT on 5/19/2016. There is a 12 mm diameter peripherally enhancing lesion in the anterior left frontal lobe, which also measured 12 mm in diameter on the prior exam. However, there is an associated 7 mm wide nodular enhancing component on the anterolateral aspect, which previously measured up to 4 mm. Otherwise, the confluent area of surrounding vasogenic edema has perhaps slightly diminished in extent. A moderate degree of scattered cerebral white matter T2 hyperintensity without enhancement likely represent chronic small vessel ischemic disease. There is no evidence of or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A 12 mm diameter peripherally enhancing metastatic lesion in the anterior left frontal lobe, has not significantly changed. However, the associated 7 mm wide nodular enhancing component on the anterolateral aspect, previously measured up to 4 mm. While tumors can sometimes transiently increase in size after radiation therapy, focal tumor progression is certainly a consideration. Otherwise, the confluent area of surrounding vasogenic edema has perhaps slightly diminished in extent.


Instruction: Generate impression based on findings.

Input: 50 year-old man with non-ischemic dilated cardiomyopathy referred for MRI to evaluate possible etiologies. Left VentricleThe left ventricle is severely dilated with severe systolic dysfunction. The overall LV ejection fraction is 11%, the LV end diastolic volume index is 204 ml/m2 (normal range: 74+/-15), the LVEDV is 491 ml (normal range 142+/-34), the LV end systolic volume index is 182 ml/m2 (normal range 25+/-9), the LVESV is 438 ml (normal range 47+/-19), the LV mass index is 48 g/m2 (normal range 85+/-15), and the LV mass is 116 g (normal range 164+/-36). There is global hypokinesis with regional variation. There are patches of transmural late gadolinium enhancement at the mid inferoseptal and lateral walls suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The distribution is not compatible with ischemia. No apical thrombus seen on this study.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 19%, the RV end diastolic volume index is 140 ml/m2 (normal range 82+/-16), the RVEDV is 336 ml (normal range 142+/-31), the RV end systolic volume index is 113 ml/m2 (normal range 31+/-9), and the RVESV is 272 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is severe mitral regurgitation with bileaflet teeteringPulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate 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 moderate to severely dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMultiple pulmonary nodules noted. These are better described on recent CT. 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. The left ventricle is severely dilated with severe systolic dysfunction. The overall LV ejection fraction is 11%. There are patches of transmural late gadolinium enhancement at the mid inferoseptal and lateral walls suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The distribution is not compatible with ischemia.2. The right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 19%3. There is severe mitral regurgitation4. There is at least moderate tricuspid regurgitation.5. Moderate-severely dilated main pulmonary artery6. See extra-cardiac findings.All LGE images not available for review. Will add addendum if new findings seen.


Instruction: Generate impression based on findings.

Input: 86 years Male (DOB:1/27/1930)Reason: hydrocephalus History: gait issuesPROVIDER/ATTENDING NAME: PETER C WARNKE PETER C WARNKE Since prior examination the patient has undergone right frontal burr hole placement. Since prior examination a septation hasn't developed along the anterior aspect of the third ventricle posterior to the infundibular recess and anterior to the foramen of Monro.Since prior exam the patient is developed some dural thickening adjacent to the right frontal bone. Since the prior exam the patient is developed the small extra-axial 5 mm focus of T2, T1 and FLAIR signal hyperintensity behind and adjacent to the right occipital lobe measuring about 4 mm in diameter.There is an 8 x 6 mm sagittal dimension nonenhancing lesion just above the tectal plate associated with some depression of the tectal plate and narrowing of the aqueduct. This could be a source of obstructive hydrocephalus. It abuts the junction of the vein of Galen and internal cerebral veins on one side and the tectal plate on the other side is associated with punctate foci of signal loss and has heterogeneous signal on T2 imaging. The adjacent portion of the aqueduct is nearly obliterated.There is a couple punctate foci of signal hyperintensity on diffusion-weighted imaging which are not associated with diffusion restriction. These are located in the left occipital lobe and in the left middle frontal gyrus subcortical white matter. These could not be identified on the prior MRI.There is redemonstration of ventriculomegaly. Biventricular diameter is 50 mm on the current exam and was 50 mm on the prior exam. The third ventricle width is 11 mm on the current exam and 11 mm on the prior exam.There are subdural effusions present bilaterally which were also present on the prior exam. These are also stable.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Punctate focus of T2 and FLAIR signal hyperintensity is present in the right basal ganglia. Several punctate foci of signal hyperintensity are present in the pons.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. The eyeball lenses are thin.

Output: 1.Since the prior exam the patient is undergone right sided burr hole placement for stereotactic third ventriculostomy. There are now some septations present within the third ventricle. The size of the lateral ventricles and third ventricles remain unchanged.2.The prior exam the patient is developed a couple new extra-axial collections adjacent to the right frontal lobe and right occipital lobe. These are relatively small in size. One possibility is that there postoperative nature they do not have any significant mass effect.3.A couple new punctate foci of diffusion abnormality are present which do not appear to represent diffusion restriction. These could represent new vascular events which no longer have diffusion restriction.4.There is redemonstration and no change of a small calcified lesion interposed between the tectal plate and the junction of the vein of Galen and internal cerebral veins. The aqueduct is narrowed immediately adjacent to this lesion. This could potentially represent pineal gland but its location is rather odd. Signal characteristics indicated that they may be associated with calcifications. Its location suggesting may be a potential cause for significant narrowing of the aqueduct and explain the patient's ventriculomegaly. It is associated with near obliteration of the aqueduct at its site.5.Periventricular and subcortical white matter lesions of a mild degree and scattered lesions in the brainstem and right basal ganglia are nonspecific. At this age they are most likely vascular related. 6.Subdural effusions are stable compared to the prior exam. This could be related to atrophy.


Instruction: Generate impression based on findings.

Input: clinical question: Patient with decreased mental status and with new right facial droop. Signs and symptoms: Right facial droop. Nonenhanced head CT:Extensive small vessel disease as was noted on prior MRI exam is again identified. The age of a small was ischemic strokes cannot be determined on CT.Also as was noted on prior exam an old large right frontal MCA territory cortical stroke shows no interval change. Prominence of cortical sulci and ventricular system are believed to be at least partially secondary to underlying parenchymal volume loss secondary to old ischemic strokes.No evidence of hemorrhage, mass effect or midline shift or hydrocephalus.Head CT is not sensitive for detection of any acute strokes.Calvarium is intact. There is evidence of an old left orbital blowout fracture of the floor and the lamina papyracea as was noted on prior exam.

Output: 1.Advanced to small vessel is of indeterminate age.2.Old right MCA frontal lobe cortical stroke as was noted on prior exam.3.No evidence of hemorrhage, mass-effect or midline shift.


Instruction: Generate impression based on findings.

Input: New onset numbness, but normal neurological exam . There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. The 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: 78 years, Male, vertigo and hearing loss. History of HCC and atrial fibrillation. Multiple sequences are mildly motion degraded. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration for age. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes and similar to prior. There is a focus of susceptibility indicating chronic hemorrhage in the right occipital lobe, which is new since prior. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits without evidence of bilateral intraocular lens implants. There is partial opacification of the right-sided mastoid air cells. There is also mild opacification of the bilateral anterior ethmoid air cells. Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: 1. Mild chronic small vessel ischemic changes similar to prior study from 12/18/2014. There is no evidence of acute ischemia.2. Small focus of chronic hemorrhage in the right occipital lobe which is new since prior MRI. This finding is nonspecific in etiology.3. Partial opacification of the right mastoid air cells.4. If there is significant suspicion for intracranial metastatic disease consider postcontrast sequences, although there is no gross evidence of intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Male, 8 years old, status post Chiari decompression, now with central apnea. Expected findings are seen status post suboccipital craniectomy and resection of the posterior arch of C1. The CSF space posteriorly through the foramen magnum is expanded relative to the prior examination. Robust biphasic CSF flow is seen through the anterior aspect of the foramen magnum. Posteriorly, within the expanded CSF space, there is a blush of flow related signal, but no significant CSF flow is seen along the posterior aspect of the spinal cord from the C2 level down.Cytotoxic edema is evident within the cerebellar tonsils compatible with surgical debulking and tonsillopexi. The tonsils appear much less elongated than on the preoperative examination. Apart from this, no additional significant brainstem or cerebellar edema is seen. The known multiloculated spinal cord syrinx is partially visualized. The brain parenchyma otherwise shows normal morphology and signal characteristics. No significant generalized mass effect is seen. No large intracranial hemorrhage is detected. The ventricular system has increased in caliber by several millimeters, both supratentorially and infratentorially. For example, the right temporal horn now measures 10 mm in width, previously 6 mm.

Output: 1.Expected findings status post Chiari decompression. The CSF space through the posterior foramen magnum is expanded and there is evidence of mild CSF flow in this area. No flow related signal is seen, however, more inferiorly along the posterior cervical spinal cord.2.Postoperative changes are seen within the cerebellar tonsils compatible with debulking and tonsillopexi. Edema within these operated tissues is within expected postoperative limits. No other significant brain stem or cerebellar edema is noted.3.Since the prior examination, the caliber of the ventricular system has increased by several millimeters. The size of the ventricles, however, probably remains within normal limits.


Instruction: Generate impression based on findings.

Input: 47-year-old female with shoulder pain for weeks and limited range of motion. Evaluate for rotator cuff tear versus adhesive capsulitis. ROTATOR CUFF: There is increased signal abnormality within the supraspinatus indicating mild tendinosis. The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. Mild degenerative changes of the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Although this examination was not protocoled for detailed evaluation of the glenoid labrum, there is linear increased signal abnormality traversing the posterior superior glenoid labrum raising the possibility of a tear. The glenohumeral joint alignment is anatomic.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Supraspinatus tendinosis without evidence of a full-thickness rotator cuff tear. 2. Findings suspicious for a posterosuperior labral tear. This could be further evaluated with a dedicated MRI arthrogram if clinically warrented.


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. The imaged spinal cord displays normal signal and morphology although there is unchanged mild dilatation of the central spinal canal measuring up to 1 mm. The conus terminates 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.

Output: 1.No evidence of tethered cord.2.Unchanged mild dilatation of the imaged central spinal canal.


Instruction: Generate impression based on findings.

Input: Images are limited by patient motion. The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body heights are well-maintained. There is multilevel disk narrowing, most prominent at C5-C6 through C7-T1. No worrisome focal marrow signal abnormality is appreciated, with endplate degenerative changes at C5-C6 and C6-C7. The spinal cord is of normal caliber and signal.At C2-C3, there is no significant disk pathology or stenosis.At C3-C4, there is a trace disk bulge and minimal bilateral facet arthropathy resulting in mild bilateral foraminal narrowing.At C4-C5, there is a mild diffuse posterior osteophyte disk complex with right paracentral/proximal foraminal prominence. There is indentation of the right ventral thecal sac laterally. There is suggestion of minimal bilateral uncovertebral hypertrophy with overall moderate right foraminal narrowing.At C5-C6, there is a trace posterior osteophyte disk complex a slight left paracentral prominence and bilateral uncovertebral hypertrophy without stenosis.At C6-C7, there is a mild diffuse posterior osteophyte disk complex with bilateral uncovertebral hypertrophy. There is mild bilateral foraminal narrowing.At C7-T1, there is a trace posterior osteophyte disk complex with bilateral uncovertebral hypertrophy and mild bilateral foraminal narrowing.THORACIC SPINE

Output: 1. Mild cervical spondylotic changes with moderate right foraminal narrowing at C4-C5.2. No significant thoracic degenerative changes.3. Incidental prominent probable lipoma within the posterior subcutaneous fat along the mid thoracic region with mild localized mass-effect. Please correlate with physical exam.


Instruction: Generate impression based on findings.

Input: 47-year-old woman with left hip pain ACETABULAR LABRUM: There is degenerative tearing of the anterior and the anterior superior labrum with thickened soft tissue surrounding the labrum suggesting focal synovitis or labral hypertrophy.ARTICULAR CARTILAGE AND BONE: No erosions are evident. The articular cartilage of the hip appears intact. Bone marrow signal intensity is within normal limits. SOFT TISSUES: Unremarkable appearance of the soft tissues. ADDITIONAL

Output: Tearing of the anterior and anterior superior labrum with other findings detailed above.


Instruction: Generate impression based on findings.

Input: 16-month-old female with first time seizures: eyes rolling back, bilateral extremity shaking. Evaluate for structural abnormalities. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears within normal limits. No findings to suggest seizure focus are appreciated. Specifically, there is no evidence of gray matter heterotopia or cortical dysplasia. The bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture. There is no abnormal intracranial enhancement. A 10 mm cystic focus is evident within the right occipital lobe, in line with the expected location of the occipital horn of the lateral ventricle. This collection follows CSF signal on all sequences with no surrounding parenchymal abnormality. The ventricles and basal cisterns are otherwise 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. Please note that artifact of uncertain etiology obscures the left aspect of the posterior fossa on certain sequences.

Output: No specific findings are seen to account for the patient's seizures. A cystic focus within the right occipital lobe likely reflects a normal variant partial sequestration of the occipital horn, or perhaps a neuroglial cyst.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Brain MRI:There is a small focal area of restricted diffusion with ADC hypointensity within the midbrain, just rightward posterior-lateral to the cerebral aqueduct. There is a questionable punctate focus of restricted diffusion along the rightward superior aspect of the vermis.T2 hyperintensity is present within the white matter, pons, and medial cerebellar hemispheres, confluent in several locations, without restricted diffusion. Punctate foci of susceptibility hypointensity are noted in the right cerebellum, midline midbrain, leftward pons, and medial bilateral cerebellar hemispheres. A small focus of encephalomalacia is noted within the peripheral left cerebellar hemisphere.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Brain MRA:There is smooth stenosis of a left M2 MCA segment. There is also smooth tapering of the distal right vertebral artery with a more focal significant stenosis at the confluence with the left vertebral artery. Antegrade flow is maintained through these segments.There is antegrade flow within the distal left vertebral artery, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior and posterior cerebral arteries as well as right middle renal artery. No arterial occlusions, arteriovenous malformations, or aneurysms are identified.

Output: 1.There is a small focal area of restricted diffusion with ADC hypointensity within the midbrain, just rightward posterior-lateral to the cerebral aqueduct consistent with acute to subacute ischemia. There is a questionable punctate focus of restricted diffusion along the rightward superior aspect of the vermis.2.Advanced chronic small vessel ischemic disease involving both supratentorial and supratentorial brain. Aforementioned foci of susceptibility most likely represent remote microhemorrhage associated with the small vessel disease.3.There is smooth stenosis of a left M2 MCA segment. There is also smooth tapering of the distal right vertebral artery with a more focal significant stenosis at the confluence with the left vertebral artery. Antegrade flow is maintained through these segments.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with seizures and history of strokes. MRI brain:A band of encephalomalacia is seen involving the posterior left middle frontal gyrus, the left centrum semiovale and left parietal and occipital lobes, all within the MCA distribution. A small chronic cortical infarct is evident within the right inferior parietal lobule.No evidence of parenchymal edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Apart from ex vacuo dilatation of the left lateral ventricular atrium, the ventricles are within normal limits.MRA brain:A slight paucity of left MCA M3 and M4 branches is noted relative to the right. Otherwise, no significant intracranial vascular abnormalities are observed. No aneurysm or vascular malformation is detected. The ACOM artery is moderately sized and unremarkable. Prominent bilateral PCOM arteries are evident.MRA neck:No significant vascular stenosis is detected in the carotid vessels of the neck by NASCET criteria. No significant vascular stenosis is detected in the vertebral vessels.

Output: 1.Evidence of a large chronic left MCA distribution infarct with a small right parietal lobe chronic infarct.2.No acute ischemia or other acute intracranial abnormalities are detected.3.Slight paucity of distal left MCA vessels is compatible with the chronic infarction in this distribution. Otherwise, no significant intracranial vascular lesion is detected.4.No significant vascular lesion is seen in the neck.


Instruction: Generate impression based on findings.

Input: Mild cognitive impairment, so stated [G31.84], Reason for Study: ^Reason: ETIOLOGY FOR DEMENTIA History: FORGETING DATES AND NAMES No evidence of acute ischemic or hemorrhagic lesion on scan.Multiple scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular and centrum semiovale are seen indicating nonspecific small vessel ischemic disease, unchanged.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickenings on bilateral ethmoid sinuses.

Output: Nonspecific small vessel ischemic disease, unchanged.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Brain: The images are partly degraded by dental brace artifact. There are several predominantly periventricular callososeptal T2 hyperintense white matter lesions without associated enhancement, similar to prior examination. However, a punctate nonenhancing focus of T2 hyperintensity adjacent to the left lateral ventricle appears to be new. There is a blush of enhancement the mid pons, consistent with capillary to telangiectasia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.  Cervical Spine: There appears to be a T2 hyperintense lesion in the right spinal cord at the C2-C3 level. There are no enhancing spinal cord lesions. There is lack of the usual cervical lordosis, but no spondylolisthesis. The vertebral body heights are preserved. The bone marrow appears unremarkable. There is no evidence of significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues are unremarkable.

Output: 1. Multiple intracranial demyelinating lesions, with what may represent a small new lesion in the left parietal lobe periventricular white matter, although assessment is limited by differences and dental artifact.2. Possible small demyelinating lesion in the right upper cervical spinal cord, without enhancing lesion to suggest acute inflammation.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, 4 years old, status post trauma, pedestrian versus truck, GCS 15 with neck pain. Brain:No definite evidence of intracranial hemorrhage is seen. The area of concern as noted on the prior CT examination along the right aspect of the clivus shows corresponding FLAIR signal which is typical of a flow-related artifact. No other correlating findings on the other MR sequences are detected.Scalp swelling and hematoma formation are evident in the right occipital region. No parenchymal or extra-axial abnormality is seen subjacent to this region. However, there is a very subtle gyral FLAIR hyperintensity within the left frontal lobe with some associated very subtle hypervascularity in the sulci.No significant generalized mass effect is seen. No other parenchymal abnormalities are detected. The ventricles are normal in size and morphology.Cervical spine: Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema or marrow replacement is seen. The visualized spinal cord shows normal signal intensity and morphology. No epidural abnormalities are detected. The paraspinal soft tissues are within normal limits. There are no findings to suggest ligamentous injury.

Output: 1.No definite acute intracranial hemorrhage is seen. The area suspected to represent a small amount of blood product along the right clivus does not show convincing MR features to confirm the presence of hemorrhage. This finding may have been artifactual or it may have represented a small amount blood product which has since resolved.2.Very subtle FLAIR hyperintensity seen within the left frontal region along with very subtle associated sulcal vascularity. As this is opposite the region of right occipital scalp injury, it could represent a mild contrecoup contusion. A follow-up examination is suggested to assess for resolution.3.Assessment of the cervical spine is within normal limits. There are no findings to indicate posttraumatic injury.


Instruction: Generate impression based on findings.

Input: 60-year-old female on heparin and eptifibatide drips with an INR of 2.1, presenting with headache. No evidence of intracranial hemorrhage, edema, mass, midline shift or hydrocephalus. Nonspecific small right frontal hypodensity. Left frontal hypodensity is likely post-traumatic change but very nonspecific. If further evaluation is clinically warranted, MRI is recommended for further characterization.The ventricles and basal cisterns are unremarkable in size and configuration.The calvaria and skull base are radiographically unremarkable. Visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence for acute intracranial hemorrhage.2. Left frontal hypodensity along the orbital gyrus is is nonspecific. Although location raises the question of trauma, additional considerations include edema due to other causes such as neoplasm or infarction. If further evaluation is clinically warranted, MRI is recommended for further characterization.


Instruction: Generate impression based on findings.

Input: 54-year-old male with numbness and tingling. Non-enhanced CT of the cervical spine:Axial 3-mm nonenhanced CT of the cervical spine is obtained. Sagittal and coronal 2-D reformatted images were obtained as well.The bony density in the alignment the vertebral column is unremarkable. Very minimal degenerative disk disease is identified.Limited view of the skull base and review of foramina magnum are unremarkable.There is no evidence of bony central spinal stenosis.Minimal compromise of the left neural foramina at C5 -- C6 secondary to hypertrophic changes of the left uncovertebral is noted.Mild compromise of the left neural foramina at C6 -- C7 also secondary to hypertrophic changes of uncovertebral is present. This examination is otherwise unremarkable.For better evaluation of cervical spine and in particular for better assessment of soft tissues in particular the disk material and ligaments which could result in compromise of the neural foramina an MRI is recommended. This examination is not sensitive for detection of subtle abnormalities of the disk including herniated disk.

Output: 1.Mild degenerative disk disease and resultant compromise of the left neural foramina at C5 -- C6 and C6 -- C7 levels. No detectable bony central spinal stenosis.2.MRI examination of cervical spine is significantly more sensitive for detection of subtle disk abnormalities, neural foramina compromise and the spinal cord.


Instruction: Generate impression based on findings.

Input: 62-year-old male with history of intraventricular hemorrhage. Now with fever and abdominal pain. Exam is somewhat limited by motion artifact.CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions and basilar atelectasis. Right apical scarring also present.MEDIASTINUM AND HILA: Calcified hilar lymph nodes without any pathologically enlarged lymph nodes. Small pericardial effusion. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Calcified granuloma indicative of prior granulomatous infection. There is a likely gallstone in the gallbladder neck but this is unclear due to the motion artifact. No pericolicystic fluid or biliary ductal dilatation.SPLEEN: Calcified granuloma without any other abnormality.PANCREAS: No significant abnormality notedADRENAL GLANDS: 3 x 1.8 centimeter left adrenal nodule. 1.3 x 1.7 cm right adrenal nodule. These are nonspecific on this examination but likely represent adenomas given the patient has no primary malignancy. Dedicated adrenal CT or MRI may be performed for further characterization as clinically indicated.KIDNEYS, URETERS: Atrophic. Hypodense lesions in both kidneys are too small to characterize but likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is slightly enlarged.BLADDER: The bladder is distended without any focal abnormalities.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. No specific source of fever as clinically queried.2. Bilateral pleural effusions and pericardial effusion.3. Distended bladder with enlarged prostate. Consider Foley catheter for drainage.4. Bilateral adrenal nodules which are nonspecific on this examination but likely represent bilateral adenomas. Dedicated imaging of the adrenals with either CT or MR could be obtained for more specific diagnosis if clinically indicated.These findings were communicated to the clinical service at 9:15 a.m.


Instruction: Generate impression based on findings.

Input: The patient submitted outside MRI dated 6/5/14. Submitted outside study was compared to the current MRI dated 2/18/15.On the prior study, there are multiple masses and segmental non mass enhancement in the lower inner quadrant in the left breast. The lumpectomy was performed for these lesions in July 2014. No other significant changes are noted.

Output: Known left breast cancer, for which a lumpectomy was performed in July 2014.


Instruction: Generate impression based on findings.

Input: 45-year-old female with menorrhagia and uterine fibroids. Preimaging for UFE. PELVIS:UTERUS, ADNEXA: The uterus measures 11.7 cm in length, 10 cm in transverse, and 6 cm in AP diameter. The endometrial stripe measures 10.9 mm in thickness. Normal junctional zone. A left lateral intramural T2 hypointense fibroid measures 3.2 x 3.1 x 3.4 cm (axial series 501 image 31, coronal series 601 image 11) and causes a mild deformity of the endometrial canal (series 901 image 24). Avid enhancement of the fibroid is noted.Incidental note is made of a 2 cm nabothian cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild colonic diverticulosis without evidence for acute diverticulitis. Trace pelvic ascites, likely physiologic.BONES, SOFT TISSUES: Rectus diastases.OTHER: No significant abnormality noted.

Output: Left lateral uterine fibroid measuring up to 3.4 cm in diameter is predominantly intramural in location, however associated mild deformity of the endometrial canal is noted and a small submucosal component cannot be excluded.


Instruction: Generate impression based on findings.

Input: Male 85 years old Reason: 85 yo M with chondrocalcinosis with worsening pain in R ankle/foot; evaluate for ligament/tendon tear/inflammation, soft tissue swelling History: pain, difficulty with ambulation needing wheelchair. TENDONS: A small amount of fluid within the sheaths of the posterior tibial and flexor digitorum tendons is within normal limits. There is fluid within the flexor hallucis longus tendon sheath just proximal to the knot of Henry which may represent mild tenosynovitis. A small amount of fluid in the peroneal tendon sheaths is within normal limits. Increased signal intensity within the peroneus brevis tendon as it courses beneath the fibular tip likely represents mild tendinosis. The Achilles' tendon appears normal.LIGAMENTS: The lateral collateral ligament complex is intact. The distal tibiofibular syndesmotic complex is intact. The deep fibers of the deltoid ligament have lost their normal striations and there is an ossicle distal to the medial malleolus. These findings suggest old trauma. The superficial components of the deltoid ligament appear unusually thickened which may likewise reflect old injury.ARTICULAR SURFACES AND BONE: There is edema within the distal tibia that extends from the epiphysis into the distal diaphysis, off the field of view of this study. The signal abnormality is most concentrated along the anterolateral aspect of the distal tibial epiphysis and appears associated with a thin band of horizontally oriented low signal intensity immediately adjacent to the physeal scar. We suspect that this constellation of findings represents a stress fracture with edema extending into the distal tibial diaphysis. Additional foci of signal abnormality within the foot are likely degenerative in etiology reflecting mild osteoarthritis. Metallic artifact within the head and neck of the first metatarsophalangeal joint represents arthroplasty which is incompletely imaged on this study. The ankle joint itself appears normal with no joint effusion. We see no osteochondral defects.ADDITIONAL

Output: 1. Bone marrow edema in the distal tibia as described above. This appears most concentrated along the lateral aspect of the distal tibial epiphysis and is associated with a small linear focus of low signal intensity that we suspect represents a stress fracture.2. Fluid within the flexor hallucis longus tendon sheath proximal to the knot of Henry may represent tenosynovitis.3. Generalized soft tissue swelling.4. Other findings as described above.Findings discussed by myself Dr. Ward with Dr Siddiqui 5:35 p.m.. 04/17/15.


Instruction: Generate impression based on findings.

Input: Reason: 76M hx GL 4+3=7 prostate cancer. Evaluate for focal lesion for focal ablation therapy. History: as above PELVIS:PROSTATE:Prostate Size: 4.8 x 3.3 x 3.5 cmPeripheral Zone: There is a 2.0 x 2.0 cm T2/ADC hypointense lesion in the peripheral zone of the right mid and base of the prostate. This lesion extends into the transition zone and along the inferior aspect of the seminal vesicles.Central Gland: Multiple BPH nodules.Seminal Vesicles: Large lesion at the right mid and base extends to the inferior seminal vesicles.Extracapsular Extension: There is indistinctness of the capsule at the level of the right base (801/17).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.Large lesion in the peripheral zone of the right mid prostate and base, suspicious for prostate adenocarcinoma.2.Irregularity of the capsule of the right base, raising suspicion for extracapsular extension.3.Lesion at the right base is immediately adjacent to the seminal vesicles, microinvasion cannot be excluded.4.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Clinical question: History of superior sagittal meningioma status post FRT. Signs and symptoms: Surveillance scan. Pre and post enhanced brain MRI:Examination redemonstrates a mass within the superior sagittal sinus in the posterior parietal region. The mass results in expansion and complete occlusion of the sinus similar to prior exam. It extends for approximately 60 mm within the sinus and with maximum expansion of sinuses of approximately 16.2mm measured on sagittal images. Although there is no significant change in transaxial dimensions of this enhancing mass there is subtle interval decrease in expansion of the sinus since prior study. It measures 16.2 mm on current exam compared to prior study measurements of approximately 19.2 mm suggesting subtle interval decreased size of tumor. Thickening of the overlapping parietal bone with a rim of enhancement remains identical to prior study. The expanded sinus demonstrate mild flattening deformity of the adjacent parietal lobe without detectable FLAIR or T2 signal abnormality to suggest edema.The signal void of superior sagittal sinus anterior to the tumor extends for approximately 30 mm and related enhancement highly suggestive of thrombosed sinus. This finding is fairly similar to prior study. The signal intensity of superior sagittal sinus posterior to the tumor in the occipital region is detected and with normal pattern of enhancement.The anatomical morphology as well as signal intensity of brain parenchyma is otherwise within normal on all MRI sequences and without detectable abnormal parenchymal or left meningeal enhancement.Unremarkable images to the orbits, paranasal sinuses and mastoid air cells.

Output: 1.Expansile enhancing mass within the posterior parietal superior sagittal sinus consistent with patient's known meningioma demonstrates subtle interval decreased size (sagittal post enhanced measuring 16.2 compared to prior study measurement of 19.2 mm) compared to prior exam and stable otherwise.2.Unremarkable and stable exam otherwise.


Instruction: Generate impression based on findings.

Input: Female 34 years old with left leg mass, evaluate for lipoma. Markers were placed in the region of palpable mass along the anterior tibial subcutaneous tissues. There is a focal prominence of fat within this region without discrete mass evident. Findings may represent an underlying lipoma. No abnormal enhancement was identified. Bone marrow signal intensity is within normal limits. There is mild subcutaneous edema about the medial and lateral malleolus.

Output: Focal prominence of fat within the region of palpable mass likely representing a lipoma. No evidence of malignant features.


Instruction: Generate impression based on findings.

Input: 72 year old man with ascending aortic aneurysm referred to evaluate Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 187 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 73 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 113 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVEDV is 168 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet and opens widely. There moderate aortic regurgitation. The regurgitant volume 26ml and regurgitant fraction 24%. 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 mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root and ascending aorta are mildly dilatedSinuses of Valsalva: 4.6 x 4.8 cmSinotubular junction: 4.2x4.3 cmAscending aorta (maximal diameter): 4.4 x 4.6cmMid Aortic Arch: 3.3x3.4cmPulmonary 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. Normal LV size and systolic function (LVEF 61%).2. Normal RV size and systolic function (RVEF 57%).3. Moderate aortic regurgitation.4. Mild to moderate tricuspid regurgitation.5. Dilated aortic root and ascending aorta, as above.When compared to the prior study, no significant change.


Instruction: Generate impression based on findings.

Input: 42 years Male (DOB:4/12/1974)Reason: history of L frontal brain tumor s/p resection and RT History: nonePROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA The patient is status post left frontal craniotomy for left frontal lobe surgery. There is a small linear focus of enhancement present along the inferior medial aspect of the resection site which is stable compared to prior exam. There is also small focus of T1 signal hyperintensity adjacent to the frontal horn of left lateral ventricle. Perfusion imaging does not demonstrate any areas of increased microvascularity. The signal characteristics of the apparent fluid within the resection cavity are similar to spinal fluid.There is some leptomeningeal enhancement present in the left middle frontal gyrus which was also present on the prior exam and has not changed. This associated with some leptomeningeal FLAIR signal hyperintensity.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images predominantly located in the left hemisphere. This was also 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.

Output: 1.The patient is status post left frontal lobe surgery. The appearance of the resection site is stable compared to the prior exam. Small focus of enhancement at the surgical site remains stable. It is quite possible that it is related to postoperative effect.2.Leptomeningeal enhancement along the left middle frontal gyrus is stable compared to the prior exam. One possibility is that this represents collateralized venous flow.3.Left hemispheric periventricular white matter lesions present which are nonspecific but may be posttreatment related.


Instruction: Generate impression based on findings.

Input: Female; 73 years old. Reason: new abd pain History: known ovarian cancer ABDOMEN:LUNG BASES: Cardiomegaly.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: Left pelvicaliectasis, unchanged. RETROPERITONEUM, LYMPH NODES: Reference right retrocrural lymphadenopathy has mildly increased and measures up to 2.9 x 2.2 cm (series 8/14), previously 2.5 x 1.8 cm. Multiple additional retroperitoneal lymph nodes have overall mildly increased in size. No new sites of disease.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Fatty marrow infiltration in the lumbar spine, likely due to post-radiation effect.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left common iliac node versus soft tissue measures 1.2 x 1.0 cm, unchanged (series 13/34).BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Right total hip prosthesis.OTHER: Trace pelvic free fluid, which may be reactive to the increased retroperitoneal lymphadenopathy.

Output: Increased retrocrural and retroperitoneal lymphadenopathy. No new sites of disease.


Instruction: Generate impression based on findings.

Input: Parkinson disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is blurring of the substantia nigrosomes bilaterally. There is mineralization of the bilateral globi pallidi. There is mild nonspecific cerebral white matter T2 hyperintensity. The ventricles and sulci are mildly prominent due to 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 are bilateral lens implants. There is mild scattered paranasal sinus inflammatory disease.

Output: Findings compatible with Parkinson disease. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Status post spinal cord untethering and lipoma. History of VACTERL syndrome. There are postsurgical changes of recent spinal cord untethering with foci of air within the lower lumbar epidural space and posterior paraspinous soft tissues as well as laminotomy defects involving the lower lumbar spine. Intradural blood products are evident with low T2 signal in the distal thecal sac. There are also postoperative fluid and blood products in the dorsal epidural space from the L3 level to the lumbosacral junction with associated severe effacement of the thecal sac and mass effect on the conus, which is low-lying, as well as the cauda equina nerve roots. Filar lipoma is again evident with decrease in amount of fat since the preoperative study consistent with resection. Precise conus position is difficult to discern due to the diminutive appearance of the lumbar thecal sac. Conus is anteriorly displaced related to the epidural fluid which also limits the utility of the prone sequence. Vertebral body heights and alignment are maintained. Neural foramina are patent.

Output: Interval postoperative changes of spinal cord untethering. There is severe effacement of the distal thecal sac from the L3 to the S1 levels related to epidural fluid and blood products.Dr. Ali discussed above findings with Amanda Johnson at 12:30 PM on 8/24/2016.


Instruction: Generate impression based on findings.

Input: 72-year-old woman with remote history of breast cancer, now with increased tone in the upper extremities, pain, and decreasing ambulation. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has grossly normal signal characteristics and overall morphology. Poorly characterized degenerative changes are seen in the cervical spine. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1.Examination severely limited by patient motion despite attempts to repeat after sedation.2.No gross evidence of tumor or cord pathology.3.Multilevel degenerative disc disease, poorly characterized.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. 5/21/2013 TRUS biopsy showed 3+3 disease in the left medial base. PELVIS:PROSTATE:Prostate Size: 4.8 x 6.0 x 6.9 cmPeripheral Zone: Demonstrated again are to punctate suspicious foci in the mid posterior peripheral zone. The more superior lesion measures approximately 5 mm (series 801/20). The more inferior lesion measures approximately 4 mm (series 801/17). These are both associated with restricted diffusion and are unchanged when compared to the prior study.Central Gland: Significantly enlarged transition zone consistent with benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Mild nonspecific dilatation of the partially imaged right distal ureter.OTHER: No significant abnormality noted.

Output: Two subcentimeter foci suspicious for prostatic adenocarcinoma in the mid posterior peripheral zone are unchanged. No evidence of extraprostatic extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 59-year-old male with cirrhosis and IPMN. Please evaluate. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. No suspicious focal hepatic lesions. No intra-or extra hepatic biliary ductal dilatation. Multiple subcentimeter foci of fluid signal intensity are to small to characterize, but likely represent simple cysts.SPLEEN: Splenic varices.PANCREAS: The reference T2 hyperintense, T1 hypointense, nonenhancing lesion in the uncinate process of the pancreas measures 3.8 x 2 .4 cm, previously 3.8 x 2.3 cm (image 25, series 5). No definite communication to the pancreatic duct is identified. The pancreatic duct is not dilated. No pancreatic atrophy is noted. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant ascites.

Output: 1.No significant interval change in the reference cystic lesion in the uncinate process of the pancreas. Differential considerations include a side branch IPMN as well as a macrocystic serous cystadenoma.2.Cirrhotic morphology of the liver, with no evidence of suspicious focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: History of multiple sclerosis. There are multiple T2 hyperintense lesions in supratentorial and infratentorial white matter lesions. Many of the lesions demonstrate T1 hypointensity, but none of them appear to enhance. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No appreciable change in the supratentorial and infratentorial demyelinating lesions.


Instruction: Generate impression based on findings.

Input: Elbow pain Examination is limited by motion artifact and by the patient's body habitus.Imaging was performed from the humeral head through just distal to the elbow. The images demonstrate an absent extra-articular portion of the biceps tendon within the intertubercular groove. There is marked atrophy of the long head of biceps particularly proximally with with atrophy also noted along the myotendinous junction. There is also mild muscle edema about the myotendinous junction which may represent subacute atrophy or edema. The biceps insertion upon the radial tuberosity is intact. The marrow signal of the humerus is normal. The signal and caliber of the remaining are musculature is normal.

Output: Marked atrophy of the long head of the biceps proximally with fatty atrophy extending through the myotendinous junction, the result of proximal biceps tendon rupture.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: stroke, seizures History: 82Yrs female with h/o above p/w possible first time sz? There is no evidence of acute ischemic or hemorrhagic lesion.Tissue loss with corresponding ventricular enlargement on the right hemisphere involving right basal ganglia, right thalamus, right frontal, temporal and somewhat parietal lobe with evidence of susceptibility lesions indicating hemosiderin deposition. Patchy FLAIR high signal intensity on bilateral periventricular white matter indicating nonspecific small vessel ischemic lesion.There is no mass, mass effect, edema, midline shift, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Right hemispheric extensive encephalomalacia with ex vacuo changes of the right lateral ventricle as described above with hemosiderin deposition indicating prior hemorrhagic infarction.2. No evidence of acute ischemic or hemorrhagic lesion. 3. Minimal non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 27 year old admitted with troponin elevation and left ventricular systolic dysfunction being evaluated for etiology of cardiomyopathy. Left VentricleThe left ventricle is moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 267 ml (normal range 142+/-34), the LV end systolic volume index is 87 ml/m2 (normal range 25+/-9), the LVESV is 173 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 127 g (normal range 164+/-36). There left ventricular dysfunction is global. There is an area of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process in the mid-basal inferoseptal wall in a pattern atypical for myocardial infarction and may represent an area of myocarditis .Left AtriumThe left atrium visually is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 137 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 74 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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 drain normally into the right atrium.PericardiumThere is a small pericardial effusion, there is no hemodynamic compromise relating to the effusion. Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%.There left ventricular dysfunction is global. There is an area of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process in the mid-basal inferoseptal wall in a pattern atypical for myocardial infarction and may represent an area of myocarditis.2. The right ventricle is normal in size with mildly reduced systolic function (RV ejection fraction is 46%). 3. Left atrial enlargement


Instruction: Generate impression based on findings.

Input: Neck pain and left upper extremity pain since one year Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Minimal disc bulge with tiny central disc protrusion. No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C6-7: Minimal disc bulge 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: Minimal degenerative changes in the cervical spine without significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with weakness and numbness and pain in the right lower extremity, myelopathic exam, T10 sensory level. Cervical:The cervical lordosis is straightened. Alignment is unremarkable. Vertebral body height and morphology are within normal limits. Mild edema is seen along the left C6-7 endplates, likely degenerative.The visualized spinal cord demonstrates normal signal intensity. Morphology is unremarkable except as discussed below. No epidural abnormalities are suspected. No pathologic intraspinal enhancement is seen.C2-3: Unremarkable. C3-4: Central disc protrusion which minimally contacts the ventral cord. No significant spinal canal stenosis. No significant foraminal narrowing. C4-5: Unremarkable. C5-6: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C6-7: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation which contacts and slightly flattens the ventral cord. There is a moderate generalized spinal canal stenosis. There is a superimposed left foraminal protrusion which severely narrows the left neural foramen. The right neural foramen is mildly narrowed.C7-T1: Unremarkable. Thoracic:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is seen.The spinal cord demonstrates normal signal intensity and morphology. No pathologic cord or leptomeningeal enhancement is seen. No epidural pathology is suspected.A small left paracentral disc protrusion is seen at T7-8. Scattered facet hypertrophy is also noted. No significant spinal canal or foraminal stenosis is detected.As seen on a lateral scout sequence, there are six lumbar type vertebral bodies and there may be partial fusion across the L5-6 level. Relatively mild degenerative disease affects the partially visualized lumbar spine.

Output: 1.Multilevel degenerative findings are seen in the cervical spine, most severely affecting the C6-7 level where there is a disc osteophyte complex which causes moderate generalized spinal canal stenosis. At the same level, there is a left foraminal protrusion which severely narrows the neural foramen.2.Relatively mild degenerative findings are seen in the thoracic spine without significant spinal canal or foraminal stenosis.3.No spinal cord or epidural abnormalities are detected in the cervical or thoracic regions.


Instruction: Generate impression based on findings.

Input: Lumbago with sciatica, right side. Lower back pain after injury one month ago. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits without evidence of fracture. Small Schmorl's nodes are noted involving the endplates at the L1 through L4 vertebral bodies. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the upper L1 level.There is evidence of epidural lipomatosis with mild to moderate degree of spinal canal narrowing particularly at the L2-L3 and L3-L4 levels. There are mild degenerative changes including disc desiccation with small left paracentral protrusion at the left L5-S1 level without associated spinal canal or neural foraminal stenosis. Remainder of the lumbar discs are unremarkable. There is also mild facet arthropathy, relatively more prominent in the lower lumbar spine. No evidence of spondylolysis within the limits of MRI. Paraspinous soft tissues are unremarkable.

Output: 1. Small central disc protrusion at the L5-S1 level without associated spinal canal or neural foraminal stenosis. Neural foramina in the remainder of the lumbar spine are also patent.2. Evidence of epidural lipomatosis which narrows the lumbar spinal canal to a mild to moderate degree, particularly at the L2-L3 and L3-L4 levels.3. Additional findings including small multilevel Schmorl's nodes and mild facet arthropathy. No evidence of edema or height loss in the vertebral bodies to suggest recent trauma.


Instruction: Generate impression based on findings.

Input: Head and neck cancer. Head CT:There is a vague area of enhancement in the left temporal lobe (image #11, series 10). This should be evaluated with MRI brain to exclude the possibility of a metastatic disease. No obvious mass is identified.Neck CT:Post-treatment changes with associated soft tissue thickening in the neck are unchanged. There is no evidence of mass, or adenopathy based on size criteria.The limited view of the upper lungs appear unremarkable.Degenerative disease of the cervical spine is again present, with mild neuroforaminal narrowing at C3 -- C4 and C4 -- C5 levels.

Output: 1. Vague enhancement in the left temporal lobe may be vascular in etiology. However, further evaluation with MRI brain without and with contrast is recommended to exclude the small possibility of a metastatic focus. 2. No evidence of recurrence or adenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Reason: r/o meniscal/ligamentous pathology History: pain MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Normal appearing left knee without findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: The patient is a 68-year-old male with history of lung cancer status post resection and brain mets status post resection presenting with two days of confusion. In the area of the known posterior parietal lobe metastatic lesion seen on the comparison MRI, there is a 2.8 x 1.6 cm area of high attenuation consistent with hemorrhagic conversion of this lesion. Edema appears increased from the time of the comparison study. Effacement of the sulci is increased from the MRI secondary to the increase in edema, metastasis and subdural fluid. The second left parietal metastatic lesion is not well visualized on this examination.There are bilateral subdural hematomas, larger on the right. A high density component to the right sided subdural hematoma is consistent with an acute component to this subdural hemorrhage.The patient has undergone two craniotomies. Encephalomalacia and bony defects are seen in the right frontal and left parietal regions.The calvaria and skull base are radiographically normal except for the postsurgical changes. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Progression of metastatic disease with hemorrhagic conversion of the left posterior parietal lesion.2. Subdural hematomas with acute component seen on the right.3. Increased edema and effacement of the sulci, but no herniation.


Instruction: Generate impression based on findings.

Input: Dedicated images through the sella demonstrate a normal height of the pituitary gland. There is subtle enlargement and nodularity of the left aspect of the pituitary gland. Overall enhancement of the pituitary is somewhat inhomogeneous however no discrete lesion is identified. The pituitary stalk lies in the midline. The suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.

Output: Mild enlargement and nodularity of the left pituitary glad with overall somewhat inhomogenous pituitary enhancement. These findings are non-specific. No discrete lesion is identified. If prior imaging is available it may be submitted for comparison and an addendum will be issued.


Instruction: Generate impression based on findings.

Input: 57 year old on neoadjuvant chemotherapy for left breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. The Hydromark biopsy clip is noted in the left lower inner breast. But there is no suspicious enhancement near the clip or elsewhere. A stable benign focus in the right medial breast is noted. No abnormal lymph nodes are identified in either axillary region.A Port-a-Cath is present in the right superior chest wall.

Output: Resolution of the enhancement at the site of the left breast malignancy. No new suspicious finding. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Check flexor hallucis longus, history of dorsal bunion and first MTP. Unable to flex Exam moderately limited given field of view, specifically imaging the entire foot decreases sensitivity TENDONS: No significant abnormality noted. Specifically tendons appear intact and properly inserted given mild limitations secondary to pronounced pes planus deformity.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Scattered moderate degenerative changes with findings more pronounced in the mid foot and first MTP is previously described on plain film. This includes a bunion and subluxation of the first digit as well as old healed fracture deformity of the fifth metatarsal. Alignment of the hindfoot and midfoot again remains unchanged and significant for partial mid foot collapse and hind foot valgus deformity. ADDITIONAL

Output: Severe pes planovalgus and hallux valgus deformities without additional ligamentous or tendonous findings.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other intervertebral disc degeneration, lumbar region Other intervertebral disc degeneration, lumbar regionClinical question: Low back pain, evaluate for nerve root compression/ disc diseaseSigns and Symptoms: Low back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disc space height, disc desiccation and a disc bulge associated with the bilateral ligamentum flavum hypertrophy and partial effacement of the fat at the lateral recess bilaterally which is worse on the left compared to the right side. Within the neural foramina, the exiting nerve roots are surrounded by fat.At L4-5 there is loss of disc space height, diffuse disc bulge, moderate bilateral facet and ligamentum flavum hypertrophy as well as mild anterior subluxation of L4 on L5. There is effacement of fat at the lateral recess bilaterally at this level and crowding of nerve roots. Overall there is moderate spinal stenosis at this level. Within the neural foramina, the exiting nerve roots are surrounded by fat.At L3-4 there is mild loss of disc space height, disc desiccation and diffuse disc bulge associated with mild ligamentum flavum hypertrophy. The fat at the lateral recess is not effaced at this level. Within the neural foramina, the exiting nerve roots are surrounded by fat.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are endplate reactive changes present anteriorly at T12-L1 and T11-T12. The endplate reactive changes at T12-L1 are high signal on T2 and low signal on T1 transient endplate reactive changes at T11-T12 are high signal on T1.There is a large cystic lesion present in the left kidney measuring up to 6 cm in size which is not entirely included on this exam. Additional cystic lesions are present in the right kidney measuring up to 10 mm diameter which most likely represent simple cysts.

Output: 1.There are multilevel degenerative changes present in the lumbar spine with associated moderate spinal stenosis at L4-5 and encroachment of the nerve roots at the lateral recess at L5-S1.2.There are some subacute endplate reactive changes at T12-L1.3.There is a large cystic lesion present in the left kidney. Additional imaging may help further evaluate this since it is not entirely included on this exam.


Instruction: Generate impression based on findings.

Input: Reason: knee mass/pain History: pain The medial and lateral meniscus appear intact. No full-thickness or near full-thickness articular cartilage defects are identified. No bone marrow signal abnormality is seen. The cruciate and collateral ligaments appear intact. The extensor mechanism appears intact. There is a small amount of fluid within the joint without evidence of a large effusion. There is a skin marker along the anteromedial aspect of the knee presumably corresponding to the patient's palpable area of concern. There is a 8.1 x 2.6 x 2.1 cm heterogenous mass/collection along the anteromedial aspect of the right knee situated along and abutting the medial retinacular structures which demonstrates irregular peripheral enhancement on post contrast sequences. There is subcutaneous edema in the surrounding area.

Output: Enhancing heterogeneous mass/collection within the subcutaneous tissue along the anteromedial aspect of the medial retinacular structures is nonspecific and may be infectious, inflammatory, or neoplastic in etiology.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to right parietal craniotomy for resection of a right frontal lobe mass. There is mildly decreased diffusion along the resection margins and prominent susceptibility effect in and adjacent to the resection cavity compatible with blood products. There is residual enhancement along the resection margins most compatible with residual tumor. There is confluent T2 hyperintensity surrounding the resection cavity and extending into the deep white matter of the right frontal lobe that demonstrates questionable mildly elevated relative cerebral blood volume. There is additional elevated relative cerebral blood volume throughout the medial right cerebral hemisphere including within the corpus callosum of uncertain significance. There multiple punctate foci of T2 hyperintensity throughout the supratentorial white matter which are most compatible with chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants.

Output: Postoperative findings related to recent craniotomy with residual enhancing tumor adjacent to and surrounding the resection cavity.


Instruction: Generate impression based on findings.

Input: Right lower extremity radiculopathy. Assess for disc herniation. There are 5 lumbar-type, vertebrae. The last well-formed disc is L5-S1. Vertebral body heights in the lumbar spine are normal. Alignment is maintained. Bone marrow signal is benign. Six millimeter focal fat signal intensity in the left iliac bone may present a hemangioma. There is desiccation and mild-to-moderate height loss of the L4-L5 and L5-S1 discs. There are tiny Schmorl's nodes along the inferior endplates of T12 and L2 as well as the superior and inferior endplates of L3. The facets are normally aligned and and show no significant degenerative change.The tip of the conus medullaris lies at the lower L1 level. The conus medullaris has normal appearance and signal. The paravertebral tissues are unremarkable. Individual levels as below:T12-L1, L1-L2, L2-L3, and L3-L4: No disc herniation. No spinal canal or foraminal stenosis.L4-L5: Right paracentral disc protrusion with annular fissure results and effacement of the right lateral recess. No significant central canal stenosis. No neural foraminal stenosis.L5-S1: Central disc protrusion mildly effaces the lateral recesses and contacts the S1 nerve roots. No significant central canal stenosis. Neural foramina are patent.

Output: 1.There is a right paracentral disc protrusion at L4-L5 which may be impinging on the descending right L5 nerve root in the lateral recess.2.There is also a central disc protrusion at L5-S1 which contacts the bilateral descending S1 nerve roots.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.