Instruction: Generate impression based on findings.

Input: Male, 80 years old, with low back pain and spinal stenosis. Since the prior examination, posterior instrumented fusion has been performed with bilateral pedicle screws at L4 and L5. Laminectomy has also been performed at L4-5 with placement of an interbody fusion device. Enhancement within the posterior soft tissues of the operative bed is compatible with scarring.Spinal alignment is anatomic. Mild loss of height of the T12 vertebral body is unchanged. Likewise, moderate loss of height of the L1 vertebral body is unchanged. No significant marrow edema or pathologic marrow replacement or enhancement is seen.The distal spinal cord and conus are within normal limits. The nerve roots of the cauda equina are likewise unremarkable. No epidural abnormalities are seen.A right renal cyst is partially visualized.L1-2: Mild facet hypertrophy. Mild prominence of the dorsal epidural fat. No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Prominence of the dorsal epidural fat. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Postoperative changes. Facet hypertrophy and ligamentum flavum thickening. Prominence of the dorsal epidural fat. No significant spinal canal or foraminal stenosis. No other significant interval changes. L4-5: Postoperative changes. Hypertrophy of the residual facets. The previously seen right paracentral disc extrusion has decreased in size though some portion of it remains causing mild effacement of the right ventral thecal sac and slight displacement of the adjacent nerve roots. No significant generalized spinal canal stenosis. Moderate foraminal narrowing, unchanged on the right and slightly improved on the left. L5-S1: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis.

Output: 1.Findings are seen compatible with posterior instrumented fusion from L4 to L5. The instruments are better assessed on CT.2.A right paracentral disc herniation at L4-5 has decreased in size when compared to the prior MRI. There remains a small component of this herniation which causes effacement of the right ventral thecal sac and may contact the adjacent nerve roots. Both neural foramina are moderately narrowed.3.Mild degenerative findings at other levels are not significantly changed. Chronic compression deformity of the T12 and L1 vertebral bodies are unchanged.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect, or cerebral edema. There is a rounded 6-mm low T2 signal abnormality within the left aspect of the pituitary gland seen best on series 501 image 11. There are multiple scattered periventricular and subcortical white matter T2 hyperintense lesions which are nonspecific. There are no lesions in the posterior fossa. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is moderate opacification of the right maxillary and left sphenoid sinuses representing inspissated secretions. The skull and extracranial soft tissues are unremarkable.

Output: 1.No acute infarct.2.6-mm low T2 signal abnormality within the left aspect of the pituitary gland may represent a small adenoma, Rathke's cleft cyst, focus of old hemorrhage or other etiology. If there are signs/symptoms referable to the pituitary gland, then further evaluation with MRI pituitary gland without and with contrast would be recommended.3.Multiple nonspecific scattered periventricular and subcortical white matter T2 hyperintense lesions. Differential diagnosis includes vascular related etiologies (which would be advanced for patient's age), chronic headaches, demyelination and prior infectious/inflammatory etiologies.


Instruction: Generate impression based on findings.

Input: Bilateral brachial plexopathy. Please assess for inflammation in the right and left brachial plexus. Patient has a remote history of laryngeal cancer and is status post radiation therapy in the early 80s. The study was performed using the cardiac rather than the neurovascular coil due to patient intolerance. This results in incomplete fat saturation, including the postcontrast images, rendering them unreliable.The roots and trunks of the brachial plexi are smoothly thickened and T2 hyperintense bilaterally but more so on the left. More distally, the elements of the brachial plexus on the left may also be thickened though this appearance could also represent scarring from prior surgery. There is no discernible mass on either side of the neck.While this study is not optimally designed to assess the mediastinum, there are multiple mildly enlarged mediastinal lymph nodes. At least a few of them were present on the previous CT scan of the chest from December 11, 2014. Also, there is biapical lung fibrosis/scarring. Partially included wedge-shaped opacity in the posterior lower left lung may be atelectatic.Superior to the tracheostomy entry site, there is thickening involving the left side of the larynx (supraglottic, glottic and subglottic), which may represent posttreatment change. Small lymph nodes in the lower neck are not changed since December 2014 CT examination and may be reactive.There is multilevel degenerative cervical spine disease but without significant spinal canal or foraminal stenosis.There is thickening and sclerosis involving the lateral aspect of the right clavicle with minimal adjacent soft tissue thickening which may relate to previous fracture with adjacent soft tissue involvement. There is central T1-hypointense, T2-hyperintense signal within the medial end of the right clavicle which may reflect marrow necrosis.

Output: 1.Non-masslike relatively smooth thickening involving the brachial plexi, left side more than right, is most compatible with radiation fibrosis. 2.Biapical lung fibrosis is likely also related to previous radiation. Mediastinal lymph nodes are present on the previous CT scan from December 2014. These findings are incompletely assessed on this examination.3.Left laryngeal soft tissue thickening without discernible mass is probably posttreatment.4.Right clavicular abnormalities may reflect combination of marrow necrosis and previous fracture.


Instruction: Generate impression based on findings.

Input: 13-year-old female right knee pain and swelling. Patient injured knee, heard a pop, immediate swelling. Evaluate for chondral injury patella vs lateral meniscus tear. MENISCI: Medial and lateral menisci are intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits without evidence of contusion or fracture. Increased signal intensity of the medial and lateral patellar facet articular cartilage near the median eminence with superficial fissuring; no full thickness defect.LIGAMENTS: Cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact.ADDITIONAL

Output: Chondromalacia patella with superficial fissuring but no full thickness defect.


Instruction: Generate impression based on findings.

Input: Breast cancer metastasized to central nervous system. There is increase in size of a left inferior temporal lobe enhancing nodule, measuring up to 4 mm, previously 2 mm, and a left middle frontal gyrus lesion, measures up to 7 mm, previously 5 mm. There is no significant interval change in the other extensive supratentorial and infratentorial metastatic disease. There is vasogenic edema associated with the lesions, but otherwise an unchanged background of mild periventricular white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There are postoperative findings related to left parieto-occipital craniotomy without evidence of nodular enhancement to suggest tumor recurrence in this location. There is unchanged confluent white matter T2 hyperintensity in the treatment bed region. There is an unchanged subcentimeter enhancing lesion within the fundus of the right internal auditory canal. There is an unchanged developmental venous anomaly in the brainstem associated with punctate foci of susceptibility effect that likely represent cavernous malformations. There is unchanged mild encephalomalacia in the left cerebellar hemisphere. There is a punctate focus of high T2 signal in the anterior right precentral gyrus without discernible restricted diffusion. Otherwise, there is no evidence of acute infarct. The ventricles and basal cisterns are stable in size and configuration, with ex vacuo dilatation of the left lateral ventricle. There is an unchanged right cerebral convexity subdural fluid collection, but the left cerebral convexity subdural fluid collection has decreased in size. There is minimal midline shift to the left. The skull and extracranial soft tissues are unchanged.

Output: 1. Increase in size of left inferior temporal lobe and left middle frontal lobe metastasis. Otherwise, no significant interval change in size and number of the intracranial metastatic disease.2. An unchanged subcentimeter right internal auditory canal lesion may represent a vestibular schwannoma versus less likely a metastasis.3. Unchanged developmental venous anomaly in the brainstem associated with punctate foci of susceptibility effect that likely represent cavernous malformations.4. Unchanged right cerebral convexity subdural fluid collection, but decreased left cerebral convexity subdural fluid collection.


Instruction: Generate impression based on findings.

Input: 33-year-old female with left knee pain. Evaluate for medial meniscus tear. MENISCI: There is attenuation of the body of the medial meniscus likely representing a combination of a radial tear and additional chronic attritional tearing. The body of the medial meniscus at this location is replaced with intermediate signal intensity on image 16 of series 3 likely representing extensive focal degeneration and additional tearing. There is mild intrasubstance intermediate signal intensity within the posterior horn of the medial meniscus likely representing intrasubstance degeneration, but otherwise the anterior and posterior horns appear intact. The lateral meniscus is normal.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the articular cartilage of the weightbearing portion of the medial femoral condyle and medial tibial plateau with a linear full-thickness cartilage cleft centrally along the medial tibial plateau and degenerative low signal intensity in the underlying subchondral bone. The articular cartilage of the lateral femoral compartment appears intact. Focal low signal intensity within the articular cartilage of the lateral facet of the patella and focal high signal intensity centrally within the femoral trochlea likely represent additional sites of cartilage degeneration. There is tricompartmental osteophyte formation.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Medial meniscus tear and osteoarthritis as described above.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: eval CTA findings History: headache There is limited exam due to patient's diffusion to continue.There is no evidence of acute ischemic lesion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift. The cerebellar tonsil shows slightly downward displacement at the level of foramen magnum which is within normal limits.Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickenings on bilateral maxillary sinuses.

Output: 1. Limited exam.2. No evidence of acute ischemic lesion.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB: 7/8/1951)Reason: R/O MYELOPATHY History: MYELOPATHIC EXAMPROVIDER/ATTENDING NAME: RICHARD KRAIG HELENE G RUBEIZ Exam is limited due to patient motion artifact. To the extent of visualization the cervical vertebral bodies are appropriate in overall alignment and height and the cervical spinal cord has normal signal characteristics and overall morphology. No obvious mass is identified in the cervical spine. There is no obvious compromise to the spinal canal or exiting nerve roots appreciated

Output: 1.Exam is limited due to patient motion artifact which will obscure more subtle abnormalities. To the extent of visualization, there is no compromise to the cervical spinal cord and no mass lesion appreciated within the spinal canal or spinal cord. More subtle lesions would not be appreciated on exam like this.


Instruction: Generate impression based on findings.

Input: 48-year-old female patient with pain and positive serologies (CCP, RF, RNP) but without definite diagnosis of CTD. Right hand with possible synovitis. There is an erosion about the radial aspect of the first metacarpal head with increased fluid about the first metacarpophalangeal joint and enhancement of the synovium on postcontrast imaging consistent with synovitis. Increased fluid on T2-weighted images is also noted about the remaining metacarpophalangeal joints, most predominately the second and third. There is synovial enhancement at the third and, to a lesser degree, the second metacarpophalangeal joints consistent with synovitis. Inflammation is also noted in the soft tissues radial to the second metacarpophalangeal joint. Fluid and enhancement surrounding the extensor tendon overlying the third metacarpophalangeal joint is consistent with tenosynovitis.The visualized tendinous structures are otherwise intact.

Output: 1. Synovitis of multiple metacarpophalangeal joints, most predominately the first and third, with underlying erosions at the first MCP.2. Tenosynovitis of the extensor tendon overlying the third MCP.


Instruction: Generate impression based on findings.

Input: Diagnosis: Carpal tunnel syndrome, right upper limb. Carpal tunnel syndrome, left upper limbClinical question: disk disease or post traumatic injurySigns and Symptoms: hand pain The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is mild posterior subluxation of C5 on C6 associated with the diffuse disc bulge, disc desiccation, small central disc protrusion, endplate and uncovertebral osteophytes as well as mild ligamentum flavum hypertrophy. There is effacement of spinal fluid ventral and posterior to the spinal cord at this level and overall mild to moderate degree of spinal stenosis. There is encroachment of the exiting nerve roots within the neural foramina bilaterally due to combination of disc material and osteophytes.At C6-7 there is loss of disc space height, disc desiccation and a disc bulge associated with endplate and uncovertebral osteophytes and encroachment of the exiting nerve roots bilaterally. There is mild hypertrophy of the ligamentum flavum hypertrophy present. There is mild narrowing of the spinal canal 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 degenerative changes present in the cervical spine with mild to moderate spinal stenosis at C5-6 associated with mild subluxation as well as encroachment of exiting nerve roots bilaterally at C5-6 and C6-7.


Instruction: Generate impression based on findings.

Input: T4aN2b base of tongue squamous cell carcinoma status post treatment. There is no measurable tumor in the right tongue region. Likewise, there is no evidence of residual significant lymphadenopathy in the neck. For example, a necrotic right level 2B lymph node measures 4 mm in short axis and an ill-defined right level 2A lymph node measures 6 mm in short axis. The thyroid salivary glands are unchanged. The larynx appears to be intact. There is multilevel degenerative cervical spondylosis with mild spinal canal narrowing at C3-4 and C4-5. There is rightward nasal septal deviation. The orbits and imaged intracranial structures are unremarkable.

Output: No evidence of measurable tumor in the right tongue base and no evidence of significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Headache sharp pain back of the head. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis, weakness, leg. Follow-up for progression. Cervical: There is a discrete T2 hyperintense lesion involving the left dorsal aspect of the cord at the C7 level which is seen on the sagittal STIR as well as axial T2 sequences. There are additional tiny punctate lesions at the right ventral C3 and right ventral C6 levels seen on both the axial T2 and mFFE sequences likely representing additional demyelinating plaques. There is possible additional tiny lesion at the left anterior cord at the upper C4 level.Vertebral body heights and alignment in the cervical spine are normal. There is no significant disc disease or spinal canal or neural foraminal stenosis at any level. Bone marrow signal is benign. Paraspinous soft tissues are unremarkable.Thoracic: There is a discrete T2 hyperintense lesion involving the left dorsal cord at the left T11-T12 level. Otherwise no additional lesion within the thoracic cord is definitively appreciated. Thoracic vertebral body heights are maintained. Alignment is maintained. No significant spinal canal or neural foraminal stenosis is seen. Bone marrow signal is benign with no suspicious lesions. Paraspinous soft tissues are unremarkable.

Output: There are at least three T2 hyperintense lesions in the cervical cord, relatively more prominent at the left dorsal C7 level. There is also a thoracic cord lesion at the left T11-T12 level. Findings are compatible with known history of demyelinating disease. An addendum can be made to prior studies if available.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (3/31/15, 4/6/15, 10/9/15, 11/2/15), ultrasound images of right breast (10/12/15), images from ultrasound guided biopsy and postprocedural right mammographic images (11/2/2015), breast MRI (11/10/2015), ultrasound images of right breast (11/12/2015), images from stereotactic needle biopsy of right breast and postprocedural right mammographic images (11/19/2015) performed at Presence St. Joseph Medical Center. For comparison, digital mammographic images (1/11/14) are available. DIGITAL MAMMOGRAPHIC IMAGES (3/31/15, 4/6/15, 10/9/15, 11/2/15): The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution.In the right breast at lateral aspect around 9:00 position, there are pleomorphic calcifications, including fine linear type with a developing focal asymmetry. The calcifications are extending segmentally in discontiguous fashion, measuring 60 x 40 mm (AP x LR). The focal asymmetry is present at posterior aspect of these calcifications, measuring 11 mm. There is another asymmetry seen best on CC view at medial anterior aspect of the right breast measuring 7 mm.A circumscribed oval mass with multiple coarse benign-appearing calcifications is present at 12:00 position in the right breast, likely a fibroadenoma.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (10/12/15):Ill-defined hypoechoic mass measuring 7 x 9 mm at 9:00 position with echogenic rim is detected, corresponding to the focal asymmetry seen on the mammogram at posterior aspect of the segmentally distributed calcifications.IMAGES FROM ULTRASOUND GUIDED BIOPSY AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/2/2015):Ultrasound guided biopsy was performed for the mass at 9:00 position with an appropriate needle placement. Postprocedural mammograms demonstrate a marker clip (Hydromark) at the site of the focal asymmetry at 9:00 position in the right breast.Per outside radiology report, the result was malignant.BREAST MRI (11/10/2015):The study was performed with a protocol outlined in the outside report.There are 2 enhancing masses in the right breast, one at 9:00 position measuring 19 x 13 x 12 mm (AP x LR x CC), and the other at 3:00 position measuring 14 x 21 x 11 mm. The one at 9:00 position is proven carcinoma and the marker clip is present at the anterior aspect of this mass. Non-mass enhancement is present between the two masses, measuring 49 x 71 x 20 mm.No abnormal enhancement is seen in the left breast.No abnormal lymph nodes are present in either axilla.ULTRASOUND IMAGES OF RIGHT BREAST (11/12/2015):The study was performed as second look ultrasound to look for a correlate of MR detected mass at 3:00 position in the right breast. No sonographic correlate was detected in this study.IMAGES FROM STEREOTACTIC NEEDLE BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/19/2015):Stereotactic biopsy was performed for the asymmetry best seen on CC view at medial right breast, because the asymmetry is likely correlating to the MR detected mass at 3:00 position. Postprocedural mammograms demonstrate a marker clip at upper inner aspect of the right breast, near the site of the enhancing mass seen on the MRI. Distance between 2 clips is 135 mm on CC view.Per outside radiology report, the biopsy result was malignant; invasive ductal carcinoma.

Output: 1. Biopsy proven carcinoma in the right breast, 2 sites; one at 9:00 position and the other at 3:00 position. Mammograms demonstrate suspicious calcifications segmentally at lateral right breast and MRI demonstrates extensive non-mass enhancement between the two malignant masses in the right breast.2. No mammographic or MR evidence of malignancy in the left breast.3. No MR evidence of abnormal lymph nodes in either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis 1 unable to void BONE MARROW: No significant abnormality noted.SOFT TISSUES: There is an enlarged nerve fiber measuring approximately 6 mm to the left of L5 vertebral body. Additionally there is a 6 mm enlarged nerve fiber immediately anterior to the left psoas muscle.JOINTS: No significant abnormality noted.ADDITIONAL

Output: Enlarged nerve fibers adjacent to the lumbar vertebral body and anterior to the left psoas muscle likely representing the patient's known history of neurofibromatosis.


Instruction: Generate impression based on findings.

Input: Evaluate for stenosis, aneurysms History: SAH MRI of the brainFoci of diffusion restriction are present along the central portion of the body of the corpus callosum as well the left calloso-cingulate junction.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.A small amount of subarachnoid blood adjacent to the left occipital lobe is less conspicuous on this MRI. There are only very subtle findings that could be suggestive of subarachnoid blood products given the CT findings.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right vertebral artery is larger than the left vertebral artery. The left jugular is hypoplastic distal to the origin of the left posterior inferior cerebellar artery.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.Diffusion restriction along the central portion of the corpus callosum is present and is a rather unusual finding. Although infarction and diffuse axonal injury cannot be excluded rare entities such as Susac disease or Machiafavi Bignami Disease in the appropriate clinical setting should be considered.2.A small amount of subarachnoid blood adjacent to the left occipital lobe is less conspicuous on this MRI.3.No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.5.MR venogram of the brain is within normal limits.6.Findings were discussed with Dr Ardelt


Instruction: Generate impression based on findings.

Input: 63-year-old male with AML and recent bacteremia and liver lesions on MRI and July. CT in August showed resolving lesions. We would like a confirmation. ABDOMEN:LIVER, BILIARY TRACT: Multiple enhancing lesions scattered through the liver have decreased in size in the interval. The previously described segment 6 lesion is no longer visualized on postcontrast imaging. The largest lesion in segment 5 measures 1.7 x 1.8 cm (axial series 1402 image 55), and this lesion measured 1.5 x 3.3 cm on the 7/28/2016 exam. An additional small subcentimeter enhancing lesion in the anterior-inferior right hepatic lobe (axial series 1402 image 23) has also decreased in size in the interval.Normal liver contour. The diffuse T2 hypointensity of the liver and spleen is compatible with hemosiderosis.SPLEEN: T2 hypointense signal is compatible with hemosiderosis.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: Diffuse T2 hypointense signal intensity compatible with hemosiderosis.OTHER: Bilateral pleural effusions.

Output: 1.The previously described largest lesion of hepatic segment 6 has resolved. The other known enhancing hepatic lesions have decreased in size.2.Diffuse T2 hypointense signal intensity of the liver, spleen, and bone marrow are compatible with hemosiderosis.


Instruction: Generate impression based on findings.

Input: Beast cancer status post treatment, with treatment related AML, with watershed infarcts. There is no evidence of significant steno-occlusive lesions. There is no evidence of saccular cerebral aneurysms.

Output: No evidence of significant steno-occlusive lesions.


Instruction: Generate impression based on findings.

Input: Desmoid tumor of the thigh There is abnormal heterogeneous signal intensity and enhancement of the adductor musculature of the hip and thigh. While we suspect the enhancing component reflects the patient's known desmoid tumor, there are numerous fatty foci in the adductor musculature containing low signal intensity margins that could reflect areas of heterotopic ossification. There is additional more masslike heterogeneous signal intensity and enhancement involving the vastus lateralis and to a lesser degree the vastus intermedius measuring approximately 6.5 x 2 cm in the transverse dimension and 12 cm in the craniocaudal dimension. Again, the enhancing component likely reflects the patient's desmoid tumor with multiple foci of fat-containing low signal intensity rims suggesting areas of heterotopic ossification.There is fatty replacement of the semitendinosus muscle with peripheral and septal low signal intensity which may reflect scarring or mineralization. Similar findings affect the long head of the biceps femoris proximally with a small (1 cm) focus of enhancement within the mid belly which likely represents a small focus of desmoid tumor. There are additional poorly defined foci of abnormal signal intensity and enhancement noted along the anterior margin of the hamstrings likely reflecting additional tumoral deposits. There is fatty atrophy of the semimembranosus and long head of the biceps femoris. There is scarring posterolaterally along the deep crural fascia with adjacent fatty lobules and poorly defined enhancement which may reflect prior surgical changes. There is strand-like enhancement of the distal fibers of the gluteus maximus which may reflect additional foci of tumor; the distal attachment of the muscle on the femur is not well seen which may be the result of chronic tearing.The bone marrow signal of the femur itself is normal.

Output: Desmoid tumor of the right thigh as described above.


Instruction: Generate impression based on findings.

Input: Headaches. Brain: The cerebellar tonsils extend up to 9 mm inferior to the foramen magnum and display pointed morphologies. The posterior fossa also appears to be slightly small. Nevertheless, there is flow of cerebrospinal fluid across the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Findings compatible with Chiari malformation, but no syringohydromyelia.


Instruction: Generate impression based on findings.

Input: 43-year-old man with history of early cirrhosis, elevated alkaline phosphatase, and right upper quadrant pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular and cirrhotic in morphology with reticular T2 signal but without focal lesion. The hepatic vasculature appears patent.The gallbladder is normal. The intra and extra hepatic ducts are smooth and nondilated.SPLEEN: Innumerable round, medium-sized splenic lesions are identified. These lesions are prominently T2 hypointense with isointense centers. These lesions do not significantly enhance. The spleen is normal in size.PANCREAS: Pancreas appears normal and the pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Innumerable splenic lesions, nonspecific and with differential diagnosis that includes benign or malignant etiologies.2.Cirrhotic liver with fibrosis but no focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: Male 68 years old Reason: evidence of metastasis, inflammation History: left facial numbness. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There are a few scattered areas of nonenhancing T2/FLAIR hyperintensity in the subcortical white matter which are nonspecific but may be related to chronic small vessel ischemic disease. There is a asymmetric is prominent enhancement in the expected location of the right geniculate ganglion, as well as asymmetric enhancement and thickening of the mastoid segment of the right seventh cranial nerve. There is asymmetric enhancement and prominence of the left V3 nerve just distal to Meckel's cave. There is no abnormal enhancing mass within the brain parenchyma. 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. Small lipoma along the left frontal scalp.

Output: 1.Abnormal asymmetric enhancement in the right geniculate ganglion and left V3 segment of the trigeminal nerve. Isolated metastatic disease to these locations would be unusual without evidence of other intracranial leptomeningeal involvement. Differential includes granulomatous, infectious, and other inflammatory causes. Lymphoma is also considered. Recommend follow-up dedicated trigeminal nerve MRI protocol to further evaluate. 2.No evidence of enhancing intraparenchymal mass to suggest metastatic disease to the brain.


Instruction: Generate impression based on findings.

Input: 31-year-old female with headache and blurred vision, evaluate for cerebritis or abscess. Lack of contrast limits evaluation for abscess or infection. Given this caveat:A right frontal approach ventricular catheter is redemonstrated, terminating at the level of the right lateral ventricle, unchanged in position. T2 hyperintensity surrounding the catheter as it traverses the right frontal lobe is stable in appearance. A previously demonstrated subcentimeter pocket of fluid surrounding a small portion of the catheter is also stable (best seen image 19/28, series 501).The ventricles are uniformly small, unchanged. The basal cisterns remain patent.T2 hyperintensity and swelling within the body of the corpus callosum is stable. Scattered additional nonspecific foci of T2 hyperintensity within the cerebral hemispheres are unchanged. No evidence of restricted diffusion is seen, though the diffusion sequences are significantly degraded by susceptibility artifact. A few scattered punctate foci of susceptibility are evident through the cerebral hemispheres compatible with microhemorrhage, but again, a large portion of the susceptibility sequence is degraded by artifact from the shunt system.

Output: 1.Lack of contrast limits evaluation for abscess or infection.2.T2 hyperintensity surrounding the frontal approach catheter as it traverses the right frontal lobe is stable in appearance. A previously demonstrated subcentimeter pocket of fluid surrounding a small portion of the catheter is also stable.3.The ventricles are uniformly small, unchanged.4.T2 hyperintensity and swelling within the body of the corpus callosum is stable.


Instruction: Generate impression based on findings.

Input: 59 year-old male with history of pituitary adenoma and resection, surveillance scan. Redemonstrated are postoperative changes of the pituitary gland with residual normal enhancing pituitary tissue along the right side of sella. The infundibulum is slightly deviated rightward. There is minimally hypo-enhancing soft tissue in the left sella. These findings appear stable. The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable. The orbits and contents are unremarkable. Limited view of the intracranial structure is unremarkable.

Output: Stable exam with unchanged appearance of presumed residual pituitary tissue.


Instruction: Generate impression based on findings.

Input: Syrinx follow up. There is decrease in caliber of a long-segment syrinx, which now measures up to 3 mm in width, previously 7 mm. There is multilevel degenerative spondylosis in the incompletely imaged cervical spine. There is no significant spinal canal narrowing in the thoracic spine. There is normal vertebral bone marrow signal and the alignment of vertebral column is unchanged.

Output: 1. Decreased caliber of the long-segment syrinx.2. Incompletely imaged degenerative spondylosis in the cervical spine.


Instruction: Generate impression based on findings.

Input: 52-year-old female with anisocoria, poor balance and incontinence. Evaluate for brain metastases. Further history reveals metastatic renal cell cancer history status post SRS to the right cerebellum. Since previous exam there has been interval increase in size of the hemorrhagic right basal ganglia metastatic lesion which now measures 1.2 x 1.2 cm (series 1001, image 19), compared to 0.4 x 0.6 cm previously. There is now a small amount of mass effect on the adjacent brain parenchyma as well as some surrounding parenchymal edema. There is small amount of mass effect on the adjacent sulci than right lateral ventricle. There is perhaps a small amount of focal leftward midline shift of 2 mm. Just posterior and medial to the right basal ganglia lesion is a second 3 x 5 mm enhancing focus which was not present on the prior examination and is suspicious for a additional site of metastasis.Within the right lateral cerebellum there has been interval decrease in the size and enhancement pattern of the hemorrhagic metastatic lesion. There is now only residual susceptibility abnormality and no appreciable enhancement status post SRS.The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Interval increase in the hemorrhagic right basal ganglia metastatic lesion with mild surrounding edema and with some mild mass effect and sulcal effacement.2.Just medial and posterior to the right basal ganglia lesion is a small enhancing focus which is suspicious for a small new metastasis.3.Interval decrease in the size and enhancement of the right cerebellar metastatic lesion post-treatment, which now only demonstrates susceptibility abnormality.


Instruction: Generate impression based on findings.

Input: Male, 6 years old, with focal onset seizure, right temporal EEG abnormality. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion, edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The mesial temporal structures are symmetric and free of signal abnormality. In particular, no lesions are detected in the right temporal lobe. Signal intensity of the bone marrow is unremarkable.

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


Instruction: Generate impression based on findings.

Input: There are postsurgical findings related to thoracic spinal decompression and posterior spinal instrumentation extending from T7-T12. There is are destructive changes involving T9 and T10 vertebrae with extension of material into the prevertebral space and into the spinal canal epidural space with apparent compression of the spinal cord. Otherwise, the lack of contrast and extensive susceptibility artifact related to the hardware render evaluation of these levels virtually nondiagnostic. The spinal canal superior and inferior to these operated levels is patent and the thoracic spine alignment is unchanged. Limited evaluation of the cervical spine on the sagittal counting sequence demonstrates postsurgical findings related to anterior cervical fusion at C5 to C6 and mild anterolisthesis of C5 on C6, as well as moderate spinal canal stenosis at this level. There is also multilevel degenerative spondylosis of the lumbar spine with Schmorl's nodes, fatty endplate signal alterations, and disc bulges and facet hypertrophy at L4-L5 and L5-S1 with moderate spinal stenosis at L4-L5 and apparent severe neural foramina narrowing at the level of L4-L5, as well as mild spinal stenosis at the level of L5-S1.

Output: 1. Postsurgical findings related to spinal canal decompression and instrumentation from T7 to T12 with destructive changes involving T9 and T10 vertebrae with extension of material that may represent hemorrhage and/or residual infected tissues into the prevertebral space and into the spinal canal epidural space with apparent compression of the spinal cord. Otherwise, the lack of contrast and extensive susceptibility artifact related to the hardware render evaluation of these levels virtually nondiagnostic. 2. Postsurgical changes of anterior cervical fusion at C5-C6 with mild anterolisthesis of C5 on C6.3. Degenerative changes of the lumbar spine, most severe at the level of L4-L5, although this is incompletely characterized.Discussed with Dr. Choi at 11:15 AM on 12/10/15.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Carpal tunnel release with persistent symptoms Tendons: There is mildly increased signal within the extensor carpi ulnaris tendon which may reflect mild tendinosis. The extensor tendons are intact. The flexor tendons are intact. There is no tenosynovitis.Ligaments: The scapholunate ligament is intact. The lunotriquetral ligament is intact. The triangular fibrocartilage complex is intact.Bones: Bone marrow signal is normal. There is no dislocation or subluxation. There is no joint effusion. Mild degenerative signal is noted within the capitate and lunate.Muscles: There is no muscle tear or atrophy of the flexor or extensor compartments.Nerves: There is a bifid median nerve. The median nerve appears slightly enlarged but is of normal signal intensity and does not demonstrate abnormal enhancement following gadolinium administration. The flexor retinaculum is absent relating to prior release. There is no abnormal enhancement surrounding the flexor compartment and there is no evidence of mass lesion or mass effect. The ulnar nerve in Guyon’s canal is unremarkable.

Output: Mildly enlarged bifid median nerve which demonstrates normal signal intensity and no abnormal enhancement. The flexor retinaculum is absent relating to prior release and there is no abnormal mass, enhancement, or mass effect surrounding the nerve.


Instruction: Generate impression based on findings.

Input: 72-year-old female with abnormal mammogram, family history of breast cancer. Solitary cyst of unspecified breast. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Multiple, small enhancing foci symmetrically in both breasts.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 64-year-old female with neck pain, numbness in the bilateral second digits of the hands status post fall. Evaluate for herniation at the C7-C8 level. Examination is limited due to motion artifact.There is reversal of normal cervical lordosis. Craniocervical junction is intact with no evidence of ligamentous injury. Multilevel degenerative changes with Modic type signal abnormalities within the vertebral body endplates, otherwise marrow signal is unremarkable. Spinal cord signal is unremarkable. There is mild developmental narrowing of the spinal canal diffusely.At C2-C3 there is a central disc protrusion and bilateral uncovertebral hypertrophy. At C3-C4 there is left facet hypertrophy and uncovertebral hypertrophy. There is mild left neural foraminal stenosis. No significant spinal canal stenosis.At C4-C5 there is central disc protrusion with associated flattening of the ventral canal. There is bilateral uncovertebral hypertrophy. There is mild left neural foraminal stenosis and no significant spinal canal stenosis.At C5-C6 there is diffuse disc osteophyte complex as well as left paracentral disc protrusion with associated flattening of the left ventral cord. There is bilateral uncovertebral hypertrophy. There is mild-to-moderate right and moderate left neural foraminal stenosis. There is mild to moderate spinal canal stenosis.At C6-C7 there is disc osteophyte complex and bilateral uncovertebral hypertrophy. There is moderate to severe bilateral neural foraminal stenosis as well as moderate spinal canal stenosis.At C7-T1 there is disc osteophyte complex abutting the ventral cord as well as uncovertebral and ligamentum flavum hypertrophy. There is moderate to severe left neural foraminal stenosis. No significant spinal canal stenosis.

Output: Multilevel degenerative changes, most conspicuous at C6-C7 where there is moderate to severe bilateral neural foraminal stenosis and moderate spinal canal stenosis. Moderate-severe left foraminal narrowing at C7-T1.


Instruction: Generate impression based on findings.

Input: Male 63 years old with a history of of pancreatic cyst s/p EUS 12/6/16 with small 10mm uncinate lesion essentially unchanged compared to EUS in 2013, unclear if more solid. Evaluate for neuroendocrine vs cystic/IPMN. ABDOMEN:LIVER, BILIARY TRACT: Within hepatic segment 7/8 is a 12 x 8 mm T2 hyperintense lesion with small septations that demonstrate questionable enhancement (series 3, image 14). This may represent a complex cyst. Hepatic steatosis. The hepatic vasculature is patent.No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is a 10 x 10 mm T2 hypointense, enhancing lesion in the uncinate process of the pancreas corresponding to the previously seen hypervascular lesion on CT (series 11, image 384). The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Enhancing lesion in the uncinate process most is compatible with islet cell tumor.2.Hepatic segment 7/8 lesion most likely represents a complex cyst.3.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: hx of Cowden syndrome, presenting with vertigo History: vertigo There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1.No evidence of acute ischemic or hemorrhagic lesion.2.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, with multiple sclerosis. Evaluate interval change. Numerous T2 hyperintense lesions are seen within the periventricular and juxtacortical white matter of the cerebral hemispheres, some oriented radially with respect to the ventricles and extending to the corpus callosum. Several lesions are noted in the pons and cerebellar peduncles, and at least one lesion is evident in the medulla. Marked T1 hypointensity is seen associated with lesions in the periatrial regions. The other lesions demonstrate mild to moderate T1 hypointensity. Punctate enhancement is evident in association with one small right corona radiata lesion. Incomplete ring enhancement is seen in association with a lesion along the right occipital horn. No evidence of significant mass effect or edema is noted. The corpus callosum is thin and the ventricles and sulci are prominent suggesting volume loss. No abnormal extra-axial fluid collections are detected.

Output: Numerous white matter lesions are seen compatible with long-standing multiple sclerosis. At least two lesions demonstrate enhancement suggesting active inflammation.


Instruction: Generate impression based on findings.

Input: Radiculopathy, lumbar region [M54.16], Reason for Study: ^Reason: assess for lumbar spinal stenosis/radiculopathy History: gait impairment/ radicular pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is grade 1 anterolisthesis of L4 on L5 associated with bilateral ligamentum flavum thickening resulting severe spinal stenosis at this level.The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: disc dessication, otherwise unremarkable. L1-L2: disc dessication, minimal bulging of disc and bilateral ligamentum flavum thickening results minimal spinal canal stenosis.L2-L3: disc dessication, minimal bulging of disc and bilateral ligamentum flavum thickening.L3-L4:disc dessication, minimal bulging of disc and bilateral ligamentum flavum thickening results minimal spinal canal stenosis.L4-L5: Grade 1 anterolisthesis of L4 on L5 associated with bilateral ligamentum flavum thickening results severe spinal canal stenosis. L5-S1: Diffuse bulging of disc with eccentric disc protrusion toward right side neural foramen results moderate right neuroforaminal stenosis.

Output: 1. Grade 1 anterolisthesis of L4 on L5 with severe spinal stenosis at the level of L45.2. Multilevel various degree degenerative disease of lumbar spine as described above.


Instruction: Generate impression based on findings.

Input: Again seen is evidence of prior Chiari decompression with suboccipital craniectomy and dorsal C1 laminectomy. Cerebellar tonsils again seen extending to the upper margin of the C1 level. There is residual minimally diminished CSF space at the foramen magnum similar to prior but much improved since preoperative study from 2013. Ventricular caliber remains unchanged without evidence of hydrocephalus. No extra-axial collections. No evidence of acute ischemia or hemorrhage. No intracranial mass effect, midline shift, or herniation. CSF flow sequence is nondiagnostic.SPINE

Output: 1. Again seen are postsurgical changes of Chiari I decompression and significant improvement in CSF spaces at the craniocervical junction compared to the preoperative study. Compared to postoperative cervical spine MRI, 10/17/2014, residual minimally diminished CSF space at the foramen magnum is not significantly changed. Subtle T2 hyperintensity involving the cervical cord at the C2 level is less prominent. No new cord signal abnormality or evidence of a discrete syrinx in the spinal cord.2. Mild degenerative changes in the cervical, thoracic, and lumbar spine. No high-grade spinal canal or high-grade neural foraminal stenosis at any level. Please see details above.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post ETV with fever. Signs and symptoms: As above. Pre and post enhanced brain MRI:There is an irregular focus of acute hemorrhage in the right basal ganglia with mild surrounding vasogenic edema and mass effect resulting in trace deviation of midline to the left. There is mild surrounding enhancement on postcontrast infused images. Edema appears to minimally extend into the superior right cerebral peduncle. Subtle FLAIR and T2 hyperintensity extends from this finding superiorly to the right frontal cortex at the level of a right frontal burr hole along the track of catheter insertion. Findings demonstrate no significant change compared to prior head CT examination. Mildly prominent supratentorial ventricular system remain stable since prior exam.Additionally examination demonstrate a well-demarcated focus of T2/FLAIR hyperintensity of the quadrigeminal plate without surrounding edema or enhancement. This finding measures approximately 11 x 7 mm in transaxial dimensions. Findings results in partial effacement of the aqueduct. Comparison to prior exams demonstrate no convincing evidence of interval change in the size of this lesion.Calvarium is unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.Hemorrhage and surrounding edema in the right basal ganglia along the course of a right frontal approach ventricular catheter and its associated mass effect on the third ventricle remains fairly similar to prior exams.2.Stable mildly prominent supratentorial ventricular system since prior CT examinations.3.Well-demarcated nonenhancing FLAIR/T2 hyperintensity of the quadrigeminal plate measures at 7 x 11 mm in size consistent with a mass demonstrate no significant change since prior exam.4.Unremarkable exam otherwise as detailed above.


Instruction: Generate impression based on findings.

Input: Headache(784.0) [784.0], Reason for Study: ^Reason: evaluate for structural lesions History: chronic daily headache, intractable No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness. Other malaise and fatigue Headache The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Third (oculomotor) nerve palsy, right eye [H49.01], Reason for Study: ^Reason: partial third nerve palsy History: diplopia, ptosis There is no evidence of acute ischemic lesion.Underlying brain shows diffuse brain atrophy with multifocal patchy T2 high signal intensity lesions on periventricular white matter indicating non specific small vessel ischemic disease. Bilateral basal ganglia and thalami show multiple scattered T2 high signal intensity lesions indicating multiple lacunar infarctions.Bilateral oculomotor nerves are seen without evidence of abnormal signal intensity.Midbrain and periaqueductal gray matter did not show any evidence of abnormal signal intensity on this MRI either.The right 3rd nerve appears to be close proximity to the right SCA on this MRI but its clinical implication is unknown.Although brain MRA was not performed, it does not appear to show evidence of right side posterior communicating artery aneurysm. If clinically indicated, head CTA can be considered for further imaging evaluation.Cranial nerve 4 to 12 are shown bilaterally without definitive evidence of abnormal finding.Bilateral lenses are not seen indicating postoperative status.Deformity of the right eye globe is probably related to senile change.

Output: 1. No evidence of acute ischemic stroke. 2. No evidence of abnormal enhancement.3. Close proximity of the right 3rd nerve and right SCA are seen, but its clinical implication is unknown.


Instruction: Generate impression based on findings.

Input: Female 60 years old Reason: eval for previously seen hypodensities which may represent metastatic disease seen on OSH CT in pt with etoh cirrhosis and breast mass concerning for malignancy History: eval for previously seen hypodensities which may represent metastatic disease seen on OSH CT ABDOMEN:LIVER, BILIARY TRACT: Prominence of the hepatic fissures, and contour nodularity consistent with chronic liver disease. Subtle T2 hyperintense signal suggests underlying fibrosis. No significant dropout on out of phase images to suggest hepatic steatosis. There is no focal liver lesion. Prominence of the portal vein, likely relating to chronic liver disease. There is no biliary dilatation. SPLEEN: The spleen measures at upper limits of normal at 13.0 cm.PANCREAS: At least 3 cystic lesions in the pancreatic head and uncinate process. The largest measures 1.9 x 2.1 cm and contains thin internal septations. No convincing solid enhancing component is identified. There is no pancreatic duct dilatation. This is not identified on prior CT abdomen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple mildly prominent porta hepatis lymph nodes which can be seen in the setting of chronic liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Multiple pancreatic head and uncinate process cysts. The largest measures 2.1 cm and is minimally complex containing thin internal septations. This may represent a mucinous cystic neoplasm. The appearance is somewhat atypical for IPMN. Consideration should be given to EUS and GI oncology opinion. 2. Findings consistent with chronic liver disease.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. There is unchanged mild superior endplate depression at T6. The vertebral body and disc space heights are otherwise preserved. There are multiple unchanged foci of yellow marrow versus hemangiomas throughout the thoracic spine. The vertebral bone marrow signal is otherwise unremarkable.There is multilevel mild disc desiccation as well as mild ligamentum flavum thickening at T9 through L1, worse on the left. This results in mild indentation of the thecal sac that is most severe at T10-T11 without significant spinal canal stenosis. There is a small unchanged right foraminal disc herniation at T1-T2 without significant stenosis. There are also minimal disc bulges at C7-T5 without significant spinal canal stenosis. There are partially imaged degenerative changes at C6-C7 that are not well assessed on this study. The spinal cord displays normal signal and morphology. There is no evidence of intraspinal mass or abnormal enhancement.There are multiple unchanged T2 hyperintense right thyroid nodules, with the largest measuring up to 13 mm. The paravertebral soft tissues are unremarkable.

Output: 1.No evidence of cord signal abnormality, intraspinal mass or abnormal enhancement. 2.Mild lower cervical and thoracic spine degenerative changes as detailed above are unchanged without significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Metastatic thyroid cancer. There are multiple supratentorial and infratentorial lesions compatible with metastases. There is slight interval increase in size of several lesions since December 2014. For example, a lesion in the anterior left cingulate gyrus measures up to 5 mm, previously 3 mm and a lesion in the left paracentral lobule measures up to 15 mm, previously 13 mm. There is also slightly increased edema associated with the left paracentral lobule lesion. Other lesions are not significantly changed. There is no evidence of acute infarction. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues appear unchanged. There is a right lens implant.

Output: Stable to slight interval increase in size of multiple intracranial metastases.


Instruction: Generate impression based on findings.

Input: Low pH at birth, ex 33 week premie. There is high T1 and low T2 signal hemorrhage within the bilateral lateral ventricles, third ventricle, and within the posterior fossa extra-axial spaces. There also appears to be susceptibility effect that localizes to the caudothalamic grooves, right greater than left. There is no evidence of mass or acute infarct. There is a paucity of myelination, which is likely attributable to prematurity. There is mild prominence of the subarachnoid spaces overlying the bilateral anterior temporal poles. 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: Subacute intraventricular hemorrhage, likely related to bilateral germinal matrix hemorrhages, and hemorrhage within the posterior fossa extra-axial spaces, but no evidence of ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Diagnosis: Traumatic hemorrhage of right cerebrum with loss of consciousness of unspecified duration, sequelaClinical question: AMS with intraparenchymal bleed on Head CT, monitor for progression MRI of the brainThere is a hematoma centered in the right frontal lobe involving right middle and inferior frontal gyri. There is associated vasogenic pattern of edema.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate scattered opacities in the left anterior ethmoid air cells as well as left frontal sinus.. The visualized portions of the mastoid air cells demonstrate some scattered opacities. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.The cerebellar tonsils extend approximately 6 mm below the level of foramen magnum.MRA brain:Vasculature adjacent to the right frontal lobe hematoma is attenuated.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There is a hematoma centered in the right middle frontal gyrus. An underlying cause is not detected on this exam.2.No evidence for intracranial aneurysm.3.Findings are suspicious for Chiari I malformation.


Instruction: Generate impression based on findings.

Input: Generalized right elbow pain since the morning of 2/8/15. No small or recent injury Displacement of fat pads indicating joint effusion. Calcific density anterior to the joint which likely represents dystrophic calcification, old trauma or calcification of ligament. If further evaluation is needed, CT or MRI can be obtained for further evaluation.

Output: Joint effusion with calcific densities seen anterior to the joint. All this likely represents either old trauma or dystrophic calcifications, further evaluation can be performed with CT or MR if clinically indicated


Instruction: Generate impression based on findings.

Input: 52-year-old female with shoulder pain with movement ROTATOR CUFF: Examination of the rotator cuff is limited due to patient body habitus. There is signal intensity within the bursal surface fibers of the supraspinatus tendon anteriorly at we suspect are present a combination of tendinosis and perhaps bursal surface fraying, but we see no discrete fluid-filled tear. The supraspinatus muscle is within normal limits. A streaky focus of increased signal intensity within the distal infraspinatus tendon may represent a vessel. No definite tear is visualized. The infraspinatus muscle is within normal limits. The teres minor tendon and muscle are intact. Increased signal intensity within the undersurface fibers of the subscapularis tendon suggests fraying and perhaps a tiny partial-thickness tear, but no full-thickness tear is evident. The subscapularis muscle is within normal limits.SUPRASPINATUS OUTLET: An os acromiale is noted. Mild osteoarthritis affects the acromioclavicular joint. GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. Evaluation of the labrum is limited due to non-arthrogram technique and body habitus but no abnormality is visualized.BICEPS TENDON: Increased signal intensity within the biceps tendon at its transition from the rotator interval to the bicipital groove may reflect partial thickness tearing. A small amount of fluid within the tendon sheath suggests mild tenosynovitis.

Output: 1. Limited exam demonstrating rotator cuff tendinosis and surface fraying without evidence of a full-thickness cuff tear. 2. Mild acromioclavicular joint osteoarthritis.3. Possible partial-thickness tearing of the tendon of the long head of the biceps and mild associated tenosynovitis.


Instruction: Generate impression based on findings.

Input: 36-year-old male with positive Lachman's test MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a lateral notch along the anterolateral femoral condyle with underlying articular cartilage defect measuring approximately 1 cm in AP dimension and extensive underlying edema consistent with contusion. Linear T1 hypointense signal associated with extensive edema in the posterolateral tibial condyle is consistent with fracturing and contusion, but there is no impaction. There is mild degeneration of the articular cartilage along the medial facet of the patella and posteromedial femoral condyle.LIGAMENTS: The ACL is completely torn. The PCL is intact. The medial and lateral collateral ligaments are intact.EXTENSOR MECHANISM: The patella and quadriceps tendon are intact.ADDITIONAL

Output: 1. ACL tear with associated contusions as described above.2. Chondral injury along the lateral femoral condyle. 3. Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Clinical question: 52-year-old with continued altered mental status, potential right arm paralysis. Signs and symptoms: Altered mental status Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal.Calvarium, visualized paranasal sinuses and mastoid air cells are unremarkable. Considering provided clinical information and prior negative CT from 3 -- 3 -- 2011 recommend further follow-up with an MRI.

Output: Negative nonenhanced CT brain.


Instruction: Generate impression based on findings.

Input: Right hip pain. Breast cancer, stage IIIC, new pain over right hip. Question of osseous metastasis. Bone marrow signal is within normal limits. Two foci of increased signal within the left femoral head likely represent synovial herniation pits. No fracture is identified. No abnormal osseous enhancement is seen on post-contrast imaging. There is minimal increased T2 signal and enhancement within the insertional fibers of the right gluteus medius and minimus tendons which may reflect mild inflammation. Otherwise, the remaining musculature and soft tissues are normal.

Output: 1. No evidence of an osseous metastatic lesion in the right hip.2. Minimal signal abnormality within the right gluteus medius and minimus tendons may represent mild inflammation/tendinopathy.


Instruction: Generate impression based on findings.

Input: Pituitary and suprasellar mass. There is an enhancing pituitary mass with suprasellar extension that measures up to 28 mm in height The tumor has lobulated components eccentric to the left, with mass effect upon the infundibulum, optic apparatus, hypothalamus, anterior commissure, and left medial temporal lobe. In addition, the tumor extends into the bilateral cavernous sinuses, with partial encasement of the right internal carotid artery. The internal carotid artery flow voids otherwise remain intact. The sella protrudes inferiorly and partially effaces the sphenoid sinuses. The paranasal sinuses otherwise appear to be unremarkable. There are multiple scattered punctate foci of T2 hyperintensity in the cerebral white matter.

Output: Pituitary macroadenoma with mass effect upon the infundibulum, optic apparatus, hypothalamus, anterior commissure, and left medial temporal lobe, as well as extension into the bilateral cavernous sinuses, with partial encasement of the right internal carotid artery.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. Some of the sequences are degraded by patient motion. There is an enhancing lesion centered in the sphenoid triangle with epidural extension into the left middle cranial fossa that measures up to 5 mm in thickness, with mild mass effect upon the anterior pole of the temporal lobe and associated vasogenic edema. There is no evidence of intracranial hemorrhage or acute infarct. There is minimal periventricular white matter T2 hyperintensity, which is nonspecific. There is mild diffuse cerebral volume loss. There is mild coaptation of the right frontal horn of the lateral ventricle. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mucosal thickening in the maxillary sinuses. There is a partially-imaged cystic lesion in deep lobe of the parotid gland that projects into the right parapharyngeal space that measures at least 15 mm. There are also multiple subcentimeter cystic foci in the superficial right parotid gland. There appear to be small scalp lipomas in the occipital region.

Output: 1. Metastatic lesion centered in the left sphenoid triangle with epidural extension into the left middle cranial fossa and associated mild vasogenic edema in the anterior temporal lobe.2. Multiple cystic lesions in the right parotid gland, which may be sequela of an inflammatory or autoimmune process versus a neoplastic condition such as Warthin tumors. Follow up with dedicated parotid imaging may be useful if clinically warranted.


Instruction: Generate impression based on findings.

Input: Diagnosis: Encounter for examination for normal comparison and control in clinical research programClinical question: Day 28: clinical trial eval The patient status post right frontal craniotomy for removal of a right frontal lobe mass. There is signal hyperintensity present along the right frontal lobe within the subcortical and periventricular white matter in the right superior middle and inferior frontal gyri as well as the white matter of the right external capsule. The extent of the white matter signal abnormality remains stable and compared to the previous exam from October 19, however, this white matter signal change appears to be more extensive than on the 7/23/2015 exam. Compared to the 9/15/2015 exam - which is preoperative- the outer extent of the white matter signal change appears very similar. There are punctate foci of susceptibility effect present within the white matter signal change adjacent to the surgical site. These were also present on the 9/15/2015 exam. There is redemonstration of ill-defined patchy enhancement where these punctate foci of susceptibility are surrounding the surgical margins . This contrast enhancement is stable and compared to the previous exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Since the previous exam is no substantial change. There is redemonstration of status post right frontal lobe surgery. The possibility of a residual neoplasm in the remaining right frontal lobe cannot be excluded.


Instruction: Generate impression based on findings.

Input: 64-year-old male with history of nasopharyngeal cancer presents with increasing fatigue, right ear effusion and ulcer noted in the nasopharynx Beam hardening artifact from dental hardware limits evaluation of oral cavity.There is intense enhancement and swelling of the mucosa of posterior nasopharynx. A nonenhancing ulceration is seen in the posterior-superior nasopharynx with debris and air bubbles seen within the ulcer crater. There is subtle cortical erosion along the anterior clivus immediately posterior to the ulceration which appears more prominent and conspicuous on this exam as compared to the previous exam. These findings may represent infection, tumor, or be related to post radiation changes. MRI with contrast is recommended for further characterization.There is no evidence of exophytic mass. The right submandibular gland appears slightly enlarged in comparison to the left; however no discrete mass is identified. The parotid and thyroid glands are unremarkable.Atherosclerotic calcifications are again seen at the common carotid artery bifurcation bilaterally and at the origins of the great vessels arising from the aortic arch. Stable postsurgical changes are seen in the right neck. No pathologically enlarged cervical lymph nodes are identified.There is mild mucosal thickening involving the left ethmoid and sphenoid sinuses. Additionally, there is partial opacification of the right mastoid air cells without bone erosions or destruction. The right middle ear cavity also appears opacified without evidence of bony destruction.Vertebral body heights are maintained without evidence of acute fracture. Mild degenerative changes affect the cervical spine. See accompanying CT scan of the chest for additional information.

Output: 1. Ulceration is seen in the posterior-superior nasopharynx with associated subtle cortical erosion of the anterior clivus which appears mildly progressed as compared to the prior exams. These findings may represent infection, tumor or be related to post-radiation change. MRI with contrast is recommended for further characterization.2. New partial opacification of the right mastoid air cells and right middle ear cavity without bony destruction, raising the question of post obstructive otitis.


Instruction: Generate impression based on findings.

Input: Syncope.IMAGE ACQUISITIONS: 5-mm contiguous axial CT sections of the brain without contrast infusion. No acute intracranial hemorrhage, mass effect or shift of midline structures.There are multiple patchy areas of low attenuation in cerebral white matter both in deep white matter and in juxtacortical white matter, a nonspecific finding but atypical for age, either representing chronic ischemic/degenerative change or possibly demyelination. Consider follow-up MRI of the brain for further evaluation, as indicated clinically.There is no depressed calvarial fracture. Craniofacial structures are unremarkable.

Output: Extent of patchy white matter low attenuation is greater than expected for patient's age. If there is underlying risk for accelerated atherosclerosis such as diabetes or hypercholesterolemia, or if the patient has hypertension, the finding could be explained by this. Demyelination is not excluded. Follow-up as indicated clinically.


Instruction: Generate impression based on findings.

Input: Neurosarcoidosis with recent visual changes. Evaluate for any interim changes. Orbits: There is persistent enhancement and T2 hyperintensity of the orbital segment of the right orbital nerve. Otherwise, there has been interval resolution of enhancement and swelling of the rest of the right optic nerve, optic chiasm, and left optic nerve. The bilateral globes, extraocular muscles and orbital fat bilaterally appear unremarkable. There is an enhancing skin excrescence along the lateral aspect of the left lateral orbital rim that measures up to 5 mm. Brain: There has been interval resolution of the abnormal leptomeningeal enhancement. Furthermore, there has been marked interval decrease in the degree of abnormal perivascular enhancement. There is no evidence of intracranial hemorrhage, mass, or acute cerebral infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a right maxillary sinus retention cyst. The skull and scalp soft tissues are grossly unremarkable.

Output: 1. Persistent abnormality of the orbital segment of the right orbital nerve related to neurosarcoidosis. Otherwise, the inflammation involving the rest of the right optic nerve, optic chiasm, and left optic nerve have resolved. 2. Interval resolution of the abnormal leptomeningeal and markedly decreased perivascular enhancement related to neurosarcoidosis.


Instruction: Generate impression based on findings.

Input: Redemonstrated are multiple foci of susceptibility abnormality within the supratentorial brain, consistent with the diagnosis of cerebral cavernous malformations. None demonstrate perilesional edema. There are no associated developmental venous anomalies. Previously identified lesions which had enlarged on the comparison exam demonstrates some change of internal signal characteristics, however none currently have significantly enlarged.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Redemonstrated are multiple foci of susceptibility abnormality within the supratentorial brain, consistent with the diagnosis of cerebral cavernous malformations. None demonstrate perilesional edema. Previously identified lesions which had enlarged on the comparison exam demonstrates some change of internal signal characteristics, however none currently have significantly enlarged.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [780.4], Reason for Study: ^Reason: any signs of ischemia, infarction, bleed, or mass History: expressive aphasia, ataxia There is a subtle restricted diffusion on the right cingulate gyrus indicating subacute ischemic infarct. There is no evidence of hemorrhage transformation.Underlying brain shows advanced non specific small vessel ischemic disease.Encephalomalacia on the right middle and inferior frontal gyri likely due to prior ischemic infarction. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening of the left maxillary sinus.

Output: 1. Restricted diffusion on the right cingulate gyrus indicating acute or subacute ischemic infarction without evidence of hemorrhagic transformation.2. Advanced non specific small vessel ischemic disease.3. Old ischemic infarction with encephalomalacia on the left middle and inferior frontal gyri.


Instruction: Generate impression based on findings.

Input: Evaluate for new acute CVA. History of lower extremity weakness, numbness. There is an area of cortical and subcortical T2 hyperintensity in the left posterolateral parietoccipital junction with interval volume loss. There is no evidence of intracranial hemorrhage or acute infarct. The pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild unchanged mucosal thickening in the right maxillary sinus. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Encephalomalacia in the left posterolateral parietoccipital junction related to a chronic infarct, but no evidence of acute infarction. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Cognitive concerns. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is fluid in the bilateral mastoid air cells. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. Mild scattered cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Mild diffuse cerebral volume loss.3. Nonspecific fluid in the bilateral mastoid air cells.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE RFA. New left lobe lesion seen on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: Lobular liver contour compatible with cirrhosis. Findings suggestive of iron deposition.Limited non-enhanced study shows signal abnormality and retraction of the lateral left hepatic lobe segment. Otherwise, no focal lesion is evident.Small perihepatic ascites. Partially contracted gallbladder with multiple small gallstones. No intra or extrahepatic biliary ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate renal hyperintensities, probable cysts are unchanged. Very low intensity filling defect within the right collecting system may represent a nonobstructive calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate left-sided pleural effusion with adjacent lower lobe consolidation/atelectasis. Sternotomy changes.OTHER: No significant abnormality noted.

Output: Limited study. Due to the patient's renal function no intravenous contrast was given. No focal liver lesion is identified.Moderate left pleural effusion with adjacent consolidation/atelectasis.Non-obstructive calculus in the right renal pelvis.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: space occupying lesion History: headache No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Minimal mucosal thickening especially sphenoid sinus and partial fluid collections on the right mastoid air cells are seen.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Non Hodgkin's lymphoma. Brain: There is persistent diffuse mild enlargement and enhancement of right trigeminal nerve. There is no evidence of intracranial hemorrhage or acute infarct. There is extensive confluent cerebral white matter T2 hyperintensity. There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a small left maxillary sinus retention cyst. Cervical Spine: There is persistent diffuse mild enlargement and enhancement of multiple bilateral lower cervical and upper thoracic nerve roots. Otherwise, there is no evidence of tumor or abnormal enhancement within the cervical spinal canal. The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is unchanged mild multilevel degenerative spondylosis, but no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Persistent diffuse mild enlargement and enhancement of right trigeminal nerve and multiple bilateral lower cervical and upper thoracic nerve roots, which may represent lymphomatous involvement.2. Extensive cerebral white matter abnormality is likely treatment-related.


Instruction: Generate impression based on findings.

Input: Check for sacroiliitis. Pain in left hip. Ulcerative pancreatitis Osseous structures and specifically the SI articulations appear normal. No MR findings to support inflammation. SI joints are well visualized. No abnormal enhancementVisualized portions of the neural canal in the nerve roots are unremarkable.Vascular and the intrapelvic contents are normal. No abnormal fluid or discrete segments of bowel in this limited evaluation.External muscular compartments and soft tissues are also unremarkable.

Output: Normal exam


Instruction: Generate impression based on findings.

Input: Clinical question: Multiple sclerosis. Please perform exam with Dr.Javed's MS protocol. Signs and symptoms: Gait disorder. Pre and post enhanced brain MRI:Examination redemonstrate stable scattered foci of FLAIR hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres as well as left basal ganglia and pons without convincing evidence of interval change/progression. Note should be made that some of the lesions appear more conspicuous on the current exam which is technique related secondary to utilization of 3T scanner on current study compared to 1.5 T scanner in prior exam. This change in particular is noticeable in the pons.There is no evidence of any enhancing demyelinating plaque on this study.Mild prominence of cerebral cortical sulci remains similar to prior study. Ventricular system are within normal size and without deviation of midline.

Output: Stable scattered supratentorial and pontine foci of FLAIR hyperintensity consistent with patient's known multiple sclerosis without detectable enhancing plaque.


Instruction: Generate impression based on findings.

Input: 62 year old woman with history of OHT, PCI to RCA in June 2015, referred for cardiac stress MRI for interval follow up post PCI.MEDICATIONS: Eliquis, ASA, Plavix, Lipitor, insulin, Prograf, Cellcept, Prednisone First Pass PerfusionDuring hyperemia, a perfusion defect is seen in the basal inferior and inferoseptal walls. This defect is related to the below described myocardial infarction and does not represent ischemia. A prominent dark rim artifact is noted in the mid-ventricle.Viability/ Myocardial ScarThere is an area of subendocardial late gadolinium enhancement noted in the basal to mid inferior wall, similar to prior MRI. This extends to ~50% of the myocardial thickness, consistent with prior nearly transmural myocardial infarction; this segment has a low probability of viability. The remaining myocardium is viable. There is additionally a small region of late gadolinium enhancement which involves the apical anterior wall and spares the endocardium. This "patch" of late gadolinium enhancement is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing or infiltrative process such as prior rejection or myocarditis, and is unchanged from prior.Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. There is hypokinesis of the basal inferior wall. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 56 ml/m2 (normal range: 65+/-11), the LVEDV is 115 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 62 ml (normal range 31+/-10), the LV mass index is 50 g/m2, and the LV mass is 102 g. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 60 ml/m2 (normal range 69+/-14), the RVEDV is 123 ml (normal range 110+/-24), the RV end systolic volume index is 22 ml/m2 (normal range 22+/-8), and the RVESV is 46 ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is mild to moderate atheromatous disease of the descending thoracic aorta.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 FindingsSternal wires are present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a nearly transmural myocardial infarction and an associated myocardial perfusion defect involving the basal to mid inferior wall. There is no evidence of ischemia beyond the myocardial infarction in this territory. 2. Normal LV size with mildly reduced systolic function (LVEF 46%) with evidence of mild hypokinesis in the basal inferior wall. Once again, an atypical (non-myocardial infarction) pattern of late gadolinium enhancement involving the apical anterior wall is noted, which likely represents fatty infiltration from an episode of prior rejection. 3. Normal RV size and systolic function (RVEF 63%). There is a slight improvement in LVEF when compared to the prior study from 5/6/2014. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease. Known proximal transverse colon stricture. Presents with recurrent obstructive symptoms. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 10 mm and tapers smoothly at the ampulla without an obstructing mass or stone. Minimal intrahepatic biliary ductal dilatation. Fatty liver without suspicious lesion or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a 9 cm moderate fixed stricture of the transverse colon without significant proximal colonic dilatation. The wall appears moderately circumferentially thickened with adjacent fibrofatty proliferation and postcontrast enhancement. Additionally there is a severe stricture at the splenic flexure measuring approximately 5 cm in length again without significant proximal dilatation.The terminal ileum is well seen without wall thickening, abnormal postcontrast enhancement, fibrofatty proliferation or proximal bowel dilatation. The remainder of the small bowel is normal in caliber and overall appearance.No loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small pleural effusions.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild body wall edema.OTHER: No significant abnormality noted.

Output: 1. Acute on chronic moderate degree 9 cm proximal transverse colon stricture and severe 5 cm splenic flexure stricture. No evidence of associated large bowel or small bowel obstruction.2. The small bowel is unremarkable. No fluid collection.3. Mild biliary ductal dilatation without a focal mass or stone likely related to cholecystectomy.


Instruction: Generate impression based on findings.

Input: Recurrent T2N2B squamous cell carcinoma of the base of the tongue, previously treated with concurrent cisplatin/RT and now receiving chemotherapy. There are post-treatment findings in the neck, including partial left glossectomy and pharyngectomy with flap reconstruction via mandibulotomy. There is no evidence of gross tumor in the oral cavity. There is no evidence of significant cervical lymphadenopathy based on size criteria. The remaining salivary glands appear to be unchanged. There are multilevel posterior cervical disc-osteophyte complexes that narrow the spinal canal. The imaged intracranial structures and orbits are unremarkable.

Output: 1. Extensive treatment effects in the upper aerodigestive tract region without evidence of gross tumor recurrence in the oral cavity region.2. No significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Increased left lower extremity pain, numbness and urinary retention, spinal stenosis at lumbar region.Clinical question: Evaluate for nerve root compression. L1 is designated as the first nonrib-bearing lumbar vertebra. L5 and S1 demonstrate transitional lumbosacral morphology. Vertebral body heights are within normal limits. Alignment is within normal limits. There is redemonstration of a chronic pars fracture involving L4 on the right, which is better seen on prior CT. There is a small focus of T1 and T2 hypointensity in L3 vertebral body, nonspecific and without correlate on the outside CT. No aggressive bony lesions are detected. The conus medullaris is normal in position terminating at L1-L2.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is ligamentum flavum thickening and bilateral facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: There is loss of T2 signal intensity of the disc along with minimal disc bulge and a small central annular fissure/protrusion. There is ligamentum flavum thickening and bilateral facet arthropathy. No spinal canal or neural foraminal stenosis.L4-L5: There is mild loss of disc height with mild loss of T2 signal. There is mild disc bulge. There is evidence of previous surgery with findings of laminectomy. There is severe hypertrophy of the left facet joint, fluid in the facet joint and thickening of ligamentum flavum. In addition, the facet complex and the adjacent soft tissues are edematous. There is moderate right facet hypertrophy. These findings contribute to produce severe transverse spinal canal narrowing with probable nerve root impingement. There is mild bilateral narrowing of the neural foramina.L5-S1: There is a mild disc bulge with moderate bilateral foraminal narrowing. There is bilateral facet arthropathy. S1-S2: No significant neural foramen narrowing or spinal canal stenosis.Paraspinous soft tissues are within normal limits.

Output: Degenerative disc changes predominantly involving L4-L5 with severe left and moderate right facet arthropathy, resulting in severe transverse spinal canal narrowing and possible nerve impingement at this level. There is edema of the left facet complex at this level likely indicating a component of acute inflammation.At L5-S1, there is moderate bilateral neural foraminal narrowing. Additional foraminal narrowing as detailed above.