Instruction: Generate impression based on findings.

Input: Male 65 years old with elevated PSA, evaluate for disease. Biopsy in 2007 was negative. PELVIS:PROSTATE:Prostate Size: 5.6 x 3.9 x 4.6 cmPeripheral Zone: Within the anterior apex is a 10 x 7 mm focus of abnormal T2-weighted and ADC hypointensity. There is no early contrast enhancement associated with this lesion. No additional lesions are identified.Central Gland: Benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: There is a nonspecific enhancing lesion within the left ischio unchanged in size compared to the CT from 2006.OTHER: No significant abnormality noted.

Output: 1.10 x 7 mm focus of signal abnormality in the anterior prostate apex is of intermediate suspicion for prostate adenocarcinoma (PIRADS 3).2.No pelvic lymphadenopathy or evidence of extracapsular extension.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: Episodic loss of balance; no falls; look for occult cerebrovascular disease. There is no evidence of intracranial hemorrhage or acute infarct. There is a nonspecific punctate focus of high T2 signal in the right peritrigonal white matter and minimal more diffuse periventricular white matter T2 hyperintensity bilaterally. There is heterogeneous enhancement of the pituitary gland, which is otherwise not particularly enlarged. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are small retention cysts in the left maxillary sinus. There is a punctate Thornwaldt cyst in the nasopharynx.

Output: 1. Nonspecific punctate focus of high T2 signal in the right peritrigonal white matter and minimal more diffuse periventricular white matter T2 hyperintensity bilaterally, which may represent chronic small vessel ischemic disease, but no evidence of intracranial hemorrhage or acute infarct. 2. Apparent heterogeneous enhancement of the pituitary gland may be attributable to an underlying pituitary microadenoma, for example. Follow up with dedicated pituitary MRI may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Professional left-sided gaze, no right-sided weakness, fever, tachypnea Non-infused CT of brain.Axial 4-mm CT images of the entire head was performed.Images through posterior fossa are unremarkable.Images through supratentorial space demonstrate an area of low-attenuation in the periventricular white matter of right posterior frontal -- parietal region. This is not a specific however it may represent a small vessel stroke. Very subtle subcortical low-attenuation adjacent to the frontal horn of the right lateral ventricle may also represent a small vessel stroke finding. The age of these strokes cannot be determined on CT. if clinical concern for acute process is persist an MRI is recommended. No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus is detected. Cortical sulci is unremarkable. Ventricular system and all CSF cisterns are unremarkable.

Output: Findings suspect that of small vessel disease of indeterminate age. No evidence of acute hemorrhage or cortical stroke.


Instruction: Generate impression based on findings.

Input: Ms. Dieckow is a 58 year old female with a personal history of right breast lumpectomy in 2006 for breast cancer, treated with radiation and chemotherapy. No current breast complaints. Family history of breast carcinoma in a paternal aunt, paternal great aunt, and paternal great-grandmother. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the superior right breast, compatible with stated history of right breast lumpectomy. Multiple scattered foci of enhancement are seen throughout the left breast, appearing similar when compared to multiple prior examinations. No one focus appears more suspicious than the rest.There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 52 years Male (DOB:6/19/1964)Reason: r/o compression or stenosis History: neck and back pain, left sided weakness PROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a disc bulge at T8-9.No abnormal enhancing lesions are appreciated in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are appreciated in the lumbar spine.Is level.At L5-S1 there is marked bilateral facet hypertrophy present associated with mild anterior subluxation of L5 on S1. There is narrowing of the neural foramina bilaterally at this level associated with mild encroachment of exiting nerve roots. There is no significant compromise to the spinal canalAt L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are some degenerative changes present in the lower lumbar spine at L5-S1 where there is some mild subluxation and facet hypertrophy associated with some mild encroachment of the exiting nerve roots2.There is some mild degenerative changes present in the cervical and thoracic spines without significant compromise to spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 7 years Female (DOB:2/9/2009)Reason: r/o HHV6 infection History: change in mentationPROVIDER/ATTENDING NAME: GRACE P CHONG GRACE P CHONG The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of confluent periventricular T2 and FLAIR hyperintense white matter which remains fairly stable compared to the previous exam.There is a small T2, FLAIR hyperintense focus in the left cerebellar white matter.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.

Output: 1.Increased T2 signal within the periventricular white matter which is nonspecific but favored to reflect treatment effect..2.There is a new small lesion in the left cerebellar white matter. This is nonspecific. One possibility is that this represents an infection.3.Persistent opacification of the paranasal sinuses, mastoid air cells, and middle ears.4.No new lesions are appreciated within the brain parenchyma.


Instruction: Generate impression based on findings.

Input: There has been interval evolution of the signal characteristics of the subcentimeter lesion within anterior pituitary lobe, including decreased T1 hyperintensity. The pituitary stalk remains midline. There is no suprasellar extension or optic chiasm abutment. There is no abnormal intracranial enhancement. The ventricles are stable in size of configuration. The major cerebral flow voids are intact. The extracranial structures are unremarkable.

Output: Interval change in the signal characteristics of the subcentimeter pituitary lesion, suggestive of evolution of prior intratumoral hemorrhage.


Instruction: Generate impression based on findings.

Input: 18 years, Female, apneic while sleeping. Evaluate for abnormality of the upper cervical spine and lower brainstem. History of Chiari type I malformation status post decompression surgery with C1 laminectomy and dural graft. Previously identified restricted diffusion within the right greater than left cerebellum is decreased in T2 hyperintensity compared to prior, with unchanged extent, compatible with subacute posterior inferior cerebral artery infarction.There is no new restricted diffusion. There is no susceptibility artifact to suggest hemorrhage. There is no extra-axial collection. No intracranial mass or mass-effect is identified. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There are persistent retained secretions within the bilateral mastoid air cells. There is a left maxillary sinus mucous retention cysts, unchanged. Patient is status post Chiari decompression with suboccipital craniectomy and resection of the posterior arch of C1. There is redistribution of fluid within the posterior occiput soft tissues, though unchanged in size.CERVICAL SPINE: There is residual mild T2 hyperintensity within the upper cervical cord, though evaluation is limited on this study. The cervical spine alignment is within normal limits, with preserved cervical lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Evolving subacute infarction within the right greater than left cerebellum, in a PICA distribution.2. Stable postsurgical changes status post Chiari decompression.3. Residual mild T2 hyperintensity within the upper cervical cord, though evaluation is limited.


Instruction: Generate impression based on findings.

Input: Right leg pain with intervertebral disc protrusion midline, low back pain Mild to moderate degenerative changes in the cervical spine are partially imaged including disc osteophyte complexes at the C4-C5, C5-C6, and C6-C7 levels.Thoracic: Vertebral body heights in the thoracic spine are normal. Alignment is normal. Bone marrow signal is benign with small scattered foci of T1 hyperintensity compatible with foci of fat or hemangiomas. There is no abnormal cord signal.Mild degenerative changes are seen in the thoracic spine including small right paracentral disc protrusion at the T3-T4 level which mildly deforms the ventral aspect of the cord. Posterior thecal sac is widely patent at this level without evidence of significant spinal canal stenosis. There is mild right-sided neural foraminal stenosis at T3-T4.Minimal disc protrusion is seen at T5-T6 and T6-T7. There is prominent ligamentum flavum thickening/calcification along the left T9-T10 and T10-T11 levels with minimal narrowing of the left posterior aspect of the thecal sac. There is moderate right T8-T9 neural foraminal stenosis. Spinal canal and neural foramina are otherwise patent.Lumbar: Please note for the purposes of numbering there are 5 lumbar type vertebral bodies and a lumbarized transitional segment labeled L6 for the purposes of this study. As such the most inferior well-defined disc space is labeled L6-S1. Vertebral body heights are within normal limits. There is minimal anterolisthesis of L5 on L6. Alignment is otherwise within normal limits. Bone marrow signal is slightly heterogeneous without discrete destructive osseous lesion. Hemangioma involving the L4 vertebral body incidentally noted. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:T12-L1: Mild disc bulge with minimal central protrusion component partially effacing the ventral thecal sac. No significant neural foraminal stenosis.L1-L2: Small central disc protrusion, without significant spinal canal or neural foraminal stenosis. L2-L3: Central and paracentral disc protrusion, ligamentum flavum thickening, and facet arthropathy result in moderate central spinal canal stenosis at this level. There is effacement of the lateral recesses. There is mild bilateral neural foraminal stenosis.L3-L4: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy without significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis.L4-L5: Mild disc bulge, facet arthropathy, and ligamentum flavum thickening without significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L5-L6: Advanced bilateral facet arthropathy and minimal anterolisthesis. There is disc uncovering and mild bulge. There is effacement of the lateral recesses, right worse in left. There is moderate central canal stenosis. There is mild to moderate neural foraminal stenosis bilaterally.There is subluxation and mild fragmentation involving the facet joints as well as possible pars defect, which can be better assessed with CT. L6-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Right renal cyst partially visualized.

Output: 1. Mild degenerative changes in the thoracic spine without cord signal abnormality or high-grade spinal canal stenosis at any level. There is mild right T3-T4 and moderate right T8-T9 neural foraminal stenosis. Small disc protrusion at the T3-T4 level and ligamentum flavum thickening/calcification at the T9-T10 and T10-T11 levels minimally narrow the thecal sac without significant spinal canal stenosis.2. Please note variant anatomy with transitional lumbosacral junction and numbering (L1-L6) as detailed above. There are multilevel degenerative changes in the lumbar spine with moderate central spinal canal and lateral recess stenosis at the L2-L3 and L5-L6 levels. There is advanced facet arthropathy at L5-L6 with minimal anterolisthesis. Relatively mild neural foraminal stenosis at multiple levels as detailed above.3. Degenerative changes in the cervical spine are partially imaged.


Instruction: Generate impression based on findings.

Input: Atypical meningioma surveillance. There are postoperative findings related to right transfrontal resection of a planum sphenoidale meningioma. There is an unchanged plaque-like area of heterogeneous enhancement along the posterior right planum sphenoidale, which measures approximately up to 5 mm in thickness. There is a persistent punctate focus of enhancement along the right frontal lobe resection cavity posteromedial margin. There is unchanged diffuse confluent T2 hyperintensity in the right frontal lobe surrounding the resection cavity, as well as in the left anterior left frontal lobe periventricular white matter. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Postoperative findings related to right transfrontal resection of a planum sphenoidale meningioma without significant change in the small amount of residual tumor along the right planum sphenoidale associated with hyperostosis. Persistent nonspecific punctate focus of enhancement along the right frontal lobe resection cavity posteromedial margin.


Instruction: Generate impression based on findings.

Input: H/o meningioma. S/p fall. There is a redemonstration of the left frontal mass with surrounding vasogenic edema, which appears unchanged from the prior brain MRI. Effacement of the frontal horn of the left lateral ventricle and minimal rightward midline shift are again seen. The right frontal mass seen on the previous brain MRI is obscured by beam hardening artifacts.  The brain is otherwise normal attenuation and morphology. There is no intracranial hemorrhage or abnormal extra-axial fluid collection. The ventricles and cortical sulci appear prominent.A small right frontal subgaleal hematoma is noted. No calvarial fracture is identified. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.No evidence of intracranial hemorrhage or calvarial fracture. Small right frontal subgaleal hematoma.2.Left frontal meningioma. Right frontal mass cannot be evaluated due to beam hardening artifacts.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with left orbital mass, visual deficits and pale nerves on exam, would like to characterize lesion and optic nerve compression. A well demarcated, ovoid masslike lesion is evident within the posterior intraconal space of the left superolateral orbit. The lesion measures 12 x 9 x 9 mm. The lesion demonstrates patchy enhancement on the earliest postcontrast images with subsequent fill-in on later postcontrast images. The lesion contacts but does not infiltrate or significantly deform the superior rectus and lateral rectus muscles. The lesion also contacts and mildly displaces the optic nerve medially. The nerve does not appear to be significantly impinged, and no optic nerve signal abnormality is seen.No abnormalities of the right orbital structures are seen. The globes are round and symmetric. Bilateral lens replacement is noted. Mild patchy mucosal thickening of the visualized paranasal sinuses is seen.

Output: An ovoid masslike lesion is evident occupying the upper outer aspect of the left intraconal space. The lesion exerts mild mass effect upon the optic nerve but without significant nerve compression. The imaging features of this lesion favor a benign cavernous hemangioma. Some other type of vascular anomaly, or even a nerve sheath tumor, would be less likely considerations.


Instruction: Generate impression based on findings.

Input: 66-year-old female status post heart transplant and partial gastrectomy. Presenting with right upper quadrant pain anemia ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Ill-defined hypodense lesion in the left lobe of the liver measuring 10 x 9 mm on image number 14, series number 3, nonspecific. This lesion is not well seen on previous CT and MRI. Follow-up imaging with liver MR 6-month helpful. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Enhancing mass in the anterior aspect of the left kidney measuring 16 x 13 mm image number 47, series number 3 has slightly increased in size compared to previous CT and MRI. Simple appearing left renal cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes involving the abdominal aorta predominantly SMA. Celiac trunk and IMA are patent.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Transplant kidney in the right iliac fossa without evidence of hydronephrosis, focal lesions.

Output: Right adrenal mass suspicious for renal cell carcinoma slightly increased in size compared to previous studies.Liver MRI may be helpful in 6 months for further evaluation of the nonspecific, but new lesion in the left lobe of the liver.


Instruction: Generate impression based on findings.

Input: 62-year-old man with history of alcoholic cirrhosis, please evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. No focal suspicious hepatic lesion identified. There is nonocclusive mural thrombus in the portal vein (1005/194-229) and superior mesenteric vein, similar to the CT from 9/2015. Portosystemic varices noted.The gallbladder is distended and there is trace pericholecystic fluid which is nonspecific in the setting of cirrhosis and ascites. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: Splenomegaly without focal splenic lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts without suspicious focal renal lesion.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of ascites noted.

Output: 1.Cirrhotic morphology liver without suspicious focal hepatic lesion.2.Nonocclusive portal vein and SMV thrombus, similar to that seen on CT from 9/2015.


Instruction: Generate impression based on findings.

Input: History of possible IPMN on recent CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No suspicious liver lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: As seen on the prior CT there is a 7 mm uncinate process unilocular cystic focus which appears to communicate with the normal caliber main pancreatic duct (series 11, image 134). It demonstrates no abnormal postcontrast enhancement or restricted diffusion. No pancreatic ductal dilatation or parenchymal atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 7 mm uncinate process unilocular cystic lesion appears to communicate with the normal caliber main pancreatic duct and is likely a side-branch IPMN with no specific suspicious imaging features.


Instruction: Generate impression based on findings.

Input: New onset headache and radiculopathy. The study is moderately limited by patient motion.BRAIN: There is no acute infarct or acute intracranial hemorrhage. The right parietal cystic encephalomalacia, cortical hemosiderin staining/mineralization and gliosis remain unchanged. This is associated with ex vacuo enlargement of the right lateral ventricular posterior body. Otherwise, the ventricles, sulci and basal cisterns remain enlarged, reflecting underlying brain volume loss. There is no mass-effect, midline shift or brain herniation. The major intracranial vascular flow voids are preserved.The orbits are grossly unremarkable as well as the skull and scalp soft tissues. There is mild maxillary mucosal thickening.CERVICAL SPINE: Alignment is anatomic. There is no acute fracture. There is multilevel disc desiccation. There are small disc bulges at C5-C6 and C6-C7 causing minimal ventral indentations of the thecal sac. The spinal canal is otherwise mildly developmentally narrowed. The cervical spinal cord is normal in morphology and signal. There is also no significant neural foraminal stenosis.

Output: 1.Examination is moderately limited by patient motion.2.Brain: Right parietal encephalomalacia and gliosis, probably from chronic infarct, and global moderate brain volume loss are unchanged since August 2010. No acute infarct, acute hemorrhage or mass-effect.3.Cervical spine: No acute fracture or traumatic malalignment. Mild developmental cervical spinal canal narrowing but no significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Wrist pain LIGAMENTS: No significant abnormality noted. Specifically, there is no evidence of scapholunate or lunotriquetral disruption.TRIANGULAR FIBROCARTILAGE COMPLEX: There is overlying metallic susceptibility relating to prior surgical intervention. There is fragmentation of the TFCC which is likely a combination of postsurgical changes and posttraumatic injury.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: 1. No evidence of scapholunate or lunotriquetral disruption.2. Fragmentation of the TFCC which is likely a combination of postsurgical and posttraumatic changes.


Instruction: Generate impression based on findings.

Input: 45-year-old female with inability to lift right shoulder, pain. Evaluate for shoulder tear. Unspecified injury of right shoulder and upper arm, initial encounter, localized swelling, mass or lump, neck. ROTATOR CUFF: There is thickening and intermediate signal intensity of the supraspinatus tendon indicating tendinosis. The supraspinatus muscle appears normal. The remaining rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is anatomic. The glenoid labrum is grossly normal on this nonarthrogram study. There are small subchondral cysts in the humeral head.BICEPS TENDON: The long head of the biceps tendon appears normal.ADDITIONAL

Output: 1. Tendinosis of the supraspinatus tendon. No rotator cuff tear.2. No soft tissue mass is identified.


Instruction: Generate impression based on findings.

Input: History of rectal cancer. Also history of gallbladder adenocarcinoma on cholecystectomy pathology.Rectal tumor demonstrated invasive moderately differentiated adenocarcinoma. No regional lymphadenopathy on pathology report. PELVIS:PROSTATE/SEMINAL VESICLES: Heterogeneous mildly enlarged prostate.BLADDER: No significant abnormality noted.LYMPH NODES: The perirectal space lymph nodes remain markedly decreased in size from the initial study without measurable lymph node enlargement, unchanged.The referenced lymph node at the level of the rectosigmoid junction on the left measures 6 x 3 mm (series 4/5), compared to 8 x 5 mm previously.BOWEL, MESENTERY: In the location of the original solid rectal lesion again seen is a predominantly markedly low T2 weighted focus affecting the left posterolateral aspect of the rectum (series 4/25) measuring up to 1.6 x 0.9 cm (series 4/25), not significantly changed accounting for differences in measurement technique. There is no evidence of extramural extension. No significant restricted diffusion or appreciable postcontrast enhancement is evident.Sigmoid diverticulosis is noted.BONES, SOFT TISSUES: Minimal presacral soft tissue stranding and minimal fluid is likely treatment related.OTHER: No significant abnormality noted.

Output: Stable post-treatment appearance of the rectal mass with imaging characteristics suggestive of post-radiation scar tissue without residual restricted diffusion or appreciable post-contrast enhancement. Interval mild decrease in reference pelvic lymph node. No measurable perirectal lymphadenopathy, similar to the prior and markedly improved from the initial staging examination.


Instruction: Generate impression based on findings.

Input: Weakness, visual disturbances, evaluate for multiple sclerosis flare. Also history of pseudotumor. Again seen are multiple T2 hyperintense lesions in the supratentorial and infratentorial white matter consistent with known demyelinating disease. Compared to 3/31/2011, there is a new focus of flair hyperintensity involving the left posterior frontal periventricular white matter involving the left precentral gyrus, axial flair image 23/34. There is also a small T2/flair hyperintense focus lateral to the left frontal horn, axial T2 image 18 of 30, which is also new. There is a focus of T2/flair hyperintensity involving the subcortical right frontal white matter which is decreased in the interval. No abnormal enhancement. No restricted diffusion. No intracranial hemorrhage. No intracranial mass or mass-effect. There is global parenchymal volume loss which is advanced for age. Volume loss also is noted involving the corpus callosum. Multiple lesions with T1 hypointensity are also again seen.Dedicated orbital sequences were not obtained, however, no obvious abnormality is appreciated. Empty sella is again noted. There is mild mucosal thickening involving the paranasal sinuses. There is moderate opacification of the right mastoid air cells.

Output: 1. Chronic demyelinating disease involving the supratentorial and infratentorial white matter. There is evidence of progression with at least two new lesions in the left frontal white matter as detailed above compared to 3/31/2011. No abnormal enhancement to suggest active demyelination. 2. Partially empty sella which is a normal variant but can be seen with intracranial hypertension in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: 75 year old woman with history of LV dysfunction who presents for stress cardiac MRI to evaluate for coronary disease as etiology of cardiomyopathyMEDICATIONS: hydralazine, isosorbide dinitrate, lisinopril, zocor First Pass PerfusionDuring hyperemia, there is a perfusion defect noted in the mid-inferior/inferolateral wallViability/ Myocardial ScarThere is late gadolinium enhancement transmural in thickness in the mid-inferolateral wall. This region is likely not viable. The remainder of the myocardium is viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 21%, the LV end diastolic volume index is 114 ml/m2 (normal range: 65+/-11), the LVEDV is 208 ml (normal range 109+/-23), the LV end systolic volume index is 89 ml/m2 (normal range 18+/-5), the LVESV is 164 ml (normal range 31+/-10), the LV mass index is 64 g/m2, and the LV mass is 117 g. There is diffuse hypokinesis. Mid-distal inferior and inferolateral akinesis. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 35%%, the RV end diastolic volume index is 80 ml/m2 (normal range 69+/-14), the RVEDV is 147 ml (normal range 110+/-24), the RV end systolic volume index is 52 ml/m2 (normal range 22+/-8), and the RVESV is 96 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there at least mild mitral regurgitation difficult to quantify on this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilatated. Venous AnatomyThe IVC is dilated.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function (LVEF 21%). Mid-distal inferior and inferolateral akinesis. 2. There is a perfusion defect noted in the mid-inferior/ inferolateral wall3. There is late gadolinium enhancement transmural in thickness in the mid-inferolateral wall. This region is likely not viable. The remainder of the myocardium is viable. 4. The right ventricle is normal in size with moderately reduced systolic function (RVEF 35%).


Instruction: Generate impression based on findings.

Input: H/o meningioma. S/p fall. There is a redemonstration of the left frontal mass with surrounding vasogenic edema, which appears unchanged from the prior brain MRI. Effacement of the frontal horn of the left lateral ventricle and minimal rightward midline shift are again seen. The right frontal mass seen on the previous brain MRI is obscured by beam hardening artifacts.  The brain is otherwise normal attenuation and morphology. There is no intracranial hemorrhage or abnormal extra-axial fluid collection. The ventricles and cortical sulci appear prominent.A small right frontal subgaleal hematoma is noted. No calvarial fracture is identified. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.No evidence of intracranial hemorrhage or calvarial fracture. Small right frontal subgaleal hematoma.2.Left frontal meningioma. Right frontal mass cannot be evaluated due to beam hardening artifacts.


Instruction: Generate impression based on findings.

Input: 53-year-old male with right shoulder and neck pain/radiculopathy. The vertebral body heights are preserved. There is mild loss of intervertebral disc height and disc signal throughout the cervical spine related to with degenerative disease. There is a small focus of increased T2 marrow signal in the C5 vertebral body may represent an atypical intraosseous hemangioma. Reactive marrow signal is present along the vertebral body endplates at C3-4. There is mild straightening of the cervical lordosis, but no spondylolisthesis. At C2-C3, there is a small disc osteophyte complex asymmetric to the left, but no significant spinal canal or neural foraminal stenosis. At C3-C4, there is asymmetric hypertrophy of the right uncovertebral joint with moderate right neural foraminal stenosis and mild spinal canal stenosis. At C4-C5, there is a small disc osteophyte complex with trace right neural foraminal stenosis, but no significant spinal canal or left neural foraminal stenosis. At C5-C6, there is minimal uncovertebral joint hypertrophy, but no significant spinal canal or neural foraminal stenosis. At C6-C7, there is a small disc osteophyte complex with minimal right neural foraminal narrowing, but no significant left neural foraminal or spinal canal stenosis. At C7-T1, there is no disc bulge, spinal canal stenosis, or neuroforaminal narrowing.

Output: Multilevel spondylosis, which is most pronounced at C3-4, where there is moderate right neural foraminal stenosis and mild spinal canal narrowing.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left oropharyngeal reconstruction for recurrent cancer. Initial swallow of a small amount of water soluble contrast demonstrated gross tracheal aspiration. The examination was discontinued at this point. Evaluation for postsurgical leak could not be performed as the bolus of contrast was not sufficient.TOTAL FLUOROSCOPY TIME: 3 seconds

Output: Tracheal aspiration. Evaluation for post-surgical leak not possible due to insufficient contrast bolus.


Instruction: Generate impression based on findings.

Input: 31 year old woman with history of Crohn's disease and palpitations with previous episodes of ventricular bigeminy and childhood non-sustained VT, referred for cardiac MRI to evaluate for scar. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 92 ml/m2 (normal range: 65+/-11), the LVEDV is 160 ml (normal range 109+/-23), the LV end systolic volume index is 41 ml/m2 (normal range 18+/-5), the LVESV is 71 ml (normal range 31+/-10), the LV mass index is 37 g/m2 (normal range 67+/-11), and the LV mass is 63 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native T1 myocardial relaxation time is 1070ms which is borderline elevated.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 96 ml/m2 (normal range 69+/-14), the RVEDV is 167 ml (normal range 110+/-24), the RV end systolic volume index is 47 ml/m2 (normal range 22+/-8), and the RVESV is 82 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is trivial pericardial effusion without evidence of pericardial inflammation. Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with normal systolic function (EF 56%). 2. The right ventricle is normal in size with normal systolic function (EF 51%). 3. There is no evidence of myocardial late gadolinium enhancement to suggest underlying infiltrative, inflammatory or major fibrotic process. 4. The native myocardial T1 relaxation time is borderline elevated, which could represent subtle interstitial myocardial fibrosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 48 years old, with blurry vision, prior history of optic neuritis. Evaluate for demyelinating lesions. Brain:A single T2 hyperintense, moderately T1 hypointense lesion is again seen within the periventricular white matter of the left parietal lobe. Accounting for differences in technique, this lesion has not substantially changed from the prior examination. No new white matter lesions are detected. Brain parenchymal morphology is unremarkable. No abnormal fluid collections are observed. The ventricular system is normal in size and morphology. A hypoenhancing lesion within the posterior pituitary gland, evident on the prior examination, is not as discretely visualized on today's study.Orbits:Within the limitations of mild motion artifact, no convincing signal abnormality is evident affecting either optic nerve, or the optic chiasm. No findings to suggest intraorbital inflammation are seen. The globes are round and symmetric. The extraocular muscles demonstrate normal morphology and signal characteristics.

Output: 1.A single white matter lesion is redemonstrated within the left parietal periventricular white matter showing no significant interval change. No new white matter lesions are identified in the brain.2.Within the limitations of a mildly motion degraded, noncontrast examination, no specific abnormalities of the optic apparatus are seen.


Instruction: Generate impression based on findings.

Input: 54 years, Female, dizziness and giddiness. Evaluate for ischemia. There is restricted diffusion within the right inferior medial cerebellum with correlative ADC hypointensity and T2 hyperintensity, consistent with acute infarction. No intracranial hemorrhage is evident by susceptibility weighted imaging. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are a few punctate foci of T2/FLAIR hyperintensity are seen in the right frontal and left parietal subcortical white matter, which are nonspecific, but most compatible with chronic small vessel ischemic changes. Major flow-voids are preservedSella and orbits are within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1.Acute infarction within the right posterior inferior cerebellar artery territory.2.Nonspecific T2 hyperintense foci within the subcortical white matter, most likely secondary to chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 20 years old, with history of AML status post transplant on cyclosporine, presenting with altered mental status and hallucinations. Evaluate for PRES. No evidence of restricted diffusion is seen. No focal parenchymal signal abnormality, edema or mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. No pathologic parenchymal or extra-axial enhancement is seen. The ventricles are normal in size and morphology.

Output: Unremarkable evaluation with no findings to suggest PRES or any other specific etiology to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female 33 years old Reason: biliary ductal dilatation History: RUQ abdominal pain, cholelithiasis ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No focal solid hepatic lesions. The hepatic and portal veins are patent.Hyperenhancement of the hepatic parenchyma near the gallbladder fossa. Gallbladder is distended and contains multiple layering stones. There are scattered stones within the gallbladder neck and possibly within the cystic duct. There is new gallbladder wall edema and mild infiltration of the surrounding fat with mild pericholecystic fluid.Common bile duct is normal in caliber. It measures 3 mm near the head of the pancreas. No definite filling defects to suggest choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney is absent. Left renal cortical cyst with some hemorrhagic components.RETROPERITONEUM, LYMPH NODES: Nonspecific small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of cholelithiasis with increasing gallbladder wall edema, mild pericholecystic fluid and gallbladder distention compatible with early cholecystitis.2.No definite evidence of choledocholithiasis.3.No MR evidence for acute pancreatitis.


Instruction: Generate impression based on findings.

Input: 42 years, Female, with multiple sclerosis, evaluate for progression. Multiple T2/FLAIR hyperintense lesions are again seen including adjacent to the right temporal horn, left occipital horn, adjacent to the right lateral ventricle atrium as well as along the left midbrain tectum and superior cerebellar peduncle. These lesions were present on prior. No new lesions. Unchanged 39 x 50 mm right middle cranial fossa arachnoid cyst associated with mild expansion of the right middle cranial fossa. Unchanged 9 x 6 mm extra-axial dural based enhancing nodule along the left postcentral sulcus without mass effect on the adjacent parenchyma. Brain parenchymal volume is preserved. No abnormal enhancement to suggest active demyelination.No new intracranial mass or mass effect is seen. Ventricles are normal in size. No extra-axial collections. Extracranial soft tissues are unremarkable.

Output: 1. Scattered T2/FLAIR hyperintense lesions are nonspecific but compatible with known demyelinating disease. No new lesions. No abnormal enhancement to suggest active demyelination.2. Unchanged arachnoid cyst in the right middle cranial fossa.3. Unchanged small left parietal meningioma without significant mass effect.


Instruction: Generate impression based on findings.

Input: Male 60 years old Reason: stroke? Mass lesion? History: R sided weakness. Limited evaluation demonstrates no evidence of intracranial hemorrhage or mass. There is hyperintensity on the diffusion and isointense signal on the ADC bilaterally in the prefrontal gyri, hippocampal, and left mesial temporal lobe. There is no convincing T2 signal to suggest that this is T2 shine through. These areas of apparent restriction do not reflect vascular territories. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a large mucous retention cyst in the left maxillary sinus, occupying approximately half the sinus. The partially evaluated orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Findings of multiple areas of apparent diffusion restriction on this limited MRI may reflect the patient's recent toxic exposure, possibly representing early leukoencephalopathy. Recommend repeat study to fully evaluate when clinically possible.


Instruction: Generate impression based on findings.

Input: 38-year-old male with tenderness, fever. Evaluate for epidural abscess. Alignment and bone density are within normal limits. Vertebral body heights and disk spaces are maintained. Hypertrophy of the facet joints at L3-4, L4-5, and L5-S1. The dorsal epidural fat pads are intact. There is no definite dural thickening along the ventral aspect of the spinal canal. No evidence of effacement on the thecal sac to suggest an epidural process. The paraspinous muscles are normal. No evidence of central spinal stenosis or neuroforaminal compromise at any level.

Output: Limited study in evaluating for an epidural abscess. However, within the limitations, there are no findings to suggest an epidural process. No other specific findings on this study to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate labrum History: pain ROTATOR CUFF: The supraspinatus, infraspinatus, teres minor, and subscapularis tendons are intact without evidence of tearing.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a tear of the anterior superior glenoid labrum with extension into the mid posterior labrum. The bone marrow signal is normal. There is no acute fracture.BICEPS TENDON: The long and short heads of the biceps tendon are intact. ADDITIONAL

Output: SLAP tear with extension into the mid posterior labrum.


Instruction: Generate impression based on findings.

Input: Bilateral essential tremor preoperative planning for DBS. There is no evidence of intracranial hemorrhage or mass. There a mild scattered nonspecific cerebral white matter T2 hyperintense lesions. 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is staphylomatous deformity and enlargement of the right globe.

Output: Grossly unremarkable treatment planning MRI.


Instruction: Generate impression based on findings.

Input: Assess extent of resection and 4 vent outflow obstruction status post resection of medulloblastoma. There are interval postoperative findings related to suboccipital craniotomy for resection of a fourth ventricular tumor. There is globular mass with low T1 signal in the fourth ventricle that measures up to approximately 35 mm in width with susceptibility effect, but no discernible enhancement. There is also a component with relatively intermediate T1 signal along in the inferior aspect of the fourth ventricle. There is a channel for cerebrospinal fluid to communicate between the upper fourth ventricle and cerebral aqueduct, but the inferior fourth ventricle and outflow pathways remains largely effaced. There is interval insertion of a right transfrontal ventricular catheter that terminates in the right lateral ventricle. There is interval slight decrease in size of the third and lateral ventricles. There is hemorrhage layering within the occipital horns of the bilateral lateral and third ventricles. There are also globular structures with susceptibility effect and mildly high T2 signal in the lateral and third ventricles around the foramina of Monro. There is persistent diffuse periventricular white matter T2 hyperintensity. There are patchy areas of high T2 signal and restricted diffusion in the medial cerebellar hemispheres along the surgical approach, which may represent There is fluid within the right maxillary sinus.

Output: 1. Interval gross total resection of a fourth ventricular tumor with blood clots in the ventricular system and what may represent a small amount of residual neoplasm along the inferior aspect of the fourth ventricle. Follow up MRI may be useful for distinguishing among these possibilities.2. Interval insertion of a right transfrontal ventricular shunt catheter with slight decrease in size of the third and lateral ventricles.


Instruction: Generate impression based on findings.

Input: 43-year-old male with pain. Evaluate for extensor carpi radialis brevis degeneration. LIGAMENTS: Although this examination was not protocoled for detailed evaluation of the intrinsic ligaments of the elbow, the ulnar collateral ligament appears intact. The radial collateral ligament appears intact. The lateral collateral ligament appears intact.TENDONS: There is intermediate signal intensity within the common extensor tendon indicating moderate tendinosis. There is linear fluid signal abnormality within the common extensor tendon at the level of its insertion on the lateral epicondyle, indicating a tear, measuring approximately 6 mm in the craniocaudal dimension (image 11; series 601). There is intermediate signal intensity within the common flexor tendon indicating moderate tendinosis. The triceps tendon appears intact. The biceps and brachialis muscles and tendons appear intact.ARTICULAR SURFACES AND BONE: There is near full-thickness articular cartilage degeneration affecting the radiocapitellar joint. No bone marrow signal abnormality is identified. SURROUNDING STRUCTURES: The imaged musculature is normal in appearanceADDITIONAL

Output: Tendinosis and partial-thickness insertional tearing of the common extensor tendon as described above. Tendinosis of the common flexor tendon. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: Multiple sclerosis progression. History: gait problems. There is marked interval progression of T2 hyperintense lesions in the supratentorial and infratentorial white matter. Many of the lesions also display T1 hypointensity. 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: Marked progression of the demyelinating lesions since March 2013.


Instruction: Generate impression based on findings.

Input: History of spinal schwannoma. Low back pain, LE weakness, weak urine stream. There is possible mild residual myelomalacia in the lower cervical and upper thoracic spine related to a previously resected spinal mass. Otherwise, the spinal cord appears unremarkable, with no evidence of acute cord compression. There are degenerative changes in the cervical and lumbar spine, which is most pronounced at L4-5. The vertebral body heights are preserved. There is nonspecific subcentimeter skin nodularity at the surgical incision site. Within the limits of this study, no mass or fluid collection is identified.

Output: Possible mild residual myelomalacia in the lower cervical and upper thoracic spine related to a previously resected spinal mass. Otherwise, the spinal cord appears unremarkable, with no evidence of acute cord compression. Within the limits of this study, no mass or fluid collection is identified.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Numbness in the left leg, evaluate for multiple sclerosis progression. Brain: Again seen are multiple T2/flair hyperintense lesions in the periventricular and subcortical white matter with appearance and distribution consistent with known demyelinating disease. There is slight interval decrease in size of right frontal lesion. Many of the lesions demonstrate T1 hypointensity. There are no enhancing lesions. There is no evidence of intracranial mass or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. Thoracic Spine: Again seen are multiple T2 hyperintense lesions in the thoracic cord from T8 to T12 which are not clearly changed since 6/10/2013. No new lesions are seen. No abnormal enhancement.Vertebral body heights in the thoracic spine are normal. Alignment is normal. There is disk desiccation, small bulge and Schmorl's node at the T9-T10 level. No significant spinal canal or neural foramina stenosis.

Output: 1. Compared to MRI dated 4/12/2014, there is no significant change in size and appearance of the multiple T2/flair hyperintense supratentorial white matter lesions consistent with known demyelinating disease. No new lesions or lesions with enhancement to suggest active demyelination.2. Multiple T2 hyperintense lesions involving the thoracic cord from T8 to T12 are consistent with chronic demyelinating plaques. No new lesions are appreciated. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with aphasia and subdural hemorrhage, Brain:Bilateral cerebral convexity subdural collections are redemonstrated showing no significant interval change. They continue to measure up to 10 mm in thickness.No significant parenchymal signal abnormality is detected. No edema or mass effect is observed. No findings to suggest parenchymal hemorrhage are seen. The ventricular system is stable and normal in size.Spine:Extra-thecal fluid collections are evident along the ventral aspect of the thecal sac at L5 and S1 showing signal characteristics compatible with hemorrhage. By virtue of their morphology, these collections are favored to be subdural rather than epidural in location. They measure up to 8 mm in thickness at the S1 level with moderate associated thecal sac narrowing. Trace blood product is also evident along the dorsal thecal sac more distally at S2.No other epidural, subdural or intrathecal blood product is seen in the spine. The visualized spinal cord, conus and cauda equina demonstrate normal signal intensity and morphology.Spinal alignment is anatomic. Vertebral body heights are preserved. Although marrow signal is mildly heterogeneous in some places, no definite evidence of any pathologic marrow replacement is seen to suggest the presence of tumor.In the cervical spine, only mild disc osteophyte formation is seen without significant spinal canal narrowing. Moderately severe foraminal narrowing is seen on the left at C3-4, largely due to facet hypertrophy.In the thoracic spine, no significant disc bulge or disc herniation is seen. The spinal canal and neural foramina are patent.In the lumbar spine, loss of disc height and T2 signal is seen at L3-4, L4-5 and L5-S1. Additional level specific findings are as follows:L3-4: Mild facet hypertrophy. Disc bulge with a left foraminal protrusion. No significant generalized spinal canal stenosis. Mild left foraminal narrowing.L4-5: Facet hypertrophy, worse on the right. Disc bulging. Effacement of the right subarticular recess. Moderate right foraminal narrowing.L5-S1: Facet hypertrophy. Disc bulging asymmetric to the left. Mild effacement of the left lateral recess. Narrowing of the thecal sac due primarily to the extrathecal collection. Severe right and moderate left foraminal narrowing.Incidental note is made of scattered pleural fluid and pleural thickening on the left. At least two fractured left-sided ribs are demonstrated.

Output: 1.No significant change in the size or distribution of bilateral convexity subdural hematomas. No significant brain parenchymal abnormalities are seen.2.Extra-thecal hemorrhage, likely subdural, is seen along the ventral thecal sac at L5 and S1. These collections do result in moderate narrowing of the thecal sac, most notably at S1. The etiology for this hemorrhage is not certain. It could represent the same process that induced intracranial subdural bleeding, or it could potentially represent dependent redistribution of intracranial blood product.


Instruction: Generate impression based on findings.

Input: Male, 16 years old, with tuberous sclerosis, annual follow-up. Multiple scattered ill-defined cortical and subcortical T2 hyperintense lesions are redemonstrated without significant change. In addition, multiple small, intrinsically T1 hyperintense and perhaps minimally enhancing subependymal nodules are seen along the ventricular margins. These measure no more than 5 mm in size and are also unchanged.No new parenchymal lesions are detected. No evidence of edema or mass effect is seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.A lobular cutaneous lesion along the right forehead is redemonstrated showing no significant interval change in size when compared to the immediate prior exam.

Output: 1.Multiple intracranial stigmata of tuberous sclerosis are redemonstrated without significant interval change.2.A cutaneous right forehead lesion is also unchanged.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cord Secondary and unspecified malignant neoplasm of lymph nodes, site unspecified Squamous cell carcinoma of skin, site unspecified Secondary malignant neoplasm of brain and spinal cord Secondary and unspecified malignant neoplasm of lymph nodes, site unspecified Squamous cell carcinoma of skin, site unspecifiedClinical question: Hx of metastatic HNSCCa with single L occipital metastasis s/p SRS, surveillance scanSigns and Symptoms: HA, poor balance 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.There is redemonstration of 2 foci of susceptibility effect in the left cerebellar hemisphere 1 laterally and one medially which are only seen on the susceptibility weighted images. The one located on the lateral aspect has been identified as an enhancing nodule on the 8/12/2014 exam and could also be seen on the recent 3/21/2015 exam. On the current exam it is a punctate focus some enhancement only not significantly different than on the prior exam. The one on the medial aspect of the left cerebellar hemisphere is not readily identified on the postcontrast images on the current exam nor on prior exams. It can be identified as far back as 10/22/2014 on susceptibility weighted images.A couple punctate foci of susceptibility weighted image signal loss in the periventricular white matter were also present on the prior exam. In isolation these are of uncertain significance.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some minor mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Findings suggest hemorrhagic lesions in the left cerebellar hemisphere which have been identified on prior exams and are stable since the March 2015 exam. The more lateral one of the two was larger on prior exams and has decreased in size over time and likely represented metastasis. The more medial lesion is only identified on susceptibility imaging. The possibility that this represents another metastatic focus cannot be excluded.2.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: Complex partial seizures, R temporal epilepsy There is atrophy and increased T2/FLAIR signal intensity involving the right hippocampus. The left hippocampus appears unremarkable. The cortical sulci are in proportion to the cerebral ventricles. The gray-white matter differentiation is preserved. No intracranial hemorrhage is seen. No midline shift or mass effect is appreciated. There is no diffusion restriction to suggest ischemia.

Output: Findings compatible with right mesial temporal lobe sclerosis.


Instruction: Generate impression based on findings.

Input: Male; 29 years old. Reason: EVAL LABRAL PATH History: SAME ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:5/30/1960)Reason: eval cervical stenosis for worsening/changes History: c/o Right upper extremity radicular painDiagnosis: Other intervertebral disc degeneration, lumbosacral region. Spondylosis without myelopathy or radiculopathy, cervical regionClinical question: hx Left lumbar lami. Eval for changes, worsening stenosisPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal mass lesions are identified in the cervical spine. The patient status post anterior fusion from C3 through C7.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are endplate and uncovertebral osteophytes present this level associated with loss of disc space height and a disc bulge. There is some narrowing of the neural foramina which is worse on the right side. There is some mild encroachment of the right-sided exiting nerve roots within the neural foramen. Findings are unchanged when compared to the prior exam.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Incidental note is made of a 12 mm cystic lesion in the right thyroid lobe when compared to prior exams it does not appear to have changed significantly.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. Patient appears to be status post lower lumbar spine surgery at L4-5 level.At L5-S1 there is loss of disc space height this desiccation and endplate reactive changes. The endplate reactive changes are bright on T1. There is an associated disc bulge at this level and there is associated effacement of the fat at the left lateral recess with encroachment of the nerve roots at the left lateral recess. There are some mild encroachment of the left-sided exiting nerve roots within the neural foramen due to endplate osteophytes and disc material. When compared to the prior exam of 10/19/2015 there is not appear to be a significant change.At L4-5 since the prior exam the patient is undergone surgery with a left-sided laminotomy. There is a loss of disc space height this desiccation and diffuse disc bulge at this level associated with some mild encroachment of the right-sided exiting nerve roots within the neural foramen is not changed significantly since prior exam. There are some mild effacement of the fat at the left lateral recess at this level.. There is a right far lateral disc protrusion at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. There is some mild loss of disc space height and disc desiccation at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present this level associated with some mild loss of disc space height and disc desiccation at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present in the lumbar spine and status post recent lumbar spine surgery at L4-5..2.There is mild to moderate encroachment of the nerve roots at the left lateral recess as well as within the left neural foramen at L5-S1 due to degenerative changes which are stable since the prior exam.3.There is mild encroachment of the right-sided exiting nerve roots at L4-5 related to a right far lateral disc protrusion. This appears to be stable compared to the prior exam.4.There is mild encroachment of the nerve roots at the left lateral recess at L4-5 is bulge.5.There are mild degenerative changes present in the cervical spine without significant compromise to spinal canal or neural foramina. This findings are stable compared to the prior exam. The patient status post anterior fusion at C4-C7. There is only mild encroachment of exiting nerve roots on the right side at C3-46.There is a 12 mm cystic lesion in the right thyroid lobe which has been present on prior exams and does not appear to have changed significantly


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with numbness of the right shoulder when leaning forward. Mild straightening of the cervical lordosis is seen. Sagittal alignment is unremarkable. Vertebral body heights are preserved. No concerning marrow replacement or edema is detected. The visualized spinal cord shows normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: Left greater than right facet arthropathy. No significant spinal canal or foraminal stenosis. C3-4: Bilateral facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the right. Mild effacement of the ventral thecal sac. Severe right and mild left foraminal narrowing.C4-5: Mild facet arthropathy. Posterior disc-osteophyte complex formation with a right paracentral focal component which minimally impinges the spinal cord. No cord edema is seen. No significant generalized canal stenosis. Severe left foraminal narrowing. C5-6: Right greater than left facet arthropathy. Posterior disc-osteophyte complex formation with a focal central component which mildly impinges the spinal cord. Moderate generalized spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation with a focal component in the left paracentral zone which mildly impinges on the spinal cord. No significant generalized no stenosis. Mild left foraminal narrowing. C7-T1: Unremarkable.

Output: Multilevel disc degeneration is seen in the cervical region. Findings are most pronounced at C5-6 where there is a moderate generalized spinal canal stenosis and a focal impingement of the ventral cord. Less significant cord impingement is also seen at C4-5 and C6-7. Severe foraminal narrowing is evident on the right at C3-4, and on the left at C4-5, with moderate to severe foraminal narrowing bilaterally at C5-6.


Instruction: Generate impression based on findings.

Input: Male 18 years old Reason: 18 yo with sickle cell disease undergoing pre-stem cell transplant evaluation. Evaluation for iron overload Left VentricleThe left ventricle is normal in size. There are no regional wall motion abnormalities present. Left ventricle free wall iron load is 23 ms and interventricular septum is 34 ms (normal value).Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation. Dedicated through plane imaging of the aortic valve was not performed.Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.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 pericardial thickening or effusion.Extracardiac Findings: No focal lung opacities, effusions or pneumothorax. Partial visualization of all of this can's and solid organs of the upper abdomen are normal except for the spleen which shows hypointense signal, characteristic for sickle cell disease. Vertebral body bone changes related to sickle cell disease.

Output: 1. Normal iron load.2. Typical spleen and bone changes related to sickle cell disease. Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: PTC refractory to I131. Increasing pulmonary metastases and expansile lesion of C7: forgetfulness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few nonspecific scattered foci of T2 hyperintensity in the cerebral white matter, which may represent chronic small vessel ischemic disease. 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 metastases.


Instruction: Generate impression based on findings.

Input: 17 year-old female. Right shoulder pain x 2 years. Evaluate for labral tear versus PASTA tear. ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor muscles and tendons are intact.GLENOHUMERAL JOINT AND GLENOID LABRUM: No evidence of a glenoid labrum tear. Glenohumeral joint alignment is anatomic. BICEPS TENDON: Biceps tendon is intact and normally situated in the bicipital groove.ADDITIONAL

Output: Small cysts in the posterior humeral head consistent with posterior superior glenoid impingement (internal impingement). No associated rotator cuff or labral injury.


Instruction: Generate impression based on findings.

Input: 10 years old with ankle pain. Hx Rheumatic fever. TENDONS: No significant abnormality noted.LIGAMENTS: The anterior and posterior talofibular ligaments are intact as is the deltoid ligament.ARTICULAR SURFACES AND BONE: The articular cartilage of the ankle and subtalar joints is intact. No abnormal bone marrow signal is present.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Reason: elevated PSA, evaluate for prostate cancer (images to be used during biopsy).Additional history per electronic medical record:64-year-old very healthy male with an elevated PSA ranging from 7.8 to 11.6 ng/mL with an elevated prostate health index score, as well as an elevated Select MDx score with normal digital rectal examination. PELVIS:PROSTATE:Prostate Size: 5.4 x 4.2 x 3.9 cm.Peripheral Zone: There are ill-defined scattered areas of decreased ADC/T2 signal within the bilateral peripheral zones without discrete focal lesions. No suspicious areas of early enhancement.Central Gland: Nodules compatible with benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: A few very small nonspecific pelvic sidewall lymph nodes. No significant lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Diverticulosis.

Output: Scattered ill-defined areas of low T2/ADC signal within the bilateral peripheral zones which are indeterminant. No focal, discrete lesions are identified.


Instruction: Generate impression based on findings.

Input: Headache, dizziness, blurred vision, evaluate for posterior circulatory insufficiency. MRI Brain:No restricted diffusion to suggest acute infarction. No evidence of acute intracranial hemorrhage or extraaxial collection. A 12 mm dural based lesion along the left convexity is incompletely characterized without contrast but is without associated mass effect. There are a few scattered punctate foci of white matter T2 hyperintensity, which are nonspecific but most consistent with mild chronic small vessel ischemic disease. Otherwise, the signal intensity of the brain parenchyma is within normal limits. No midline shift or herniation. Note is made of an empty sella, a normal variant. The ventricles and sulci are normal in size. There is a mucus retention cyst in the right maxillary sinus. Remainder of the calvarium and extracranial soft tissues are grossly unremarkable.MRA Brain:MR angiographic demonstrate the anterior and posterior intracranial arterial circulations to be patent without evidence of flow limiting stenoses or aneurysm.

Output: 1. No evidence of acute infarct, hemorrhage, or intracranial mass effect. Mild chronic small vessel ischemic changes.2. Small dural based lesion along the left frontal convexity with calcification is favored to represent a small meningioma but is not well characterized without contrast. No associated mass effect. 3. No significant stenosis in the intracranial circulation.


Instruction: Generate impression based on findings.

Input: Rectal cancer follow-up. PELVIS:UTERUS, ADNEXA: Demonstrated again is a lobular enlarged uterus secondary to numerous well-defined hypodense masses compatible with numerous fibroids. The endometrium/endometrial cavity is distorted.BLADDER: The bladder is normally distended without a focal abnormality. Demonstrated again is abnormal marked symmetric circumferential T2-weighted mildly hyperintense thickening of the urethra extending from the bladder base for approximately 2.6 cm, similar to the prior study. No restricted diffusion or abnormal enhancement is identified.LYMPH NODES: Very small mesorectal lymph nodes are unchanged measuring less than 1 to 2 mm in short axis.BOWEL, MESENTERY: Demonstrated again is asymmetric predominantly very low T2-weighted signal intensity along the anterior lower rectum measuring approximately 2.7 cm in craniocaudal dimension and 1.6 x 0.6 cm in cross-section without restricted diffusion or abnormal postcontrast enhancement, compatible with predominantly post radiation therapeutic changes.BONES, SOFT TISSUES: There are degenerative changes of the spine with grade 2 anterolisthesis of L5 on S1. Fatty marrow changes of the sacrum compatible with post radiation changes.OTHER: No significant abnormality noted.

Output: 1.Interval mild decrease in size of the signal abnormality in the anterior distal rectum, demonstrating mostly very low T2-weighted signal intensity compatible with postradiation therapeutic changes.2.Abnormal marked circumferential thickening of the urethra is again seen. Differential considerations favor radiation-related changes, given recent cystoscopy evaluation with no urethral abnormality visualized.3.Enlarged multifibroid uterus.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with brain metastasis status post resection. MRI from postoperative serous treatment planning. Redemonstrated is evidence of right anterior temporal tumor resection. The surgical cavity is similar in size to that seen on the prior examination. Thin enhancement is evident around a majority of the resection cavity. Enhancement measuring up to 10 mm in thickness is, however, seen along the posterior margin of the cavity, along with a subcentimeter focus of enhancement medially along the cavernous sinus margin. No enhancement was evident in these areas on the immediate postoperative examination, but rather, there was restricted diffusion correlating to both sites.Generalized right cerebral mass effect has significantly improved from the prior examination. No additional enhancing intracranial lesions are seen. Ventricular caliber is within normal limits.

Output: 1.Demonstration of findings related to resection of tumor from the right anterior temporal lobe.2.Enhancement along the posterior margin of the resection cavity measuring up to 10 mm in thickness is new from the prior examination. However, given that it correlates with cytotoxic edema on the prior examination, it is favored to represent postsurgical change.


Instruction: Generate impression based on findings.

Input: Dextroscoliosis is noted with its apex centered at approximately L2/3. There are no fractures.. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Degenerative changes are noted of the lower thoracic spine which are incompletely imaged given lumbar spine acquisition technique. If the patient has symptoms referable to the thoracic spine, dedicated thoracic spine MRI may be obtained if deemed clinically beneficial.L1/2: There is a shallow left paracentral disc protrusion without significant associated mass effect or stenosis.L2/3: Asymmetric bulge to the left, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There are no significant stenoses.L3/4: Grade 1 anterolisthesis L3 on L4, asymmetric bulge to the left, ligamentum flavum thickening, and moderate bilateral facet hypertrophy. There is mild left neural foraminal and mild central stenosis.L4/5: Trace anterolisthesis L4 on L5, ligamentum flavum thickening, mild disc bulge, and moderate bilateral facet hypertrophy. There are no significant stenoses.L5/S1:Trace anterolisthesis L5 on S1, mild disc bulge, and moderate bilateral facet hypertrophy. There are no significant stenoses.

Output: 1.L1/2: There is a shallow left paracentral disc protrusion without significant associated mass effect or stenosis.2.L3/4: Mild left neural foraminal and mild central stenosis.3.Degenerative changes are noted of the lower thoracic spine which are incompletely imaged given lumbar spine acquisition technique. If the patient has symptoms referable to the thoracic spine, dedicated thoracic spine MRI may be obtained if deemed clinically beneficial.


Instruction: Generate impression based on findings.

Input: There is a normal alignment of the vertebral bodies. The conus medullaris ends at the level of L1. Marrow signal of the vertebral body mostly demonstrate degenerative changes. There is fatty signal in the vertebral bodies of L4 and S1, which is most consistent with hemangiomas.L1-L2: There is a mild to moderate disc bulge with minimal narrowing of the right neural foramina. There is minimal hypertrophy of the facets bilaterally.L2-L3: There is severe disc bulge with mild spinal stenosis. There is moderate to severe right neural foraminal narrowing. There is mild hypertrophy of the left facet and severe hypertrophy of the right facet. There is a mild hypertrophy of the ligamentum flavum. There are degenerative changes with Schmorl's nodes in the inferior endplate of L2 and in the superior endplate of L3.L3-L4: There is decrease in the intervertebral disc space with abnormal signal in the inferior endplate of L3 and the superior endplate of L4 and Schmorl's nodes. The disc is desiccated. There is moderate disc bulge There is moderate spinal stenosis and moderate narrowing of the neural foramina bilaterally. There is mild facet hypertrophy bilaterally, left more prominent than the right. L4-L5: There is narrowing of the intervertebral disc space which appears to be desiccated. There is a moderate left facet hypertrophy with mild right facet atrophy. There is moderate spinal canal stenosis. There is mild narrowing of the neural foraminal narrowing bilaterally. L5-S1: There is a disc bulge and bilateral facet hypertrophy with severe left and mild right neural foraminal compromise, but no significant spinal canal stenosis.

Output: Degenerative spondylosis of the lumbar spine with multilevel moderate spinal canal stenosis at L2 though L5 and up to severe left L5-S1 neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:8/7/1971)Reason: lumbar arthritis History: low back pain with radiculopathyPROVIDER/ATTENDING NAME: DALIA H ELMOFTY DALIA H ELMOFTY Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is some hypertrophy of the posterior longitudinal ligament present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is some hypertrophy of the posterior longitudinal ligament present.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is some hypertrophy of the posterior longitudinal ligament present associated with an impression on the ventral aspect of the thecal sac..At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a central disc extrusion present at this level with a disc material extending behind the C4 vertebral body. There is effacement of spinal fluid ventral and posterior the spinal cord at this level associated with some deformity of the spinal cord and overall a moderate degree of spinal stenosis. Compared to the exam of 8/10/2013 there may be some mild progressionAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a left paramedian disc protrusion present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Cerebellar tonsils are low lying.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal . There is redemonstration of facet hypertrophy at this level bilaterally but worse on the left versus the right side associated with mild encroachment of left-sided exiting nerve roots within the neural foramen. There is some disc desiccation at this level.At L4-5 there is a diffuse disc bulge present associated with bilateral facet and ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recess bilaterally at this level as well as crowding of nerve roots. Overall this has progressed since the prior exam. There is moderate spinal stenosis present at this level. Although the neural foraminal are narrowed, within the right neural foramen the exiting nerve roots are surrounded by fat. Within the left neural foramen there is mild encroachment of left-sided exiting nerve roots.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level as well as some ligamentum flavum hypertrophy. There is mild narrowing of the spinal canal this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are multiple ovarian cystic lesions present which are incompletely visualized on this exam. They were also present on the prior exam. It is inconclusive whether they are larger on the current versus the prior exam because cannot entirely included on this exam.

Output: 1.There are degenerative changes present in the lower lumbar spine. There is a moderate degree of spinal stenosis present at L4-5 and some mild encroachment of the left-sided exiting nerve roots at L4-5 and L5-S1 within the neural foramen. This has mildly progressed compared to the prior exam.2.There are degenerative changes present in the cervical spine worse at C4-5 where there is a disc extrusion resulting in moderate spinal stenosis. This appears to be only slightly worse on the current versus the prior exam3.There are multiple ovarian cystic lesions present. They are incompletely evaluated on this exam.


Instruction: Generate impression based on findings.

Input: 70-year-old male with history of lung cancer. Evaluate for brain metastases.DUARTE, JORGE (DOB: 1/1/1946)PROVIDER/ATTENDING NAME: BACALAO, MARIA ALEJANDRA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 2 x 5 mm extra-axial dural based sessile enhancing lesion (series 1105, image 143) which is suspected to represent a very small meningioma. Additional punctate 3 mm enhancing focus within the right occipital bone (series 1105, image 44) is nonspecific. Otherwise there are no abnormal enhancing mass lesions appreciated within the brain parenchyma. No intracranial hemorrhage is identified. The gray-white matter differentiation is preserved There are several periventricular and subcortical white matter T2/FLAIR hyperintense foci.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.Mild mucosal thickening of the paranasal sinuses with likely a small mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. Suspect a very small meningioma overlying the left frontal lobe. Additional focus of enhancement within the right occipital bone is nonspecific. No abnormal enhancement is appreciated within the brain parenchyma.2. There are several periventricular and subcortical white matter lesions which are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Diagnosis: LumbagoClinical question: low back painSigns and Symptoms: low back pain There is a prior MRI of the lumbar spine from 7/27/2012 and cervical and thoracic from 8/7/2012. Looking at these it appears that there are 4 lumbar type vertebrae present with hypoplastic ribs at T12.Lumbar vertebral bodies are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L4-S1 there is marked bilateral facet and ligamentum flavum hypertrophy associated with loss of disc height, disc desiccation and diffuse disc bulge as well as partial effacement of the fat at the lateral recess bilaterally. Overall this remains stable when compared to the 7/10/2014 exam. The exiting nerve roots within the neural foramina are surrounded by fat. Disc material abuts the exiting nerve roots as they exit the neural foramina at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.Parapelvic cysts are present in the kidneys bilaterally. This was also present on the prior exam.

Output: 1.Please note that there are only 4 lumbar-type vertebrae present when counting from C2 inferiorly. As a result the lumbosacral junction is labeled as L4-S1.2.Degenerative changes are present in the lower lumbar spine with mild anterior subluxation of L4 on S1 and mild to moderate spinal stenosis at L4-S1 where there is encroachment of nerve roots (L5 nerve roots) at the lateral recess bilaterally. This is stable when compared to the previous exam.


Instruction: Generate impression based on findings.

Input: Reason: elevated CK, severe thigh TTP and pain 1 mo after delivery, SLE - eval for myositis History: as above Muscles are unremarkable with no inflammatory changes. Subcutaneous tissues appear normal without evidence of cellulitis. Visualized vasculature is within normal limits.

Output: No specific findings of myositis. No significant abnormality.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: Is there a localized lesion to explain the recalcitrant back pain such as stress fracture or annulus tear? History: mid-lumbar back pain in a diver For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Minimal bulging of disc. No neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: Minimal bulging of disc at the level of L4-5 otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 70 year-old female with left upper extremity weakness. Evaluate for stroke. Again noted is a linear hypodensity in the region of the body of the left caudate which appears unchanged when compared to the previous study. This likely represents an old lacunar infarct of indeterminate age. Additional hypoattenuating areas near the right basal ganglia and in the periventricular white matter are again noted which appear unchanged when compared to the previous study. These findings are nonspecific but likely represent mild small vessel ischemic disease of indeterminate age. Additionally, there is severe atherosclerotic changes of the vertebral arteries bilaterally and the cavernous internal carotid arteries.Hypodensity in the high convexity of the right frontoparietal lobe as well as in the right posterior temporal lobe. These findings are age indeterminate but likely represent subacute ischemic infarct in the territory of the right cerebral artery. Further evaluation with MRI is recommended. There is no evidence of intracranial hemorrhage, midline shift or mass. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Hypodensities in the right frontoparietal lobe as well as in the right posterior temporal lobe. These findings are age indeterminate but are consistent with early to late subacute ischemic infarct in the territory of the right cerebral artery. Further evaluation with MRI is recommended if clinically indicated. There is no evidence of intracranial hemorrhage, midline shift or mass. These findings were relayed to Dr. Beverage via direct phone call at the time of dictation.2. Lacunar infarct involving the right basal ganglia which appears unchanged compared to previous study.3. Hypoattenuating areas near the right basal ganglia and in the periventricular white matter which appear unchanged when compared to the previous study. These findings are nonspecific but likely represent mild small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Right hip pain, evaluate for labral tear ACETABULAR LABRUM: Anterior superior labral tear.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: Mild bilateral gluteal atrophy. ADDITIONAL

Output: Anterior superior labral tear.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post tumor resection. Signs and symptoms: Status post craniotomy. Pre-and post-enhanced brain MRI:Examination demonstrates extensive postoperative changes of a right frontal/parietal craniotomy for removal of tumor. A small surgical cavity measuring approximately 9 x 14 mm in transaxial dimension with extensive surrounding residual vasogenic edema is present. Post-enhanced images demonstrate no convincing evidence of residual enhancement within or surrounding the surgical cavity to suggest residual tumor. Further follow-up however is needed. Constellation of findings results in regional mass-effect and without evidence of mass effect on the lateral ventricle or midline shift.The ventricular system remain within normal size similar to prior exam.Previously noted small enhancing metastatic lesions in the left hemisphere are again identified and without change. A tiny left frontal lobe developmental venous anomaly is again identified.

Output: 1.Post operative changes of right hemispheric tumor resection without detectable residual tumor on this initial study.2.Demonstration of tiny additional metastatic lesions and a small left frontal developmental venous anomaly.3.Stable normal size of ventricular system and with maintained midline.4.


Instruction: Generate impression based on findings.

Input: Reason: history of ependymoma s/p craniotomy History: off therapy 3 1/2 years There is a stable CSF signal intensity resection cavity along the posterior aspect of the left inferior frontal gyrus. There is no evidence of abnormal enhancement associated with this cavity. Minimal marginal FLAIR hyperintensity as well as scattered susceptibility are again seen, but unchanged.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Continued stable contrast enhanced postoperative MR appearance of the brain without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: 65-year-old female with slurred speech x 3 days and ataxia x 2 days on Coumadin. Rule-out intracranial hemorrhage, old stroke. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of periventricular and subcortical white matter hypodensities consistent with small vessel disease, age indeterminate. If there is clinical concern for stroke, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Sinus disease within the right sphenoid sinus. The remainder of the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: 42 years old who is status post stereotactic biopsy of right breast calcifications with pathology result of atypical ductal hyperplasia presents for research MRI. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.A marker clip from recent stereotactic biopsy is identified at posterior upper outer quadrant in the right breast.There is a regional non-mass enhancement around the marker clip, measuring 24 x 21 x 30 mm (AP x LR x CC).In the left breast, there is an enhancing lobulated mass, measuring 7 x 7 x 13 mm, at anterior 3 o'clock position.Several small patchy enhancing areas are present in both breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Regional non-mass enhancement at the site of recent stereotactic biopsy. Presence of DCIS cannot be excluded. Excisional biopsy should be considered. 2. Enhancing mass at anterior 3 o'clock position in the left breast. MR-directed ultrasound study is recommended. If no sonographic correlation is detected, MR guided biopsy should be considered. 3. Several small patchy enhancing areas in both breast, for which follow up MRI is recommended in 6 months for stability.4. No abnormal axillary lymph nodes in either axillary region. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.