Instruction: Generate impression based on findings.

Input: Reason: spondylolisthesis History: radicular pain Please note that the purposes of numbering, there are 5 lumbar vertebrae with a transitional segment labeled L6 corresponding to prior radiograph. There is grade 1 anterolisthesis of L5 on L6 with minimal anterolisthesis of L4 on L5. Vertebral body heights are intact. There is degenerative endplate changes with increased STIR signal centered at L1-L2 with developing Schmorl's nodes. Multilevel disc desiccation with disc moderate disc space loss at T11-T12 and mild disc space loss at T12-L1, L1-L2 and L5-L6. No abnormal signal within the distal cord or conus which ends at L1-L2. T12-L2: Mild diffuse disc bulge No spinal canal or neural foraminal stenosis.L1-L2: Diffuse disc bulge with a small central protrusion. Mild ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. Mild facet arthropathy and ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. Mild facet arthropathy and ligamentum flavum thickening. Moderate right and mild left neural foraminal stenosis. No spinal canal stenosis.L4-L5: Broad-based disc bulge. Moderate facet arthropathy and ligamentum flavum thickening. Moderate to severe right and moderate left neural foraminal stenosis. No spinal canal stenosis.L5-L6: Broad-based disc bulge with uncovering of the disc. Moderate facet arthropathy and ligamentum flavum thickening. Moderate bilateral neural foraminal stenosis. Mild spinal canal stenosis.L6-S1: Mild diffuse disc bulge. Prominent lateral osteophytes bilaterally with mild foraminal/extraforaminal narrowing. No spinal canal narrowing.Right renal cyst.

Output: 1.Please note that the purposes of numbering, there are 5 lumbar vertebrae with a transitional segment labeled L6. 2.Lumbar spondylosis with grade 1 spondylolisthesis (L5-6 and to a lesser degree L4-5). Advanced facet arthropathy at these levels. Mild spinal canal stenosis at L5-L6 as well as multiple levels of neural foraminal narrowing as above.


Instruction: Generate impression based on findings.

Input: 31 years Male (DOB:4/1/1984)Reason: Evaluate for spinal cord stenosis, other pathology History: PainPROVIDER/ATTENDING NAME: JAMES M MOK JAMES M MOK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height this desiccation and endplate reactive change at this level as well as a diffuse disc bulge. Endplate reactive change is high signal on T1 and low signal on T2 STIR. Most likely endplate reactive change is chronicAt L4-5 there is no significant compromise to neural foramina. There is loss of disc space height and disc desiccation as well as a broad-based left lateral recess disc extrusion. There is partial effacement of the fat at the left lateral recess at this level with encroachment of nerve roots of the left lateral recess. Some disc material extends behind the inferior endplate of L4.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There is some encroachment of the nerve roots at the left lateral recess at L4-5 related to a broad-based disc extrusion. This is probably the left L5 nerve root which is affected


Instruction: Generate impression based on findings.

Input: Pituitary adenoma, history of resection: yearly follow up. Pituitary: There are postoperative findings related to transphenoidal surgery. There is no significant interval change in size of the lobulated enhancing sellar and suprasellar mass that measures up to approximately 15 mm and abuts the left lateral aspect of the optic apparatus, which otherwise demonstrates normal signal characteristics. The cavernous sinus appear to be unchanged.Brain: There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The ventricles are unchanged in size and configuration. There is no midline shift or herniation.

Output: No significant interval change in the residual macroadenoma, which abuts the left lateral aspect of the optic apparatus.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few unchanged patchy foci of T2 hyperintensity within the left frontal and bilateral parietal white matter. The previously noted signal adjacent the right stylomastoid foramen appears symmetric on today's exam. The previously noted signal abnormality within the ventral pons is not well appreciated on today's exam. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mild mucosal thickening within the right maxillary sinus.

Output: 1.No evidence for acute ischemia, hemorrhage, or mass.2.A few unchanged patchy foci of T2 hyperintensity within the supratentorial white matter are nonspecific. There are no lesions particularly suggestive of demyelinating disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (1/27/15) performed at Northwestern Memorial Hospital. For comparison, breast MRI (6/25/14), digital mammographic images (5/28/14), ultrasound images of left breast and left axilla (5/28/14) are available. BREAST MRI (1/27/15):Breast MRI was performed with a protocol outlined in the outside radiology report.Diffuse non-mass enhancement measuring 53 x 75 x 95 mm (AP x LR x CC) is seen in the left breast. Diffuse skin thickening is present in the left breast, which is progressed from prior MRI. A marker clip is identified at posterior superior aspect of the diffuse enhancing non-mass enhancement. Per outside radiology report, this is proven malignancy.No abnormal enhancement is seen in right breast. No abnormal axillary lymph nodes are identified in either axillary region.A catheter port is placed in the right medial chest wall.DIGITAL MAMMOGRAPHIC IMAGES (5/28/14):Only CC view of both breasts are submitted.A BB marker is placed at lateral aspect of left breast, denoting the area of palpable concern. There is an ill-defined asymmetry with architectural distortion near the BB marker.No abnormal findings on right CC view.ULTRASOUND IMAGES OF LEFT BREAST AND LEFT AXILLA (5/28/14):An ill-defined hypoechoic mass with maximum diameter of 36 mm is visualized at 1:30 - 2:00 position in the left breast. An additional hypoechoic mass measuring 10 x 7 mm is visualized at 12:00 position in the left breast. In the left axilla, one normal and one borderline lymph node with cortical thickness of 4 mm are visualized.

Output: Diffuse non-mass enhancement and skin thickening of the left breast. Per outside radiology report, biopsy of the left breast lesion revealed malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Right knee and calf pain There is no evidence of fracture, malalignment, joint effusion, soft tissue swelling or vascular involvement.

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Mild spasticity with gait, evaluate for structural abnormalities No diffusion restriction is seen to suggest acute ischemia. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. The brain parenchyma is of normal signal intensity without mass lesion. The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular T2/FLAIR hyperintense foci likely represent prominent perivascular spaces, a normal variant.Normal vascular flow voids are present in the major intracranial vasculature.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: Normal brain MRI. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with altered mental status, history of HIV/AIDS, recently hypernatremic. No definite restricted diffusion is seen. Scattered subcortical areas of bright signal on the DWI sequence have no clear ADC correlates and are favored to be artifactual. Parenchymal volume loss is seen diffusely. In addition, confluent white matter T2 hyperintensity is demonstrated affecting the cerebral hemispheres, brainstem and cerebellum. No edema or mass effect is observed. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles and sulci are proportionately prominent consistent with underlying volume loss. On postcontrast images. Mild ependymal enhancement is seen along the frontal horns, the occipital horns, and perhaps minimally at the right temporal horn.

Output: 1.Diffuse parenchymal volume loss and confluent white matter signal abnormality are findings compatible with chronic HIV encephalopathy.2.Mild ependymal enhancement is seen involving the frontal and occipital horns bilaterally. This finding is of uncertain significance given the patient's recent medical history. However, the possibility is raised of superimposed infection with resulting ventriculitis, perhaps related to a viral or atypical infectious agent, without excluding other infectious agents. In the context of recent initiation of HAART, the possibility of immune reconstitution inflammatory syndrome can also be considered. Discussed with Dr. Harris at 10:30 AM on 11/21/16.


Instruction: Generate impression based on findings.

Input: Female 68 years old with right knee pain concerning for meniscal tear. MENISCI: There is a complex tear of the posterior horn and body of the medial meniscus with vertical and horizontal component. The vertical component extends to the inferior articular surface (series 101, image 9) and the horizontal component extends through the body. The anterior horn of the medial meniscus and the lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: There is near complete loss of the patellar cartilage with extensive associated marrow edema. The trochlear cartilage is thinned but without full thickness defect. In the medial and lateral compartments the cartilage of the femoral condyles is thinned but no full-thickness cartilage defects are visualized. A few small foci of marrow edema are seen in the medial femoral condyle. There are large patellofemoral compartment osteophytes, small osteophytes are seen in the medial and lateral compartments.Other than reactive marrow changes described above bone marrow signal intensity is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complex tear of the posterior horn and body of the medial meniscus contacting the inferior articular surface.2.Severe chondromalacia in the patellofemoral compartment.3.Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Reason: Multiple cafe au lait spots; does he have optic nerve glioma? Also concern for hypoxic ischemic encephalopathy. BRAIN: The ventricles and sulci are within normal limits. Mild prominence of the extra-axial subarachnoid space may be normal or related to benign prominence of the subarachnoid spaces of infancy. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. Myelination pattern is within normal limits for age. There is no diffusion abnormality. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.ORBITS:The optic nerves are symmetric and normal in size and signal intensity. There is no intraorbital mass. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are grossly unremarkable.

Output: 1.Brain within normal limits without evidence of infarction or structural abnormality.2.Orbits within normal limits without evidence of mass.


Instruction: Generate impression based on findings.

Input: History of perianal Crohn's disease. Evaluate for fistula. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Quiescent (non-active) inflammatory bowel disease of the visualized rectosigmoid. Small reactive lymph nodes are decreased in size from the prior study.BONES, SOFT TISSUES: Approaching near and likely originating from the anterior portion of the distal rectum is a fistula tract which extends anteriorly and bifurcates at the level of the base of the penis. It progresses inferiorly along both the left and right intragluteal cleft to the skin surface. No associated fluid collection to suggest an abscess. The overall appearance is similar to the prior study.Stable left intertrochanteric T2-weighted hyperintensity.OTHER: No significant abnormality noted.

Output: Perianal enterocutaneous fistula approaching and likely originated from the anterior portion of the distal rectum extending anterosuperiorly where it bifurcates at the level of the base of the penis and progresses inferiorly along both the left and right intragluteal cleft to the skin surface, appearing similar to the prior study. No associated fluid collection to suggest an abscess.


Instruction: Generate impression based on findings.

Input: 77-year-old man with history of prior heavy EtOH and liver lesions seen on prior ultrasound. ABDOMEN:LIVER, BILIARY TRACT: There is a 20 x 20 mm lesion in segment 5/6 of the liver (series 1001, image 245) which is mildly T2 hyperintense, demonstrates mild diffusion restriction, avidly enhances in the arterial phase, and washes out relative to the liver. Additionally, this lesion has a periphery of delayed enhancement and there is mild capsular retraction.The background liver is normal in intensity but the hepatic fissure is mildly widened.The portal vein branches appear patent without evidence of mass or thrombus.Small gallstones are seen. There is no intra or extra hepatic biliary duct dilatation.SPLEEN: The spleen appears normal. An accessory splenule is noted.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: There is slight nodularity at the junction of the limbs of the left adrenal gland (series 601, image 22). The right adrenal gland is normal.KIDNEYS, URETERS: Bilateral renal cysts are identified.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Segment 5/6 lesion compatible with hepatocellular carcinoma with pseudocapsule. This finding was discussed with Dr. Cornel by phone at 9:45 on 10/26/2015.


Instruction: Generate impression based on findings.

Input: 32-year-old female dancer with pain and intermittent effusions as well as a proximal tibial shaft stress fracture. Please evaluate. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified to suggest a stress fracture.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is a subcentimeter focus of fluid signal intensity within the distal fibers of the anterior cruciate ligament which may represent ganglion formation versus mucoid degeneration.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Normal appearing MRI of the knee. Specifically, there is no evidence of a proximal tibial stress fracture to correspond to the findings seen on recent radiographs.


Instruction: Generate impression based on findings.

Input: Reason: look for retained stone in CBD History: abd pain with WBC 27 Please note that there is insufficient contrast in post contrast images.ABDOMEN:LIVER, BILIARY TRACT: There is a perihepatic T2 hyperintense fluid collection measuring 5.6 x 3.0 cm in transverse dimension and 7.6 cm in craniocaudal dimension (501/22, 4 1/28). A fluid fluid level is seen, which may indicate some debris. There is diffusion restriction, suggesting infection. A small tract of fluid is seen extending from the collection along the anterior abdominal wall, adjacent to the cholecystostomy catheter.The cholecystostomy catheter is seen entering the gallbladder, however no significant portion of the drain is seen within the gallbladder lumen. There is cholelithiasis, including stones within the gallbladder neck. There are pericholecystic plantar changes, consistent with history of cholecystitis.Common bile duct measures 6 mm in diameter. There is mild intrahepatic biliary ductal dilatation. No choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense foci, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion and right basilar subsegmental atelectasis. Trace left pleural effusion with linear left basilar atelectasis.

Output: 1.Perihepatic fluid collection with a tract extending adjacent to the cholecystostomy catheter is suspected to represent a biloma. Diffusion restriction within the collection suggests infection. 2.The catheter itself enters the gallbladder, however no significant amount of catheter is seen within the gallbladder lumen. It is suspected that the catheter may be retracted and leaking from a sidehole.3.Cholelithiasis and cholecystitis again seen. No choledocholithiasis is identified.Findings discussed with service and interventional radiology team at 8:15 AM on 5/12/2016


Instruction: Generate impression based on findings.

Input: 14-year-old female with weakness/paralysis of upper and lower extremities were Brain: The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The right maxillary sinus is hypoplastic with mucosal thickening.Cervical spine: Alignment is within normal limits with slight retroflexion of the odontoid. No fracture is evident. The visualized intracranial and paraspinal contents are unremarkable. Vertebral body heights and disk spaces are maintained.C2/3: No significant neuroforaminal or spinal canal stenosis.C3/4: No significant neuroforaminal or spinal canal stenosis.C4/5: No significant neuroforaminal or spinal canal stenosis.C5/6: No significant neuroforaminal or spinal canal stenosis.C6/7: No significant neuroforaminal or spinal canal stenosis.C7/T1: No significant neuroforaminal or spinal canal stenosis.

Output: Normal brain and cervical spine.


Instruction: Generate impression based on findings.

Input: 63-year-old man with right chest wall swelling. History of chest wall sarcoma. T2 hyperintense lesion under the right pectoralis major and over the right pectoralis minor muscle measuring 2.7 x 8.2 x 6.4 cm and demonstrating internal T2 hyperintensity and relative T1 isointensity relative to adjacent skeletal muscle in a heterogeneous pattern, especially on T2 weighted sequences. There is avid enhancement within this mass post gadolinium. This mass appears to insinuate with pectoralis major muscle but appears to have a relatively well demarcated plane with the pectoralis minor muscle.

Output: Large right chest wall mass consistent with sarcoma associated with the right pectoralis major and minor muscles. This appears to invade the right pectoralis major muscle but may be free of the pectoralis minor muscle.


Instruction: Generate impression based on findings.

Input: New onset left sided focal seizures, want to assess for lesion/cortical dysplasia. There is no evidence of heterotopia, hamartoma, medial temporal sclerosis, intracranial hemorrhage, mass, or infarct. The brain parenchyma appear unremarkable, with a normal degree of myelination. 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 gross evidence of potential seizure foci, although the presence of certain types of cortical dysplasia cannot be discerned on 1.5 T MRI.


Instruction: Generate impression based on findings.

Input: Headache and blurred vision. History of pituitary macroadenoma, status post resection. Head CT scan from June 5, 2016 showed evidence of enlargement. BRAIN:There is no acute infarct or intracranial hemorrhage. There is no mass-effect, midline shift or brain herniation. The ventricles and the other CSF-containing spaces are normal in size. The brain parenchyma is unremarkable. Apart from a small right frontal developmental venous anomaly, the brain shows no abnormal contrast enhancement. The major intracranial vascular flow voids are preserved.There is moderate mucosal thickening in the left maxillary, left sphenoid and posterior right ethmoid sinuses associated with frothy secretions. In the proper clinical setting, this may reflect sinusitis. Orbits are unremarkable as well. The skull and scalp soft tissues are grossly unremarkable. There is mild nonspecific thickening of the nasopharyngeal mucosa with tiny retention cysts near midline. The parotid glands remain enlarged with small intraglandular nodes.PITUITARY:Compared to the previous, postoperative examination from May 2007, there has been increase in the size of the sellar mass with regrowth of the suprasellar part of the mass. The mass measures 24 mm craniocaudally, 21 mm anteroposteriorly and 27 mm in transverse compared to 11 mm, 15 mm and 19 mm previously. The mass is multilobulated and shows heterogeneous pattern of contrast enhancement with foci of poor contrast enhancement and dark T2 signal, which may indicate small cysts with high protein content. The mass superiorly displaces and compresses the optic chiasm and hypothalamus, more on the right than on the left. Laterally, the mass extends to partially encase the horizontal cavernous segment of the left internal carotid artery, with high likelihood of left cavernous sinus invasion. The mass abuts and partially compresses the right cavernous sinus though without definite sign of invasion. Both A1 segments are abutted by the mass but remain patent. The floor of the sella has been remodeled but there is no sign of intraosseous invasion. There are also changes of previous transsphenoidal resection.

Output: 1.There has been regrowth of the pituitary macroadenoma with significant suprasellar component, and displacing and compressing the optic chiasm. There is also suggestion of involvement of the left cavernous sinus.2.The brain shows no significant abnormality otherwise.3.Mucosal thickening and frothy secretions in the paranasal sinuses may indicate sinusitis in the proper clinical setting.


Instruction: Generate impression based on findings.

Input: Clinical question: Recent hemorrhagic infarct in left basal ganglia/thalamus, new weakness on left side. Signs and symptoms: New weakness on left. Nonenhanced brain MRI:Diffusion weighted images demonstrate multiple punctate size foci of apparent restricted diffusion in the subcortical and periventricular white matter of bilateral cerebral hemispheres. None of the findings however demonstrate corresponding ADC map signal change to confirm presence of an acute ischemic stroke. Findings likely T2 shine through from patient's extensive small vessel ischemic stroke.Acute hematoma in the left thalamus and the surrounding vasogenic edema results in mass effect on the third ventricle without appreciable deviation of midline. There is no significant change in the overall appearance of this finding and its mass effect since prior exam.In addition examination demonstrate numerous periventricular and subcortical as well as basal ganglia foci of flair hyperintensity highly suggestive of chronic small vessel ischemic strokes. Several of the small vessel ischemic strokes demonstrate internal chronic hemorrhage.No evidence of ventriculomegaly and CSF cisterns remain patent.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. Note however is made of a chronic retention cysts in the left maxillary sinus. Nonenhanced cervical MRI:There is normal anatomical alignment of the vertebral column.Foramen magnum is unremarkable.C2- C3 demonstrate mild degenerative changes, moderate left neural foraminal compromise and unremarkable otherwiseC3 -- C4 demonstrate moderate degenerative changes of facets and ligamentum flavum and mild disk disease. Constellation of changes results in significant left and moderate right neural foraminal compromise and mild central spinal stenosis.C4 -- C5 demonstrate moderate disk disease and bilateral uncovertebral hypertrophy, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in significant (left greater than right) neural foraminal compromise and mild to moderate central spinal stenosis.C5 -- C6 demonstrate moderate disk disease, asymmetric right-sided uncovertebral hypertrophy and right-sided ventral hypertrophy spur and mild facet and ligamentum flavum hypertrophy. Constellation of changes results in mild central spinal stenosis, significant right neural foraminal compromise and moderate left.C6 -- C7 demonstrate moderate disk disease and loss of disk height, mild right greater than left uncovertebral hypertrophy and mild bilateral facet and ligamentum flavum degenerative changes. There is resultant moderate bilateral neural foramina compromise and mild central spinal stenosis.C7 -- T1 demonstrate minimal right neural foramina compromise and unremarkable otherwise.Examination at T1 -- T2 and T2 -- T3 levels are unremarkable.There is normal signal intensity and caliber of the cervical and upper most visualized thoracic cord.Limited view of paraspinal soft tissues demonstrate no abnormalities.

Output: 1.Nonenhanced brain MRI demonstrate no convincing evidence of an acute ischemic stroke ( see above comments). Extensive chronic small vessel ischemic strokes with few demonstrating hemorrhagic changes. Stable left thalamic acute hemorrhage, surrounding edema and subtle mass effect without midline shift since prior head CT examination.2.Nonenhanced MRI of the cervical spine demonstrate no detectable cord caliber or signal abnormality. Extensive degenerative changes of cervical spine results in multilevel mild to moderate central spinal stenosis as well as multilevel neural foraminal compromise (some significantly) as detailed per level.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post lumbar decompression with fusion. Assess for spine stability and assess for postop bleeding. Signs and symptoms: Back pain. Nonenhanced CT of lumbar spine:Routine non-infused axial 3-mm CT images of the entire lumbar spine were obtained. Sagittal and coronal 2-D reformatted images were also acquired.Examination again demonstrates with no interval change extensive patchy sclerotic changes of the L5 vertebral body which extends into the bilateral pedicles.There is also evidence of mild compression fracture of L5 with slight bulge into the spinal canal similar to prior study.There is evidence of interval bilateral laminectomies at this level for spinal decompression. There is a drainage catheter extending from the canal at this level on the left (likely within the left epidural space) extending posteriorly and exiting the canal on the right side of the spinous process of L4.The alignment of vertebral column is similar to prior study an unremarkable.There is evidence of posterior fusion with placement of fixating rods extending from L4 to S1 and bilateral transpedicular screw placement in L4 and S1. There is no evidence of any detectable hardware abnormalities. There is extensive soft tissue thickening and and soft tissue emphysema posterior to the spinal canal in the soft tissues of lower back which appears to be within the expected range of. Findings. There is no detectable perispinal or prevertebral soft tissue abnormality or hemorrhage. Soft tissue densities there is thickening of the epidural space at the L4 level and suspected central spinal stenosis of approximately 6.5 mm. Follow-up with an MRI examination is recommended.

Output: 1.Stable patchy sclerotic changes of L4 vertebrae which extends into bilateral pedicles. There is also mild compression fracture of L4 similar to prior study. No appreciable interval change since prior study. Findings is suspected for a metastatic focus.2.Interval bilateral laminectomies at L4 vertebrae for decompression of the spinal canal. There is thickening of the lateral epidural spaces at L4 level contiguous with extensive increased soft tissue density posterior to the laminectomy site. This finding results in suspected central spinal stenosis at this level. Recommend further follow-up with an MRI to exclude hemorrhage.3.The alignment of vertebral column is unremarkable and stable since prior study.4.Postoperative changes of posterior fusion and bilateral transpedicular screw placement at L4 and S1 levels. No hardware abnormality.5.A drainage catheter extends from the right lateral epidural space at the L4 level posteriorly and exits the spinal canal as described above.


Instruction: Generate impression based on findings.

Input: Male 63 years old Reason: H/O 8 mm focal cystic pancreatic lesion. Evaluate for change. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensity in the left hepatic lobe is too small to characterize but likely represents a hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: There is a 0.6 x 0.5 cm T2 hyperintense lesion again noted within the pancreatic body. This is in connection with the main pancreatic duct and likely represents a small side branch IPMN. The appearance is not significantly changed compared to prior study. There is a second T2 hyperintense lesion within the distal pancreatic body measuring 0.5 x 0.4 cm (series 11, image 13). This is also in connection with the main pancreatic duct and the appearance is suggestive of a second side branch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Apparent gastric wall thickening is likely related to underdistention.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Stable appearance of a subcentimeter side branch IPMN in the pancreatic body. A second subcentimeter sidebranch IPMN is identified in the distal pancreatic body.


Instruction: Generate impression based on findings.

Input: 55-year-old man with history of renal cell carcinoma and right breast cancer. Now with left-sided mass. Lymph node versus other? RIGHT LOBE MEASUREMENTS: 5.6 x 1.9 x 2.2 cmLEFT LOBE MEASUREMENTS: 4.9 x 1.9 x 2.5 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 0.3 cm hypoechoic nodule that appears benign.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No definite thyroid abnormality.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with left lumbar radicular symptoms. Alignment is anatomic. Vertebral body heights are preserved. The marrow signal is diffusely somewhat hypointense on T1 and T2-weighted images but there is no evidence of pathologic edema or STIR hyperintensity. A T1/T2 hyperintense lesion within the L2 vertebral body likely represents a benign hemangioma. Scattered fatty endplate degeneration is also seen most notably at L5-S1.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No epidural abnormalities are suspected.L1-2: Disc bulging. Mild spinal canal stenosis. Moderate left foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Disc bulging. Moderate generalized spinal canal stenosis with crowding of the cauda equina and near complete effacement of CSF. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy and bulging disc. Mild spinal canal narrowing. Severe left and moderate right foraminal narrowing. L4-5: Facet arthropathy. Bulging disc. Mild spinal canal narrowing. Moderate bilateral foraminal narrowing. L5-S1: Marked facet arthropathy. Disc bulging with a superimposed central protrusion. Moderate spinal canal stenosis. Severe right and moderate left foraminal narrowing.

Output: Multilevel disc and posterior element degeneration is seen. The L2-3 level is most significantly affected where there is a moderate spinal canal stenosis with crowding of the cauda equina. Significant foraminal narrowing is also demonstrated on the left at L3-4 and on the right at L5-S1.Diffuse hypointense marrow signal may represent normal variation or marrow reconversion due to anemia or chronic illness. No focally aggressive lesions are seen.


Instruction: Generate impression based on findings.

Input: 60 years, Male, Reason: further characterize liver lesions seen on CT upper abd w/con History: patient very likely with laryngeal cancer based on biopsy prelim path, looking for metastatic vs other primary cancer. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: 1.3-cm lesion in the right hepatic lobe is hyperintense and T2 images with peripheral nodular enhancement which is isointense on delayed images, suggestive of a hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hepatic lesion is unchanged in size and likely represents a hemangioma.


Instruction: Generate impression based on findings.

Input: Reason: Eval Thumb UCL History: instability Multiple sequences are limited by patient motion artifact and splint. Additionally, repeat images were not obtained due to the patient's inability to tolerate further imaging. The ulnar collateral ligament is abnormally thickened. There is increased signal intensity which traverses the proximal fibers of the ulnar collateral ligament that we suspect represents a complete tear, however, due to the thickening of the ligament, it is difficult to determine if this represents a mid substance tear or proximal avulsion with adjacent scar tissue. It is also difficult to determine whether this represents an acute or chronic tear or if there is a Stener lesion due to the thickening of the ligament and possible adjacent scar tissue. There is also intermediate signal intensity within the distal fibers of the ligament at its attachment which may correspond to the calcification seen on recent radiographs, perhaps representing further injury to the ligament. There is edema within the base of the proximal phalanx concentrated within the volar and ulnar aspect of the proximal phalanx, but we see no fracture. We see no edema within the sesamoid bones. There is mild edema along the myotendinous junction of the adductor pollicis suggesting a strain. Fibers of the radial collateral ligament can be traced from the first metacarpal head to the base of the proximal phalanx.

Output: 1. Limited study as described above due to patient motion artifact and inability of the patient to tolerate repeat images. The ulnar collateral ligament is thickened with what appears to be a full-thickness tear, but it is difficult to assess whether this is an acute or chronic lesion or if there is a Stener lesion.2. Strain of the adductor pollicis along the myotendinous junction and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: r/o radiculopathy, back and R hip pain, history of RCC History: back and R hip pain Mild levoscoliosis of the lumbar spine. Vertebral body heights are intact. There is mild anterolisthesis of L4 relative to L5 with uncovering of the disc. There is minimal anterolisthesis of L3 on L4. The canal is mildly narrowed at all levels, likely congenital. There is multilevel disc desiccation with disc height loss at L4-L5 and L5-S1. There are degenerative endplate marrow signal changes at L4-L5. There is a lesion in the L2 vertebral body which is hyperintense on T1 and T2 images, likely focal fat. There is a lesion in the L5 vertebral body measuring 1.7 x 2.0 cm which is hyperintense on T2 images and isointense on T1 images. There appears to be a corresponding subtle hemangioma on prior CT, with probable atypical MR appearance. No abnormal signal within the distal cord or conus which ends at L1.T12-L2: Right para median annular fissure. Right facet arthropathy. Mild ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. Mild ligamentum flavum thickening. Mild facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Diffuse disc bulge. Mild ligamentum flavum thickening and facet arthropathy. Small cyst along the posterior aspect of the left facet joint. Mild to moderate spinal canal narrowing. Mild to moderate bilateral neural foraminal narrowingL3-L4: Diffuse disc bulge superimposed left neural foraminal protrusion. Moderate ligamentum flavum thickening and facet arthropathy. Moderate spinal canal stenosis. Mild bilateral neural foraminal stenosis.L4-L5: Uncovering of the disc. Diffuse disc bulge with superimposed left neural foraminal protrusion. Narrowing of the lateral recess stenoses bilaterally. Moderate facet arthropathy and ligamentum flavum thickening. Moderate to severe spinal canal stenosis. Moderate bilateral neural foraminal stenosis.L5-S1: Uncovering of the disc, with diffuse disc bulge. Mild facet arthropathy and ligamentum flavum thickening. No significant spinal canal stenosis. Moderate to severe left and mild right neural foraminal stenosis.Right upper pole renal cyst.

Output: 1.Multilevel spondylosis, most severe at L4-L5 where there is anterolisthesis, degenerative disc disease, moderate to severe spinal canal stenosis and moderate bilateral neural foraminal stenosis.2.Additional spinal canal stenosis and neural foraminal stenosis at L2-L3, L3-L4 and L5-S1 as above.3.Lesion in the L5 vertebral body may represent a atypical hemangioma.


Instruction: Generate impression based on findings.

Input: Clinical question: left-sided CVA. Signs and symptoms:left headaches, indeterminant right arm numbness. Nonenhanced head CT:Examination demonstrates extensive periventricular and subcortical low attenuation white matter. Findings are nonspecific however with no appreciable interval change since prior CT and MRI exams. There is no evidence of intracranial hemorrhage mass effect, midline shift or hydrocephalus.Calvarium is intact. Paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of an acute intracranial findings.2.Extensive periventricular and subcortical low-attenuation of white matter.


Instruction: Generate impression based on findings.

Input: Reason: 28 y/o with AS, c/o thigh pain, night pain unclear etiology History: thigh pain/night pain There is marrow edema along the medial femoral neck with periosteal reaction and a subtle focus of linear T1 signal which likely represent a stress fracture. Alignment of the hip joint is anatomic. There is a small amount of edema at the right pubis which is likely degenerative.

Output: Stress fracture of the left femoral neck.


Instruction: Generate impression based on findings.

Input: Rule out rotator cuff tear. Pain ROTATOR CUFF: Marked abnormality involving the supraspinatus representing a suspected full-thickness tear near the attachment with mild possible retraction of a proximally 1 cm, no clear fibers are observed through to the insertion. The remainder of the rotator cuff including the infraspinatus and subscapularis are otherwise intact and only demonstrate minimal tendinopathy. Minimal subdeltoid fluid.SUPRASPINATUS OUTLET: Mild narrowing with associated degenerative changes. See detail belowGLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritic changes are observed, with extensive progression of degenerative changes since prior study. Multiple subchondral cysts complicate the appearance of the humeral head with particular new abnormality involving the tuberosity. A small nondisplaced fracture fragment cannot entirely be excluded. Please correlate with physical exam and possibility of a subacute injury.Marked degenerative changes of the AC joint with underlying inflammation and small cysts or erosions.BICEPS TENDON: Tendon is grossly intact, no significant abnormality noted. ADDITIONAL

Output: Marked interval changes most pronounced involving the greater tuberosity of the humoral head and AC joint. Given the past reported history of a fall and injury, a small subacute fracture cannot be excluded but the changes and distribution (although odd given the short period of time) additionally raise concern for an inflammatory process superimposed upon the rotator cuff abnormality involving the supraspinatus insertion.Dr. Purakel assisted in this discussion and EPIC history.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for growth of meningioma. History: meningioma s/p RT in 2011. Biventricular diameter currently measures 41 mm in width and on the prior exam measured the same. Third ventricular diameter measures 9 mm and previously measured 11 mm in the temporal horns the lateral ventricles remain mildly dilated and are unchanged.There is a redemonstration of an extra-axial mass located at the left cerebellopontine angle cistern which measures 28 x 23 mm axial dimensions on the current exam and previously on the May 2014 exam measured the same. In 2009 it measured 26 x 21 mm. it has not changed substantially and signal characteristics. It remains bright on diffusion weighted imaging. There is no associated extension into the left internal auditory canal appreciated. The mass impresses on the left middle cerebellar peduncle and distorts the adjacent brainstem and left middle cerebellar peduncle. There is T2 signal hyperintensity within the left middle cerebellar peduncle which 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 and demonstrate some mucosal thickening in the right maxillary sinus associated with an air fluid level. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A left cerebellopontine angle cistern extra-axial mass compatible with meningioma remains stable.2.Mild ventriculomegaly is stable.3.Air-fluid level right maxillary sinuses a nonspecific finding, however, acute sinusitis may have a similar appearance. Please correlate with the patient's clinical symptoms


Instruction: Generate impression based on findings.

Input: Female, 33 years old, with multiple sclerosis and leg numbness. Spinal cord caliber and morphology are within normal limits. As on the prior examination, there remains some questionable vague T2 hyperintensity involving the central portion of the cord at mid to lower thoracic levels. It is unclear if this represents a real finding or an imaging artifact. In any event, it has not significantly changed from prior. No evidence of any focal spinal cord lesion is seen. No definite pathologic cord or leptomeningeal enhancement is seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are normal. Intervertebral disk morphology is unremarkable. No significant spinal canal or neuroforaminal stenosis is seen.

Output: Questionable vague signal abnormality involving the central portion of the mid to lower thoracic spinal cord is redemonstrated. It is unclear if this represents a real finding or an imaging artifact, and in any event, there has been no significant change. If this were to represent a real finding, it would be atypical for MS. No evidence of any classic MS-type lesions is seen and there is no pathologic enhancement.


Instruction: Generate impression based on findings.

Input: 70 year old man with history of coronary artery disease s/p PCI who presents with chest pain. Cardiac MRI done to evaluate for ischemia.MEDICATIONS: amlodipine, HCTZ, losartan, isordil, rosuvastatin First Pass PerfusionDuring hyperemia, a perfusion defect is noted in the basal inferoseptum, inferior, and inferolateral walls; mid anteroseptal, anterior, anterolateral, inferolateral, inferior, and inferoseptal walls; and the apical anterior, inferior, and septal walls. The overall ischemia score is 16 out of a possible 32, and 50% of the myocardium is ischemic.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with mild to moderate systolic dysfunction. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 80 ml/m2 (normal range: 74+/-15), the LVEDV is 172 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 101 ml (normal range 47+/-19), the LV mass index is 61 g/m2, and the LV mass is 130 g. There is global hypokinesis with a greater degree of hypokinesis of the basal inferoseptum and the basal to mid inferior walls.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 51%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 130 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 63 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is 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. There is an extensive burden of ischemia involving the usual territory of the LAD, LCx, and RCA. The ischemia is worst in the basal to mid inferoseptum, inferior, and inferolateral walls.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with mild to moderately reduced systolic function (LVEF 41%).4. Normal RV size and systolic function (RVEF 51%).


Instruction: Generate impression based on findings.

Input: Brain MRI:There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. A punctate focus of FLAIR signal in the left frontal white matter adjacent to the insula is unchanged and non-specific. There is no other significant parenchymal lesion or abnormal enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no 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 antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified.

Output: 1. No specific intracranial findings to account for the patient's symptoms. 2. Normal MRA of the brain.


Instruction: Generate impression based on findings.

Input: Reason: large sacral wound; eval for signs of osteomyelitis History: see above Note is made of soft tissue irregularity along the posterior aspect of the distal sacral segments and coccyx consistent with stated history of ulceration. Gas density extends to the level of the posterior aspect of the fourth sacral segment and coccyx. There is apparent cortical irregularity of the posterior margin of the coccyx suspicious for osteomyelitis. This could be confirmed with MRI if clinically warranted.

Output: Findings suggestive of osteomyelitis of the coccyx. These findings could be further evaluated with MRI if clinically warranted.


Instruction: Generate impression based on findings.

Input: Dizziness, unilateral right tinnitus and sensorineural hearing loss. There is a vascular structure that courses adjacent to the proximal cisternal segments of the right cranial nerve 7 and 8 complex. The bilateral cranial nerve 7 and 8 complexes are otherwise intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There are scattered foci of T2 hyperintensity in the imaged portions of the cerebral white matter. There are bilateral lens implants.

Output: 1. A vascular structure that courses adjacent to the proximal cisternal segments of the right cranial nerve 7 and 8 complex is of indeterminate significance. 2. Scattered foci of T2 hyperintensity in the imaged portions of the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Brain MRI:Changes of chronic infarction are redemonstrated involving the right MCA territory with encephalomalacia, gliosis, and ex vacuo dilatation of the right lateral ventricle. A small old infarct in the right cerebellum is also again noted. Both are associated with a small amount of hemosiderin staining. There is mild diffuse volume loss without a specific lobar predominant atrophy pattern. There are T2 hyperintense foci within the periventricular and subcortical white matter as well as pons without restricted diffusion or susceptibility abnormality. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Redemonstrated are changes from prior nuclear aeration. Fluid within the mastoid air cells is consistent with the patient's intubated status. Redemonstrated is a 2 cm lipoma of the right paramedian forehead.Brain MRA:There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Incidental note is made of persistent right fetal PCA circulation.

Output: 1.Chronic right cerebellar and right MCA distribution infarctions.2.No acute ischemia.3.Mild chronic small vessel ischemic disease.4.Negative MRA of the brain.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of bone [C79.51] / Malignant neoplasm of unspecified site of left female breast [C50.912], Reason for Study: ^Reason: LLE weakness (4/5), worsening back and hip pain History: as above Again demonstrated enhancing soft tissue mass involving bilateral T6 lamina and spinous process (series 14, image 5) and L23 interspinous process ligament enhancement (series18, image 10), unchanged since prior scan . The size and extent of the lesion do not show any significant interval change since prior scan. There is no evidence of intrathecal extension of the lesion.There is no other abnormal enhancement seen.Cervical spine There is normal cervical lordosis. The cranial-cervical junction is normal. Vertebral heights are maintained.No abnormal bone marrow signal intensity.Spinal cord signal intensity is normal.No abnormal enhancement.Mild degenerative changes from C45 to C67 are again seen, unchanged since prior scan including minimal spinal stenosis at the level of C67.Thoracic SpineAgain the T6 lesion involving bilateral lamina and spinous process is seen, grossly unchanged in terms of size, extent and MR characteristics since prior scan. There is normal thoracic kyphosis. The spine alignment is anatomic. The vertebral body height is preserved. Lumbar spineThe spine alignment is normal. Vertebral height is preserved. Spinal cord signal intensity is normal.No abnormal enhancement.Previously seen L34 annular fissure, mild to moderate bilateral L45 neuroforaminal stenosis are again seen and unchanged since prior scan.Alignment appears to be normal.Vertebral height is maintained.The cord signal is normal.

Output: 1. Enhancing soft tissue lesions involving T6 lamina and spinous process as well as L23 interspinous ligament are redemonstrated, unchanged since prior scan.2. Unchanged degenerative changes of cervical and lumbar spine as described above.3. No evidence of compression fracture. No evidence of new abnormal enhancement. Spinal cord signal intensity is normal.


Instruction: Generate impression based on findings.

Input: 62 years Female (DOB:2/13/1954)Reason: R/o DDD or SI joint disease History: Back pain, sciaticaPROVIDER/ATTENDING NAME: TARIQ MUSLIM MALIK TARIQ MUSLIM MALIK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a dextrocurvature to the upper lumbar spine and compensatory levocurvature to the lower lumbar spine. There is a T1 hyperintense lesion present within the L3 vertebral body most likely representing a vertebral body hemangiomaAt L5-S1 there is loss of disc space height, disc desiccation and some facet hypertrophy bilaterally. There is a disc bulge present this level. There are some mild encroachment of the nerve roots at the right lateral recess at this level.At L4-5 there is bilateral facet hypertrophy which is worse on the right compared to left side. There is some mild encroachment of the nerve roots at the right lateral recess. At L3-4 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is a disc bulge present associated with disc desiccation and some moderate facet hypertrophy as well as some moderate ligamentum flavum hypertrophy.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.Incidental note is made of multiple small gallstones within the gallbladder.

Output: 1.There are multilevel degenerative changes present in the lower lumbar spine with a mild degree of encroachment of the nerve roots at the right lateral recess at L4-5 and L5-S1 due to degenerative changes. There is a scoliotic curvature to the lumbar spine.2.Gallstones


Instruction: Generate impression based on findings.

Input: Female 38 years old with abdominal pain, nausea and vomiting. Evaluate common duct for stone/sludge. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and has a smooth contour. There is no focal liver lesion.There is cholelithiasis but no gallbladder wall thickening or surrounding edema to suggest acute cholecystitis. No filling defects are seen within the normal diameter common duct. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: 1.6 x 1.2 hyperintense focus along the right posterior mediastinum may represent a bronchogenic or pericardial cyst.

Output: Cholelithiasis without evidence of acute cholecystitis or choledocholithiasis.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with trismus and left jaw pain, attention to the left TMJ. Please note that a detailed assessment of the temporomandibular articulations was previously obtained on the dedicated TMJ MRI from 6/8/2015.Mild ill-defined increased T2 signal is evident within the soft tissues of the left masticator space surrounding the temporomandibular joint.No mass or discrete fluid collection is seen. Within the limitations of some technical artifact on the fat-suppressed postcontrast images, no definite evidence of pathologic enhancement is seen in the vicinity of the left TMJ.The aerodigestive mucosa is smooth and free of mass lesions. No pathologic adenopathy is detected in the neck. The salivary glands and the thyroid are unremarkable. The bone marrow signal characteristics are within normal limits. Reversal of the normal cervical lordosis is likely positional.

Output: Mild edema is suspected within the soft tissues of the left masticator space surrounding the temporomandibular joint. No mass or fluid collection is seen. No other specific abnormalities are detected.


Instruction: Generate impression based on findings.

Input: Male, 29 years old, with intractable epilepsy, fMRI needed for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the junction of the frontal and parietal lobes, functionally defining the pre- and post-central gyri which are otherwise somewhat anatomically ambiguous. Passive visual stimulation produces cortical activation as expected along the bilateral calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. Language is left dominant but with significant contributions from the right hemisphere on certain paradigms. For example, prominent Wernicke's area activity is seen on the right with the word generation paradigm. Cortical activation correlating to the putative Broca's area is seen on all paradigms localizing to the inferior left frontal gyrus, primarily the pars triangularis and pars orbitalis. Cortical activation correlating to the putative Wernicke's area is seen best on word generation and verb generation paradigms localizing along the posterior aspect of the superior temporal sulcus.

Output: Sensorimotor cortical activation related to hand, foot and face/tongue motion is seen bilaterally, functionally defining the somewhat anatomically ambiguous pre- and post-central gyri. Visual cortical stimulation induces cortical activation along the calcarine sulci bilaterally.Language is left dominant, though there are significant contributions from the right hemisphere which vary depending on the language task performed. Broca's and Wernicke's areas localize to their expected locations as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate cause of pain. Signs and symptoms: Right leg and back pain. Nonenhanced lumbar MRI:The lower most visualized thoracic spine and thoracic cord demonstrate mild degenerative change is an unremarkable otherwise.T12-L1, L1-L2 and L2-L3 levels are unremarkable with the exception of mild hypertrophic changes of posterior elements.L3-L4 demonstrate mild disc disease and moderate bilateral ligamentum flavum hypertrophy and mild facet degenerative changes. There is mild mass effect on the posterolateral aspect of thecal sac secondary to hypertrophied ligamentum flavum however no central spinal stenosis or neural foraminal compromise is present.L4-L5 demonstrate a stable postoperative changes of posterior fusion and placement of transpedicular screws in L4 and L5 levels. Trace anterolisthesis similar to prior study is again noted. No definitive evidence of neural foraminal compromise.L5-S1 demonstrate moderate disc disease and loss of disc height, expected postoperative changes of posterior fusion, no central spinal stenosis. Precise assessment of neural foraminal at this level is not possible due to extensive metallic hardware artifact from fusion. On axial images poorly visualized neural foramina at this level however demonstrate no convincing evidence of stenosis.

Output: 1.No convincing evidence of any acute or new findings since prior study.2.Stable post operative changes of posterior fusion at L4-L5 and with placement of bilateral transpedicular screws at L4 and L5 levels.3.No spinal stenosis or neural foraminal compromise at any level.


Instruction: Generate impression based on findings.

Input: 42-year-old man history of HIV status post kidney transplant with midfoot pain, along the metatarsal area. Rule out fracture. There is an oblique nondisplaced fracture line seen at the base of the third metatarsal, consistent with a stress fracture. There is moderate associated edema extending into the mid third metatarsal.Degenerative cysts are noted in the medial aspect of the first metatarsal head. Physiologic fluid is noted at the first MTP joint. Soft tissues are unremarkable.

Output: Nondisplaced stress fracture base of the third metatarsal.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is a mild increase in signal and globular appearance of the posterior horn of the medial meniscus without evidence of frank tearing. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild thinning of the articular cartilage of both the medial and lateral femoral condyle. A small area of increased marrow edema is seen within the posterior aspect of the medial femoral condyle. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Degenerative signal within the posterior horn of the medial meniscus without evidence of frank tear.2. Mild thinning of the articular cartilage of both the medial and lateral compartments with a small amount of presumed degenerative marrow within the posterior aspect of the medial femoral condyle.


Instruction: Generate impression based on findings.

Input: MRI ORBITS AND BRAIN/SKULLBASE: No abnormal mass or abnormal enhancement is seen within the orbits. There is abnormal T2/STIR hyperintensity involving the left optic nerve, relatively more prominent posteriorly, coronal STIR series 1501 image 19 without enhancement or mass. The subtle finding also appears to be present on prior study from 5/25/2016. Optic chiasm is unremarkable. Extraocular muscles are unremarkable.There is no appreciable lesion within the left cavernous sinus, parasellar region or orbital apex. There is mild ectasia and tortuosity of the left cavernous and paraclinoid internal carotid artery which produces asymmetric fullness of the left cavernous sinus.There is an enhancing T2 hypointense lesion at the right cerebellopontine angle extending into the right internal auditory canal measuring 7 mm in the craniocaudal dimension and approximately 19 mm in the longitudinal dimension and 10 mm in the short axis/AP dimension. No significant change in size since prior. There is no mass effect on the brainstem. No mass or gross signal abnormality involving the cochlea or semicircular canals.Brain parenchyma is partially imaged but there is no evidence of intraparenchymal mass or mass effect. No midline shift or herniation. There is moderate degree of global parenchymal volume loss commensurate patient's age. There are also multiple foci of T2 hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic disease. No hydrocephalus. No extra-axial collections.There is partial opacification of the superior right-sided mastoid air cells with T2 and intrinsic T1 hyperintensity which was also present on prior MRI from 5/25/2016. There may be dehiscence involving the tegmen mastoideum which can be better assessed with CT.MRA HEAD: There are fenestrations at the level of the anterior communicating artery as well as involving the mid to distal basilar artery along the left lateral wall. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.

Output: 1. Unchanged 19 x 10 x 7 mm enhancing lesion in the right internal auditory canal extending into the cerebellopontine angle consistent with vascular schwannoma. No mass effect on the brainstem.2. There is no lesion within the left cavernous sinus. There is tortuosity of the left cavernous and paraclinoid internal carotid artery which produces the apparent asymmetric fullness of the left cavernous sinus.3. Subtle T2 hyperintensity in the left optic nerve which also appears to be present on prior study from 5/25/2016. Finding may represent sequela of prior optic neuritis or other injury.4. Mild chronic small vessel ischemic disease and brain parenchymal volume loss.5. Partial opacification of the superior right-sided mastoid air cells with T1 hyperintensity. This finding was also present on prior study. Findings may represent proteinaceous fluid or perhaps blood products related to chronic inflammation. There may be dehiscence involving the tegmen mastoideum which can be better assessed with CT.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with spinal cord cavernoma, with neck pain and right leg weakness, evaluate cord cavernoma and for brain CCM's. Brain:No diffusion restricting lesions are seen. Scattered small foci of white matter T2 hyperintensity are redemonstrated appearing similar in size and number to the prior examination. No evidence of edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is seen. There are no susceptibility inducing lesions. The ventricles are normal in size and morphology. No intracranial hemorrhage or any abnormal extra-axial fluid collections are seen.Thoracic spine:A 4 mm lesion is redemonstrated within the right aspect of the spinal cord at the T4 level showing a rim of susceptibility effect and internal T2 intensity. The lesion itself has not significantly changed in size, though susceptibility effect extending above and below the lesion seems to have increased mildly. An associated 2 mm focus of enhancement is seen for which there is no adequate comparison as the prior examination was performed without contrast. No additional or new spinal cord lesions are seen.Spinal alignment is anatomic. Vertebral body heights are preserved. Multiple scattered Schmorl's nodes are seen. Ill-defined T2 hyperintense signal and enhancement are seen along the T7-8 endplates, slightly progressed from prior. Additional more well-defined foci of T2 hyperintensity and enhancement are demonstrated within the right transverse process of T5, the right posterior T8 vertebral body, the T10 and T12 vertebral bodies, without significant change. Mild disc degeneration is seen but without any large herniation, spinal canal or foraminal stenosis.

Output: 1.A subcentimeter lesion is redemonstrated within the right lateral aspect of the spinal cord at the T4 level showing peripheral hemosiderin staining and a small focus of associated enhancement. The imaging features of the lesion remain most suggestive of a cavernous malformation. Peripheral hemosiderin staining seems to have progressed from prior which may indicate slow interval bleeding.2.Scattered areas of marrow signal abnormality and enhancement are redemonstrated. Some of these are centered on the endplates in association with Schmorl's node deformities, as at T7-8 where findings have mildly progressed from prior. Also noted are scattered more well-defined marrow lesions which have not significantly changed. These findings are favored to represent a combination of degenerative change and atypical hemangiomas. However, the possibility of a neoplastic process cannot be entirely excluded. If clinically warranted, assessment of osseous integrity by CT may allow a more definitive diagnosis.3.No evidence of any intracranial cavernous malformation or other acute intracranial findings.


Instruction: Generate impression based on findings.

Input: 85 years, Male, metastatic lymphoma and recent blurry vision. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are extensive patchy areas of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic and/or posttreatment-related changes. There are two small foci of susceptibility in the right temporal lobe consistent with chronic microhemorrhages. No abnormal parenchymal or meningeal enhancement to suggest metastatic disease. Major flow-voids are preserved.Orbits are grossly normal. There is a round lesion involving the left aspect of the sella measuring approximately 7 x 5 mm in the transverse and craniocaudal dimensions with T1 hyperintensity and containing a fluid-fluid level. No suprasellar extension or mass effect on the optic chiasm. There is mild opacification of the ethmoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of metastatic disease in the brain. 2. No obvious mass is seen within the orbits. Dedicated orbital MRI can be considered if there is high suspicion for a structural lesion involving the orbits.3. Extensive patchy areas of signal abnormality in the white matter which is nonspecific and may represent chronic small vessel ischemic disease and/or posttreatment-related changes. There are two punctate foci of chronic microhemorrhage in the right temporal lobe, which are nonspecific in etiology.4. Subcentimeter cystic lesion involving the left aspect of the sella with fluid-fluid level. No suprasellar extension or evidence of mass effect on the optic chiasm. Finding may represent a cystic microadenoma with fluid/blood products; less likely Rathke's cyst given off midline location.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with GBM, on Avastin and CCNU. A heterogeneous mass with thick rim enhancement centered on the left parietal lobe and ventricular atrium has not significantly changed in size on the noncontrast images. As before, this lesion infiltrates the splenium of the corpus callosum extending to the contralateral side. Likewise, the morphology and thickness of enhancing tissue along the lesion margin has not significantly changed. As before, thin enhancement extends from the lesion along the ependymal surface of the left temporal horn.Within the limitations of motion degraded sequences, no additional or new enhancing lesions are seen. The previously noted leptomeningeal enhancement along the brainstem and cerebellum is not discretely identified on today's study.The degree of T2 signal abnormality surrounding the left parietal lesion has not significantly changed, nor has associated regional mass effect. The left ventricular atrium remains completely effaced but the ventricular size and morphology are unchanged.Patchy ill-defined T2 hyperintensity within the white matter elsewhere in the cerebral hemispheres is not changed from prior. No abnormal fluid collections are seen.

Output: No significant interval change in size is seen of a thick rim enhancing tumor in the left parietal lobe. As before, spread of disease is seen along the ependymal surface of the left temporal horn. Leptomeningeal disease seen previously along the brainstem and cerebellum is no longer readily apparent.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for cervical stenosis, patient with neck pain and abnormal reflexes History: neck pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk desiccation present at this level associated with small uncovertebral osteophytes and loss of disk space height. There are some endplate reactive change is present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk desiccation present at this level associated with small uncovertebral osteophytes and loss of disk space height. There is mild narrowing of neural foramina at this level. There is a 5x6mm perineural cystic appearing lesion in the distal aspect of the right neural foramen at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk desiccation present at this level associated with small uncovertebral osteophytes and loss of disk space height. There are some endplate reactive change is present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine without significant compromise of spinal canal or exiting nerve roots. A small perineural cyst in the right C5-6 neural foramen is of unknown significance


Instruction: Generate impression based on findings.

Input: Male, 50 years old, history of metastatic renal cell cancer status post neurosurgical decompression and hardware. Thoracic:Since the prior examination, the patient has undergone instrumented posterior spinal fusion. Pedicle screws are in place bilaterally at T7, T8, T11 and T12, affixed to posterior stabilization rods. Fixation continues into the lumbar spine as discussed in the next section.Laminectomy has been performed at least partially at T8 and completely at T9 and T10. This results in spinal canal compression.Near complete marrow replacement and pathologic enhancement is again seen at the T9 vertebral body and pedicles with evidence of osseous expansion. The extent of this abnormality has slightly progressed from the prior examination. Also progressed is the degree of osseous retropulsion and/or epidural disease spread into the ventral epidural space. There is progressive near complete effacement of CSF at this level, and the bilateral T9-10 neural foramina are encroached upon by tumor. Progressive marrow replacement and pathologic enhancement is seen at the T10 vertebral body level. There is no significant retropulsion or epidural disease spread detected at this level.A bulky tumor deposit at the left T3 costovertebral junction has increased slightly in size as well.Lumbar:The inferior extent of the instrumented spinal fusion is seen. Spinal fusion continues with bilateral pedicle screws at L2 and L3. Corpectomy with strut graft placement has also been performed at the L1 level. Laminectomy has been performed at least partially at T12 and at L1 for spinal canal decompression.The remaining L1 vertebral body continues to show diffusely abnormal signal characteristics. Elsewhere in the lumbar spine, no definite evidence of new or progressive marrow signal abnormality is seen. The right aspect of the sacrum, however, does show evidence of progressive marrow replacement. A small focus of marrow replacement is also seen in the left iliac bone.The cervical lordosis is straightened. Sagittal alignment is otherwise unremarkable.L1-2: Posterior canal decompression. No significant left foraminal narrowing, the right neural foramen appears to be encroached upon by residual tumor in the L1 vertebral body. L2-3: Facet hypertrophy and ligamentum flavum thickening. Mild generalized spinal canal narrowing. No significant foraminal stenosis. L3-4: Facet hypertrophy and ligamentum flavum thickening. Very mild bulging disc. No significant spinal canal or foraminal stenosis. L4-5: Facet hypertrophy and ligamentum flavum thickening. Loss of disc height and minimal disc bulging. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. The right sided sacral foramina are encroached upon by the above-mentioned tumor deposit.

Output: 1.Interval postoperative findings including instrumented posterior spinal fusion from T7 through L3.2.Laminectomy for posterior spinal canal decompression has also been performed from T8 through T10 and from T12 to L1.3.Corpectomy with strut graft placement has been performed at L1.4.Tumor within the T9 vertebral body has progressed appearing bulkier and with a greater degree of epidural encroachment. The spinal canal has, however, been decompressed posteriorly at this level.5.Progression of tumor is also seen within T10 and at the left T3 costovertebral junction.6.Apart from the residual L1 vertebral body which still contains tumor, no definite metastatic disease is detected elsewhere in the lumbar spine.7.Progression of tumor is seen in the right aspect of the sacrum with encroachment upon the sacral neural foramina. A small focus of tumor is also seen within the left iliac bone.


Instruction: Generate impression based on findings.

Input: Neck pain and numb right arm for years. There is perhaps trace disc bulging at C4 though C7, but no significant spinal canal or neural foraminal stenosis. 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 spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Perhaps trace disc bulging at C4 though C7, but no significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Female 54 years old Reason: r/o new bony mets History: new L pelvic/groin pain Again seen is a right sacral soft tissue mass extending inferiorly to the lower sacrum and crossing the midline at S2. The mass encases or at least abuts the S1 through S3 nerve roots. There is fluid within the right sacrum consistent with fracture through this lesion. There is similar signal abnormality in S5, possibly representing an additional myelomatous lesion. The tumor itself is slightly hypointense to muscle on T1 and shows some enhancement following contrast although some portions of the tumor do not show enhancement, possibly related to prior therapy.There is marrow edema in the parasymphysial region which is more suggestive of parasymphysial fractures. There is fluid in the symphysis pubis which is likely secondary to the above described fractures. Degenerative arthritic changes are present.

Output: 1. Pathological fracture of the right sacrum. Myelomatous lesion in the sacrum as described above is otherwise not significantly changed compared to prior study.2. Edema in the parasymphysial region and symphysis pubis, likely due to stress fractures, possibly secondary to pelvic instability.


Instruction: Generate impression based on findings.

Input: There is an approximately 74 CC x 50 AP x 70 ML mm encephalocele containing brain tissue covered in dura herniating through a large occipital calvarial defect. At least 50% or more brain tissue appears to have herniated through the calvarial defect. The head appears proportionally smaller than normal.The lateral ventricles are not normally formed, however there may be a rudimentary/dysmorphic lateral ventricles in the herniated portion of the brain. Dysmorphic cerebellar tissue is suspected on some images within the inferior portion of the encephalocele with a possible rudimentary fourth ventricle. The brainstem is not well depicted, and the origin of the cervical spinal cord is not clearly seen, though it may arise within the encephalocele. A normal interhemispheric falx and corpus callosum are not identified.There is apparent signal abnormality in the superficial soft tissues of the lower lumbar/sacral region posterior to the spine best seen on series 3 image 21 and series 8 image 22. Imaging quality is suboptimal at least partly due to technical constraints including fetal movement, among other factors. However, this abnormality may correlate with a suspected spine abnormality on prior fetal ultrasound. These findings may represent spinal dysraphism with possible meningocele/lipomeningocele or perhaps myelomeningocele.The remaining spinal canal appears grossly well-formed.

Output: 1. Large occipital encephalocele containing more than half of the brain tissue with dysmorphic appearance of the brain as described above.2. Finding suggesting lumbar/lumbosacral dysraphism, as questioned on the prior fetal ultrasound. Superimposed meningocele/myelomeningocele are not excluded.


Instruction: Generate impression based on findings.

Input: 20 year-old female with pain in multiple regions evaluate ligaments TENDONS: The extensor and flexor tendons are intact.LIGAMENTS: Hematoma extends adjacent to the anterior talofibular ligament, which is not well visualized, and likely torn. The posterior talofibular ligament is intact. The calcaneofibular ligament is slightly thickened and may be sprained. The anterior and posterior tibiofibular ligaments are intact.ARTICULAR SURFACES AND BONE: Fracture at the base of the fifth metatarsal and contusions in the adjacent fourth metatarsal and cuboid are again noted. There is edema within the head and body of the talus without discrete fracture line.ADDITIONAL

Output: 1. Hematoma along the lateral aspect of the ankle and ATFL tear.2. Nondisplaced base of the fifth metatarsal fracture and bone contusions as detailed above.


Instruction: Generate impression based on findings.

Input: Male; 51 years old. Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: 3 x 5 x 4.6 cm.Peripheral Zone: Low T2 signal lesion with restricted diffusion extending from the right base to apex and measuring up to 1.7 x 1.8 cm in the mid gland, compatible with prostate cancer. The lesion is located anteriorly extending to the level of the anterior fibromuscular stroma. High T1 signal throughout the prostate gland due to hemorrhage from recent biopsies.Central Gland: Heterogeneous.Seminal Vesicles: None invasion.Extracapsular Extension: None.BLADDER: Underdistended.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing left inguinal hernia.OTHER: No significant abnormality noted.

Output: Right-sided prostate cancer without extracapsular extension.


Instruction: Generate impression based on findings.

Input: 73 year old woman with history notable for knee replacement, referred for cardiac MRI for further evaluation of possible right lower pulmonary vein thrombus visualized on CT. Left VentricleThe left ventricle is normal in function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 60 ml/m2 (normal range: 65+/-11), the LVEDV is 115 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 43 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 146 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. 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. No LA or PV masses noted. Specifically, the R lower PV is without mass for its proximal 3 cm (to the first bifurcation), evaluation beyond this is technically difficult, but there is no obvious mass beyond the bifurcation.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac Findings 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. Normal LV and RV systolic function without delayed enhancement2. No LA or pulmonary vein mass noted to the level of the first bifurcation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is no evidence of abnormal enhancement on the scan.There is no evidence of abnormal susceptibility effects on gradient echo images.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, or abnormal contrast enhancement.

Output: No evidence of abnormal enhancement.No evidence of hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Patient with history of breast cancer. And question of brain mass. Complains of headaches and nausea An anatomical venous anomaly in high convexity left parietal output should clinical significant is noted. Heavily calcified mass at the level of pineal gland measures 14.7 mm times 16-mm on axial image 15. The calcification has a ring appearance with central area of non-enhancing tissue on this examination. Further evaluation with a dedicated post infused MRI of the brain is recommended. There is no evidence of any associated edema with this findings. No areas of hydrocephalus is detected. Large area of low-attenuation adjacent to the left lateral ventricle and extending inferiorly into the basal ganglia is consistent with an old stroke. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is present. No evidence of metastatic lesion is detected. Calvarium, mastoid air cells and paranasal sinuses are also unremarkable.

Output: 1.No evidence of metastatic disease to the brain.2.Heavily calcified ring lesion with no definitive enhancement at the level of the hiatal gland that should be further evaluated with a dedicated MRI. This finding has a benign appearance.


Instruction: Generate impression based on findings.

Input: 37-year-old male with history of left hemifacial spasm. Please assess left cerebellar pontine angle. There is a tiny 2-3 mm focus of enhancement located at the meatus of the left internal auditory canal. The remaining visualized portions of the left facial nerve appear unremarkable. There are no areas of restricted diffusion to suggest acute ischemia. There is asymmetric fat within the right petrous apex. The ventricular configuration is normal. Normal intracranial vascular flow voids are present. There is a small retention cyst located within the anterior aspect of the left maxillary sinus. The mastoid air cells are clear. The orbits are normal.

Output: Tiny focus of enhancement located at the meatus of the left internal auditory canal may represent a looping vessel or possibly a small mass lesion. Dedicated internal auditory canal MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 70-year-old man with history of multiple myeloma status post stem cell transplant with new onset back pain. The examination is somewhat limited without intravenous contrast. There are numerous low T1 and high T2 signal lesions throughout the axial skeleton, consistent with multiple myeloma. In particular, there is a lesion involving the T9 vertebral body, which demonstrates at least 50% compression deformity with retropulsion of the posterior aspect of the vertebral body into the spinal canal causing severe spinal stenosis and cord compression at this level. There is diffuse edema involving the vertebral body on fluid sensitive sequences suggestive of subacute or acute abnormality. There is approximately 50% compression deformity of the T3 vertebral body without evidence for retropulsion or spinal or neuroforaminal stenosis at this level. There is a lesion within the T10 vertebra with minimal deformity of the superior endplate. There is a lesion with extraosseous soft tissue extension involving the right 10th rib. There is approximately 50% compression deformity of the T11 vertebral body, without evidence for retropulsion or spinal or neural foraminal stenosis. There are additional mild vertebral compression deformities at T3, T8, T10, and T12, without retropulsion. There is no evidence for compression deformity within the lumbar spine, but the L4 vertebral body demonstrates diffusely abnormal marrow signal with small amount of edema likely related to metastatic disease. There is multilevel posterior disc osteophyte complex formation within the cervical spine, worse at C3-C4 level, where there is associated hypertrophy of the ligamentum flavum causing moderate to severe spinal stenosis and moderate bilateral neuroforaminal narrowing. There are posterior disc osteophyte complex formation at C4-T1 levels, with mild indentation upon the spinal cord at C3 though C7 and variable degrees of neural foraminal stenosis. There is a mild diffuse disc bulge at L3-L4 causing mild effacement of the ventral thecal sac however without spinal stenosis or neural foraminal stenosis. There is a mild diffuse disc bulge at L4-L5 causing mild bilateral neural foraminal narrowing. There is a disc bulge at L5-S1, without significant spinal or neural foraminal stenosis at this level. There is no spondylolisthesis. Within the right L3-L4 paraspinal musculature there is a 4.8 x 2.7 cm lobulated low signal soft tissue lesion, which appears to involve the L4 spinous process. There is a 2.8 x 1.7 cm lesion involving the posterior left iliac bone and a 2.6 x 2.3 cm low signal lesion involving the midline occipital bone. There is an additional 3.6 x 1.9 cm lesion involving the right temporal bone. There is a trace amount of fluid in the mastoid air cells. There is a small right thyroid nodule. There is a 1.9 cm diameter right renal cyst.

Output: 1. Widespread multiple myeloma throughout the axial skeleton, with a pathological fracture of the T9 vertebral body and retropulsion associated with spinal cord compression at this level. Additional multilevel vertebral compression deformities are not associated with spinal canal or neural foraminal stenosis.2. Multilevel degenerative spondylosis of the cervical spine and lower lumbar spine.Discussed with Dr. Zimmerman at 11: 15 AM on 7/9/16.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease with colonic stricture. Assess disease. ABDOMEN:LIVER, BILIARY TRACT: Normal morphology, size, signal intensity and enhancement without a focal lesion biliary ductal dilatation or vascular abnormality.Cholelithiasis without cholecystitis.SPLEEN: The spleen is normal in size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with negative oral contrast. The small bowel fold pattern is maintained.No significant small bowel dilatation, wall thickening, abnormal T2-weighted signal intensity, enhancement or restricted diffusion. The terminal ileum is well seen without evidence of active inflammation, improved from prior.No evidence of fibro-stenotic or sinus-fistulous small bowel disease. There appear to be two 2 cm tandem short-segments of moderate stricturing of the hepatic flexure with associated restricted diffusion the site of previously described disease, improved from prior. No significant upstream dilatation. Otherwise the proximal colon is normal in appearance.The distal sigmoid and rectum is nondistended with apparent mild circumferential mural thickening, hyperenhancement and restricted diffusion. No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Short segment nonflow limiting stricture with mild active inflammation affecting two 2 cm segments of the splenic flexure, improved from prior.2.Persistently collapsed distal sigmoid and rectum with possible mild-moderate active inflammation. 3.No active inflammation of the small bowel is identified. No significant free fluid or loculated fluid collection.


Instruction: Generate impression based on findings.

Input: 17-year-old male with history of germinoma status post chemotherapy and radiation therapy, off therapy since June 2014. As before, the pineal gland region appears unchanged. There are unchanged right transfrontal surgical tracks. There is no evidence of intracranial hemorrhage or acute infarct. The sella and suprasellar regions are unremarkable. The ventricles are not significantly changed in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits are grossly unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: Unchanged treated pineal germinoma.