Instruction: Generate impression based on findings.

Input: 58-year-old female with chronic history of sinusitis. Patient has history of complex pituitary surgery there is a moderate. Small amount of soft tissue and air density within the sphenoid sinus is noted. There is also presence of air within the sella and a defect across the floor of the sella and across the floor of the sphenoid sinus. All these findings are believed to be secondary to transsphenoidal hypophysectomy. No clinical information regarding the date of the procedure is provided. The amount of Bob soft tissue/fluid density within the sphenoid sinus is more than what was noted on prior study of 9 -- 24 -- 07.Very minimal mucoperiosteal thickening within the dependent portion of bilateral maxillary sinuses is again identified. These were noted on prior MRI examination from 2/27/08 and prior CT examination of the sinuses dated 9 -- 24 -- 07. TheOMUs of maxillary sinuses remain patent.

Output: 1.Postoperative changes of the sphenoid sinus and sella as detailed above.2.Very minimal residual mucoperiosteal thickening in the dependent portion of maxillary sinuses as detailed.3.4.


Instruction: Generate impression based on findings.

Input: 57-year-old woman with history of Roux-en-Y gastric bypass, evaluate for bowel obstruction. ABDOMEN:LIVER, BILIARY TRACT: There are subcentimeter hepatic cysts, otherwise the liver is normal. There is gallbladder sludge, but no evidence of cholecystitis or biliary ductal dilatation.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The patient is status post Roux-en-Y bypass and the gastrojejunal and jejunojejunal anastomoses appear intact. There is no evidence of abnormal bowel dilatation or obstruction.BONES, SOFT TISSUES: Postoperative changes are noted in the anterior abdominal soft tissues.OTHER: No significant abnormality noted.

Output: No bowel abnormality identified, specifically no abnormal bowel dilatation or obstruction. Please note that evaluation would be more ideal using CT, where the gastrojejunal and jejunojejunal postsurgical anastomoses are also more identifiable.


Instruction: Generate impression based on findings.

Input: Reason: Assess for meniscal pathology History: Lateral knee pain MENISCI: There is blunting and deformity of the posterior horn of the lateral meniscus likely representing complex degenerative tearing. There is extension of this tearing to involve the body of the meniscus. The anterior horn appears intact. There is increased signal abnormality within the posterior the medial meniscus which extends to the tibial articular surface which may represent superficial fraying.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle and lateral tibial plateau with areas completely devoid of articular cartilage, posteriorly. There is relative sparing of the articular cartilage of the medial tibiofemoral compartment. There is superficial fraying of the articular cartilage along the lateral facet of the patella. There are near full-thickness to full-thickness articular cartilage clefts along the lateral facet and median eminence of the patella with associated delamination. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex degenerative tearing of the lateral meniscus 2. Osteoarthritis of the knee most pronounced along the lateral tibiofemoral compartment with full-thickness articular cartilage defects.3. Near full-thickness to full-thickness articular cartilage clefts with delamination along the lateral facet of the patella.4. Large joint effusion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: New and increased seizure frequency in HgSS with history of prior stroke. MRI: There is extensive encephalomalacia in the left frontal and parietal lobes. However, there is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, with ex vacuo dilatation of the left lateral ventricle. There is no midline shift or herniation. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is diffuse low T1 and T2 signal in the bone marrow.MRA: There is severe steno-occlusive disease of the left supraclinoid internal carotid artery. The proximal left anterior and middle cerebral arteries appear to be diffusely narrowed as well. There is a paucity of cortical vessels overlying the areas of left cerebral hemisphere encephalomalacia. There also appears to be narrowing of the supraclinoid right internal carotid artery and minimal collateral vessel formation in the region. The vertebral, basilar, and posterior cerebral arteries are intact. There is no evidence of cerebral aneurysms.

Output: 1. Chronic left middle cerebral artery territory infarction related to sickle cell disease, without evidence of acute infarction.2. Severe steno-occlusive disease of the left supraclinoid internal carotid artery. The proximal left anterior and middle cerebral arteries, and right supraclinoid internal carotid artery also appear to be narrowed.3. The bone marrow signal alterations are likely related to sickle cell disease


Instruction: Generate impression based on findings.

Input: Reason: left ankle cyst History: left ankle cyst TENDONS: A marker was placed along the medial ankle. The tibialis posterior tendon is enlarged indicating tendinosis. Additionally, there is a complete longitudinal split tear of the tendon as it courses posteriorly and deep to the distal fibula. Near-fluid signal intensity surrounding the tendon indicates tenosynovitis. The flexor digitorum longus tendon appears normal. Mild increased signal intensity within the flexor hallux longus tendon just distal to the talar tubercle likely represents focal tendinosis. The peroneal tendons are intact.LIGAMENTS: We see no acute ligament abnormality.ARTICULAR SURFACES AND BONE: Mild osteoarthritis affects the ankle and midfoot.

Output: 1. Tendinosis, longitudinal tearing, and tenosynovitis of the posterior tibial tendon.2. Mild osteoarthritis.


Instruction: Generate impression based on findings.

Input: Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: hx left cavernous aneurysm, Â yearly f/u to evaluate change in size History: surveillance 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 10mm x 13mm sized aneurysm coil at the right paraophthalmic segment indicate post embolization status, again no evidence of recanalization, unchanged since prior scan.Two untreated arterial aneurysms are again seen; one at the proximal left ACA A1 segment arising from the left ICA terminus about 4 x 4.3mm, another at the proximal left ICA cavernous sinus segment about 3.8mm x 3.2mm. These aneurysms comparing to prior scan, show no interval change in terms of size and configuration. There is no other aneurysm seen.No evidence of intracranial arterial luminal stenosis.

Output: 1. Post coiling status of right paraophthalmic segment aneurysm, no evidence of recanalization.2. Left proximal ACA A1 segment aneurysm and left proximal cavernous sinus aneurysm are redemonstrated, unchanged in terms of size and configuration since prior scan.3. No other aneurysm was seen. No intracranial arterial luminal stenosis.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact. There are post-operative findings related to recent left frontal craniotomy, including dural enhancement along the left frontal region. There is a subjacent resection cavity containing foci of susceptibility effect, T1 hyperintensity, and decreased diffusion compatible with blood products as well as surrounding T2 hyperintensity and unchanged 7 mm rightward midline shift. There are additional foci of susceptibility compatible with subdural blood products along the falx cerebri and deep to the craniotomy flap. There is no abnormal intracranial enhancement superimposed upon areas of intrinsic T1 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. The major cerebral flow voids are intact. There is susceptibility artifact in the posterior upper cervical spine related to metallic hardware.Perfusion imaging was inadvertently performed.

Output: Expected post-operative findings related to resection of a hemorrhagic left frontal lobe lesion, with residual blood products in the surgical cavity. There is unchanged surrounding edema and resultant similar midline shift. Followup imaging recommended to assess for residual enhancing tumor.


Instruction: Generate impression based on findings.

Input: Rule out structural abnormalities, 2 year-old nonverbal, oral aversion, hypotonia.. There is mild hypoplasias of the inferior cerebellar vermis. Remainder of the posterior fossa structures are unremarkable. Corpus callosum appears within normal limits. Remainder of the brain is also unremarkable. Sulcation and myelination are age-appropriate. No evidence of infarct, intracranial mass, or mass effect. No extra-axial collections or subdural hematomas. Flow voids are present in the major vessels indicating patency. There is nonspecific opacification of the partially pneumatized maxillary sinuses. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: There is mild hypoplasia involving the inferior cerebellar vermis, which can be a normal variant. MRI of the brain is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: trigeminal neuralgia No evidence of acute ischemic or hemorrhagic lesion on this scan.About 7mm x 8mm sized fluid filled left petrous apex lesion, diagnostic possibilities are most likely benign lesions such as petrous apex effusion, asymmetric petrous pneumatization, unlikely to be other lesions such as petrous apicitis, mucocele or tumorous conditions.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.Benign petrous apex, left, most likely as described above.


Instruction: Generate impression based on findings.

Input: A 69 year old male with Marfan's syndrome and aortic dilatation referred to cardiac MRI for interval follow up of aortic dimensions. Left VentricleThe left ventricle is severely dilated with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 302 ml (normal range 142+/-34), the LV end systolic volume index is 62 ml/m2 (normal range 25+/-9), the LVESV is 144 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 148 g (normal range 164+/-36). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size (92ml). Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 115 ml/m2 (normal range 82+/-16), the RVEDV is 265 ml (normal range 142+/-31), the RV end systolic volume index is 56 ml/m2 (normal range 31+/-9), and the RVESV is 130 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated (157ml).Aortic ValveThe aortic valve opens widely and there is moderate aortic regurgitation (regurgitant fraction 21%). The aortic valve is trileaflet. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. No evidence of aortic dissection. The aortic root is aneurysmal. The following orthogonal (double oblique) dimensions were obtained of the thoracic aorta (MRA). Additionally the measurements were repeated using the same technique on the 2012 study and also the October 2015 study for direct comparison:Sinus of Valsalva: 53 x 53 x 49mm (from commissure to sinus). On the 2012 study = 52x52x51mm Sinotubular junction: 49 x 50mm. On the 2012 study = 50x47mmMid ascending aorta at the level of the main pulmonary artery: 45 x 45mm. On the 2012 study = 45x46mm.Ascending aorta immediately proximal to the innominate artery: 44 x 42mmDescending Aorta: 26 x 26mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with low normal systolic function, the LVEF is 52%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is mildly dilated with normal systolic function, the RVEF is 51%. 3. The right atrium is severely dilated (157ml).4. There is moderate aortic regurgitation (regurgitant fraction 21%).5. There is mild to moderate tricuspid regurgitation.6. The aortic root and ascending aorta are dilated. The measurements are reported above. Repeat measurement were made on the 10/2015 study and the 2012 study using identical measurement locations and techniques. When compared on a side-by-side basis to the 2012 study, the thoracic aorta is minimally more dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Reilly is a 39-year-old female with BRCA mutation and family history of breast cancer in her mother and sister. She presents for high-risk breast screening MRI. No current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Scattered foci of enhancement are seen bilaterally, all of which are stable in appearance and distribution when compared to prior examinations. There is no abnormal enhancement seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Right hip stress reaction. Evaluate for interval change. There is a subcentimeter focus of abnormal signal intensity within the posterior aspect of the medullary cavity of the distal femoral diaphysis that is nonspecific. The focal nature of the abnormality argues against a stress reaction, and the adjacent cortex appears normal. The signal intensity of the remainder of the right femur is within normal limits. Minimal osteoarthritis affects the right hip. There is a small amount of fluid within the right hip joint but this is not necessarily of any clinical significance. There is a tiny focus of fluid signal intensity along the myotendinous junction of the iliopsoas as it courses anterior to the acetabulum, which may not be of any clinical significance. The musculature of the visualized thigh is otherwise unremarkable. Signal abnormality within the left femoral head, seen on the large field-of-view images, indicates avascular necrosis; I see no subchondral fracture or articular surface collapse.

Output: Small focus of intramedullary signal within the distal femoral diaphysis is of questionable clinical significance and may simply represent an eccentrically positioned benign cartilaginous rest assuming there is no history of primary malignancy. I see no findings to suggest stress reaction. Avascular necrosis of the left femoral head and other findings as described above.


Instruction: Generate impression based on findings.

Input: 20 old female with with B cell lymphoma and known brain metastasis presents with headache and neck stiffness x 7 days. Interval resolution of the vasogenic edema within the left cerebral hemisphere. No definite evidence of the previously described mass on this study. High density material within the right transverse sinus which appears new when compared to the prior study.There is no evidence of intracranial hemorrhage or midline shift. 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. Interval resolution of the vasogenic edema involving the left hemisphere. No definite evidence of a mass within the limitations of this noncontrast study.2. High density material within the right transverse sinus possibly represents thrombosis. An MRI is recommended for further evaluation.These findings were discussed with Dr. Powell at the time of this dictation.


Instruction: Generate impression based on findings.

Input: Evaluate size of pituitary tumor: galactorrhea. There is no appreciable interval change in size of an enhancing T2 hyperintense lesion centered within the left pituitary lobe, which measures up to 12 mm. There is no mass effect upon the optic apparatus or cavernous sinuses. The pituitary stalk and posterior pituitary bright spot are intact.

Output: The pituitary adenoma appears unchanged.


Instruction: Generate impression based on findings.

Input: 47 years Female (DOB:5/2/1968)Reason: Right lumbar radiculopathy History: Right leg pain absent patellar reflexPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There appears to be a mild dextrocurvature to the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height at this level. There is a mild disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation at this level. There is a broad-based left lateral disc protrusion at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are some mild degenerative changes present in the lumbar spine without significant compromise to spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Female 25 years old Reason: 25 y.o. female with a h/o Crohn's colitis, with severe perianal fissure with likely fistula. Please evaluate for perianal; fistula and extent of colonic involvement. Past exams with motion artifact. NEEDS ANESTHESIA, SIGNIFICANT MENTAL DELAY. History: perianal fissure, possible fistula. PELVIS:UTERUS, ADNEXA: Uterus is normal in morphology. Adnexa are without diagnostic abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse thickening of the colon with increased vascularity compatible with a colitis. It involves the anus, rectum and imaged sigmoid and descending colon.BONES, SOFT TISSUES: There is a fistulous tract from the anorectal junction arising at approximately the 7:00 position that extends posteriorly to the skin. An anterior tract extending from the 1:00 position bifurcates into 2 tracts with one extending to the perineum and the other extending more anteriorly to the perineum near the posterior vagina.No abscess is evident.OTHER: No significant abnormality noted.

Output: 1.Colitis involving the imaged rectosigmoid colon2.2 perianal fistula, 1 with a branching component extending to the perineum as detailed above. No associated abscess.


Instruction: Generate impression based on findings.

Input: Male, 61 years old. Limping MENISCI: There is diffusely abnormal signal within the posterior horn of the medial meniscus with a complex combination of vertical, horizontal, and radial tearing. The anterior horn of the medial meniscus and the lateral meniscus are normal.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the articular cartilage of the medial femoral condyle and the patella, without focal cartilage defects.LIGAMENTS: The collateral and cruciate ligaments are unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Complex tear of the posterior horn of the medial meniscus.2.Generalized thinning of the articular cartilage of the medial femoral condyle and the patella, without focal cartilage defects.3.Small joint effusion.


Instruction: Generate impression based on findings.

Input: There are numerous T2 hyperintense white matter lesions. A right middle cerebellar peduncle lesion is much less conspicuous, while a ft posterior periventricular lesion appears to be new. The other lesions appear to be unchanged. 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: Numerous demyelinating lesions with interval involution of a right middle cerebellar peduncle lesion and appearance of a left posterior periventricular lesion, but no evidence of associated enhancement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Quiroga is a 46 year old female presenting for screening breast MRI. Personal history of ovarian cancer, diagnosed at the age of 43. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Port-A-Cath is seen overlying the right medial chest wall.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Evaluate for spinal cord compression: MVC, back pain. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis or disc herniation. There is mild facet hypertrophy bilaterally at L5-S1 with trace effusions and minimal neural foraminal stenosis. The spinal cord displays normal signal and morphology. The cauda equina appears to be intact. The paravertebral soft tissues are unremarkable.

Output: No evidence of spinal cord or cauda equina compression in the lumbosacral region.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: T2 N2B M0 tonsil squamous cell carcinoma on OPTIMA protocol. There is marked interval decrease in size of the right palatine tonsil tumor, without measurable disease. There is also decrease in size of the right cervical lymphadenopathy. For example, a right level 2A lymph node measures 8 x 16 mm, initially 18 x 24 mm. The thyroid and major salivary glands are unremarkable. The osseous structures are intact. The imaged intracranial structures and orbits are unremarkable.

Output: 1. Marked decrease in size of the right palatine tonsil tumor, without measurable disease. 2. Decrease in size of the right cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9] / Other specified soft tissue disorders [M79.89], Reason for Study: ^Reason: Evaluate etiology of comatose state History: comatose state Brain MRIMultifocal various sized restricted diffusion lesions on bilateral hemispheres including bilateral centrum semiovale, left temporo-occipital lobe, right side caudate nucleus, bilateral temporal lobes, bilateral basal ganglia, left cerebellar hemisphere and right middle cerebellar peduncle indicating acute ischemic infarctions.There is susceptibility lesion on the right temporal lobe indicating acute intracerebral hemorrhage, considering multifocal ischemic infarctions, this lesion could represent hemorrhagic transformation.There are also scattered susceptibility lesions on bilateral hemispheres indicating multiple petechial hemorrhages or multiple cavernous malformations or parenchymal calcifications.The ventricles, sulci and cisterns are symmetric and unremarkable. The mastoid air cells are clear.Mucosal thickening on bilateral ethmoid sinuses and right maxillary sinus. Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Brain MRVThis is non diagnostic brain MRV. Thus, if clinically indicated, the exam needs to be repeated without additional charge.There is definitive evidence of major dural sinus occlusion.

Output: 1. Multifocal various sized bihemispheric, supra and infratentorial acute ischemic infarctions with right temporal ICH. The ICH could represent hemorrhagic conversion.2. Normal brain MRA.3. Non diagnostic MRV but major dural sinuses appear to be patent.


Instruction: Generate impression based on findings.

Input: Mr. Stockwell presents with cardiomyopathy, coronary artery disease, and family history of sudden cardiac death presenting for a second evaluation of cardiomyopathy. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 24%, the LV end diastolic volume index is 178 ml/m2 (normal range: 74+/-15), the LVEDV is 328 ml (normal range 142+/-34), the LV end systolic volume index is 136 ml/m2 (normal range 25+/-9), the LVESV is 250 ml (normal range 47+/-19), the LV mass index is 82 g/m2 (normal range 85+/-15), and the LV mass is 151 g (normal range 164+/-36). There systolic dysfunction appears global with septal bounce consistent with LBBB. There is a small amount of late gadolinium enhancement which is located in the basal inferior wall and spares the endocardium. The pattern is atypical for prior myocardial infarction. It involves <5% of the LV mass and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The finding is consistent with either vasculitis or cardiac sarcoidosis, but the differential diagnosis also involves many other processes.Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 33%, the RV end diastolic volume index is 106 ml/m2 (normal range 82+/-16), the RVEDV is 191 ml (normal range 142+/-31), the RV end systolic volume index is 71 ml/m2 (normal range 31+/-9), and the RVESV is 131 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflets appear tethered with moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with severely reduced systolic function (LVEF 24%). There is a small amount of late gadolinium enhancement. The pattern is atypical for prior myocardial infarction. It involves <5% of the LV mass and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The finding is consistent with either vasculitis or cardiac sarcoidosis, but the differential diagnosis also involves many other processes.2. Normal RV size with moderately reduced systolic function (RVEF 33%).3. Severe left atrial dilation.4. Moderate mitral regurgitation.


Instruction: Generate impression based on findings.

Input: Altered mental status. Gait abnormalities. Question CVA. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is strong clinical concern for an acute stroke, an MRI may be considered for further evaluation. There is no evidence of intracranial hemorrhage, mass or midline shift. Vascular calcification is noted of the intracranial carotid arteries.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: Small vessel ischemic disease, age indeterminate. If there is strong clinical concern for acute stroke, an MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Reason: eval for cervical stenosis History: hyper-reflexia Craniocervical junction is within normal limits. Vertebral body heights and alignment are maintained. Bone marrow signal is benign. Spinal cord has a smooth contour and is without focal atrophy, edema, myelomalacia. No intraspinal hematoma, mass, or mass effect. The visualized paraspinal contents are unremarkable. Minimal degenerative changes as below:C1/2: No significant spinal canal stenosis or foraminal narrowing.C2/3: No significant spinal canal stenosis or foraminal narrowing.C3/4: No significant spinal canal stenosis or foraminal narrowing. C4/5: Mild left foraminal narrowing related to facet arthropathy. No significant spinal canal or right neural foraminal stenosis. C5/6: No significant spinal canal stenosis or foraminal narrowing. C6/7: No significant spinal canal stenosis or foraminal narrowing. C7/T1: No significant spinal canal stenosis or foraminal narrowing. Small scattered perineural cysts are incidentally noted.

Output: 1. No spinal canal stenosis at any level or evidence of cord signal abnormality.2. Minimal degenerative changes with mild left C4-5 neural foraminal narrowing. Neural foramina are otherwise patent.


Instruction: Generate impression based on findings.

Input: 70-year-old male with history of prostate cancer. Left lateral base 3+4, left medial base 3+4. PELVIS:PROSTATE:Prostate Size: 4.8 x 2.7 cmPeripheral Zone: In the left lateral base there is a T2 hypointense lesion with restricted diffusion measuring 1.4 x 0.7 cm (image 27 of series 601). This lesion abuts the seminal vesicles.Central Gland: Mild BPHSeminal Vesicles: The seminal vesicles are abutted by the aforementioned left base lesion.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left lateral peripheral base lesion compatible with patient's known prostate adenocarcinoma which abuts the seminal vesicles.


Instruction: Generate impression based on findings.

Input: Reason: R/o mass lesion f/u abnormal CT finding History: Altered mental status No abnormal diffusion restriction. No acute intracranial hemorrhage. No mass, mass effect, or midline shift. No extra-axial fluid collection. Nonspecific scattered foci of T2 hyperintensities in the subcortical and periventricular white matter. Flow voids are present within the major intracranial vasculatures. Paranasal sinuses and mastoid air cells are clear. Orbits are intact. Osseous structures are unremarkable.

Output: Nonspecific scattered foci of T2 hyperintensities in the subcortical and periventricular white matter.No extra-axial fluid collection, intracranial hemorrhage, mass, or other acute abnormality.


Instruction: Generate impression based on findings.

Input: Headache and vertigo. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.Brain MRV: There is no evidence of venous sinus thrombosis.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysm.

Output: 1. No evidence of intracranial hemorrhage, mass, or cerebral edema.2. No evidence of venous sinus thrombosis.3. No evidence of significant steno-occlusive lesions or aneurysm.


Instruction: Generate impression based on findings.

Input: Diagnosis: Headache(784.0)Clinical question: Evaluate for Chiari MalformationSigns and Symptoms: Headaches with activities The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is normal biphasic flow at the level of the foramen magnum on the CSF flow study.

Output: 1.MRI of the brain is within normal limits2.There is no evidence for Chiari malformation


Instruction: Generate impression based on findings.

Input: Reason: r/o torn patella tendon History: pain superior to patella with weight bearing MENISCI: Globular increased signal abnormality within the posterior horn of the medial meniscus indicating intrasubstance degeneration. Some of this signal extends to the femoral articular surface indicating superficial fraying. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. The medial and lateral compartment articular cartilage appears intact. There is a full-thickness articular cartilage cleft along the medial facet of the femoral trochlea with underlying subchondral signal abnormality and full-thickness articular cartilage degeneration in the surrounding area.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. A skin marker is noted along the superomedial aspect of the patella/quadriceps tendon presumably corresponding to the patient's area of concern. The quadriceps tendon is unremarkable. The patellar tendon appears intact. The vastus medialis muscle underlying the skin marker is unremarkable. There is nonspecific edema within the quadriceps fat pad which can be seen in fat pad impingement or contusion.ADDITIONAL

Output: 1. Full-thickness articular cartilage cleft along the medial facet of the femoral trochlea.2. Findings consistent with a ruptured Baker's cyst.3. Edema within the quadriceps fat pad is nonspecific but can be seen in fat pad impingement syndrome or contusion in the setting of trauma. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Altered mental status, hemorrhagic brain metastasis. Redemonstration of 2 parenchymal hemorrhagic foci including left caudate body and right occipital lobe with evidence of gadolinium enhancement. These lesions show MR evidence of localized surrounding edema.There is no other enhancing lesion is seen. On FLAIR images, there is a focal high signal intensity lesion on the right side of caudate splenium without evidence of Gad enhancement nor evidence of hemorrhage. Since the lesion shows low signal intensity on T1, this lesion may represent prior small tissue defects possibly related to lacunar infarction.There is a suspicious focal tissue defect (myelomalacia) on spinal cord at the level of C12 level (series 1201, image 17/33) with subtle adjacent enhancement. The enhancement could be related to partial volume averaging artifacts from epidural venous plexus. However, considering the patient's other intracranial enhancing lesions, if clinically indicated, dedicated cervical spine MRI with and without contrast can be considered for further evaluation.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Two intra axial hemorrhagic foci with enhancement as described above likely representing metastatic foci than simple intracranial hemorrhages.2. No other abnormal enhancement is seen.3. Suspicious C12 level cervical cord lesion as described above, if clinically indicated, dedicated cervical spine with and without contrast enhancement can be considered.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for intracranial mass or orbit, history of thyroid disease. Signs and symptoms: Biocullar diplopia. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities. Flair and T2-weighted images demonstrate few small foci of hyperintensity in the subcortical and periventricular white matter, left basal ganglia and pons which are nonspecific and non-hemorrhagic and without detectable abnormal enhancement. Considering patient's provided age of 75 this appearance is suggestive of chronic small vessel ischemic strokes of mild degree. The cortical sulci, ventricular system, CSF spaces and myelination the brain is otherwise unremarkable and with normal signal intensity on all MRI sequences. There is no evidence of abnormal enhancement the brain parenchyma or leptomeninges on is a diffuse series.Calvarium demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Signal void of major intracranial arterial branches are identified.Intracranial venous sinuses demonstrate normal pattern of enhancement.Pre-and post enhanced MRI orbits:Shin demonstrate normal signal intensity of retro-orbital fat without abnormal enhancement.Normal signal intensity, size and pattern of enhancement the extraocular musculature.Normal signal intensity and size of bilateral optic nerves in the retro-orbital spaces and in their cisternal segment without abnormal enhancement.Normal signal intensity and morphology of globes without abnormal enhancement.Normal signal intensity and pattern of enhancement of bilateral cavernous sinuses.

Output: 1.Pre-and post enhanced brain MRI demonstrate no acute intracranial findings. Findings suggestive of mild chronic small vessel ischemic strokes as detailed and unremarkable exam otherwise. No detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarium orbits protocol spaces.2.Unremarkable pre-and post enhanced MRI of orbits.3.Diffuse mild chronic because of thickening and postoperative changes of bilateral endoscopic functional sinus surgery.


Instruction: Generate impression based on findings.

Input: Male, 28 years old, history of pleomorphic xanthoastrocytoma status post laser ablation. Surveillance scan. A partially cystic, partially solid tumor is again seen centered on the tectum. Since the prior examination, the overall size of the lesion, inclusive of both cystic and solid components, has increased and now measures 40 x 34 mm transaxial by 46 mm craniocaudal, previously 35 x 27 mm transaxial by 35 mm craniocaudal (10/22/14 scan). This interval change in size represents primarily an increase in the cystic components of the lesion while the solid components have probably decreased in overall volume.This lesion continues to exert mass effect with deformation of adjacent structures. A cystic component of the lesion extends into and deforms the right cerebral peduncle to a greater degree than on prior exams. The midbrain and as a whole is deformed, the cerebral aqueduct is displaced to the left and narrowed, and the cerebellar vermis is displaced posteriorly.A right frontal approach ventricular catheter is in place, tip within the right frontal horn similar to prior. The lateral and third ventricles remain enlarged but without significant interval change from prior. The fourth ventricle is effaced. A linear tract of T2 hyperintensity running across the right occipital lobe is unchanged and compatible with prior instrumentation. No new intracranial lesions are seen.

Output: Since the prior examination, the cystic and solid tectal region lesion has increased in overall size. This represents primarily an increase in the size and volume of the cystic components, as the solid components seem to have decreased mildly.


Instruction: Generate impression based on findings.

Input: Low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from minimal retrolisthesis of L3 on L4. Bone marrow signal is benign including fatty endplate marrow signal changes at the L5-S1 level which are on a degenerative basis. The conus medullaris is normal in position.Multilevel degenerative changes are seen including disc desiccation from L2-L3 to L5-S1 with mild to moderate disc height loss at the L5-S1 level.Additional levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge eccentric to the right. Mild facet arthropathy. There is mild right neural foraminal stenosis. No spinal canal or left neural foraminal stenosis.L3-L4: Mild disc bulge slightly eccentric on the left. Mild facet arthropathy. There is mild left neural foraminal narrowing. No spinal canal or right neural foraminal stenosis.L4-L5: Disc bulge with small left foraminal protrusion. There is also moderate bilateral facet arthropathy. No significant spinal canal stenosis. There is mild to moderate left neural foraminal stenosis. Minimal right neural foraminal narrowing.L5-S1: Disc bulge and moderate facet arthropathy. No spinal canal stenosis. Mild bilateral neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine without significant spinal canal stenosis at any level. 2. Overall relatively mild neural foraminal stenosis at multiple levels as detailed above.3. Prominent facet arthropathy at the L4-5 and L5-S1 levels which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Syncope and collapse [780.2], Reason for Study: ^Reason: 31 yo lady with bradycardia and syncope, looking to evaluate for possible neuro cause, r/o Chiari malformation History: lightheadedness, syncope There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Specifically, there is no evidence of tonsillar herniation through the foramen magnum. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. CSF flow study shows normal pulsatile craniofugal and cranio petal flow through the foramen magnum anterior to the brain stem as well as posterior to the brain stem.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal contrast enhancement.2. Normal brain MR angiogram and neck MR angiogram.3. Normal CSF flow study.


Instruction: Generate impression based on findings.

Input: Concern for biliary obstruction. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and contour. The gallbladder is partially contracted without wall thickening or adjacent inflammatory changes. No gallstones. No intra or extrahepatic biliary ductal dilatation, choledocholithiasis or discrete mass lesion is evident, within the limitations of a non-contrast examination.A posterior segment 4.1 x 2.2 cm T2 hyperintense lesion is noted. On the CT dated 8/10/2012 this lesion demonstrated peripheral discontinuous nodular enhancement consistent with a hemangioma.Additional small focus of T2-hyperintense branching signal in segment IVb is favored to be a benign lesion such as an AVM as it is suspected to have been present on the CT from 5/2006 (series 5, image 38).SPLEEN: The spleen is normal in morphology signal intensity and size without a discrete lesion.PANCREAS: In the pancreatic head there is a 1.6 x 0.5 cm cystic lesion which appears to communicate with the main pancreatic duct. Additional cystic lesion measuring 7 x 9 mm in the pancreatic body/tail junction also appears to communicate with the main pancreatic duct. These likely represent side branch IPMNs. The main pancreatic duct is normal in caliber. The pancreatic parenchyma is otherwise normal in appearance.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Dilated small bowel loop in the right lower quadrant, not significantly changed from the CT dated 5/13/2015, likely related to prior small bowel surgery. It contains fecaliths compatible with stasis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No biliary ductal dilatation, obstructive stone or discrete lesion is evident. Evaluation for a mass lesion is limited by lack of intravenous contrast.2.Small cystic pancreatic lesions likely represent a sidebranch IPMNs.3.Dilated small bowel loop in the right lower quadrant, similar to prior CT containing fecaliths indicating stasis. This may be post-operative in etiology.


Instruction: Generate impression based on findings.

Input: Reason: Dizziness left facial numbness History: above The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Male, 76 years old, status post kidney transplant with complicated postoperative course, now with gram-negative bacteremia. PET scan showed uptake in the left shoulder concerning for tracking up the neck. Tracking edema and/or fluid is evident within the fascial planes of the left upper chest wall, supraclavicular fossa and neck. More specifically, the abnormal signal extends from the pectoral region into the supraclavicular fossa, around the clavicle, with involvement of the visceral space and extension along the strap muscles of the neck at least to the level of the larynx. No discrete collections are seen.Patchy abnormal signal is also seen within the marrow of the clavicle. Marked degeneration of the sternoclavicular joints is seen with large joint effusions. Large bilateral pleural effusions are demonstrated. A 2-cm T2 hyperintense nodule is evident within the subcutaneous tissues of the left upper back, a nonspecific finding. Bone marrow signal characteristics are generally T1 hypointense which may reflect chronic renal dysfunction. An 8 mm cystic lesion within the left paracentral ventral epidural space at C1-2 may represent a degenerative or synovial cyst. There is multilevel disc degeneration most severely affecting the C2-3 level where there appears to be at least mild spinal canal stenosis. The right vertebral artery flow void is not well visualized which may reflect occlusion or slow flow.

Output: Tracking edema and/or fluid is seen involving the left upper chest, supraclavicular fossa and left neck. These findings would be compatible with cellulitis. No definite evidence of an abscess is seen.Abnormal marrow signal involving the left clavicle raises concern for the possibility of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 32-year-old female with family history two relatives with pancreatic cancer ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology. No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is within normal limits. The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: Main pancreatic duct is normal in caliber. No pancreatic mass is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of a pancreatic mass.


Instruction: Generate impression based on findings.

Input: The cerebellar transverse diameter is within normal limits. There is slight prominence of the foramen of Magendie outflow and posterior fossa CSF. The posterior fossa is not enlarged and the vermis is not upturned. There is no hydrocephalus. The corpus callosum and cavum septum pellucidum are present. Gyral development is appropriate for gestational age. There is no cerebellar tonsillar herniation. There is no evidence of intracranial hemorrhage or midline lipoma.

Output: Mild prominence of the 4th ventricular outflow tract which may reflect mild hypoplasia of the inferior vermis, a mild manifestation of the Dandy-Walker spectrum, or normal variation. There is no evidence of classic Dandy-Walker malformation.


Instruction: Generate impression based on findings.

Input: 66 years Female (DOB:3/21/1950)Reason: Newly dx lung adeno with right frontal brain met History: nonePROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is redemonstration of a 7 mm ring-enhancing lesion located in the right frontal lobe. There is an associated vasogenic pattern of edema.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eye lens is thin.

Output: 1.There is a right frontal lobe ring-enhancing lesion present. Given the patient's clinical history of primary lung cancer, this most likely represents metastatic disease.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Exam was performed for the purpose of stereotactic guidance during surgery


Instruction: Generate impression based on findings.

Input: 64-year-old man with CLL, SIADH with acute mental status changes x 7 days. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. However, if there is concern for an acute stroke, an MRI may be considered for further evaluation.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. There is rightward deviation of the nasal septum.

Output: No acute findings. If there is concern for acute ischemia, an MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: 22-year-old man with a history of anterior calcaneal fracture by prior MRI. Evaluate healing.IMAGE ACQUISITIONS: Unenhanced CT of the right ankle with multiplanar reformatting. There is mild diffuse demineralization, consistent with disuse osteopenia. No definite fracture is apparent by CT imaging. No sclerotic lesions are present within the calcaneus, and there is no evidence of cortical thickening or periosteal reaction to suggest an underlying lesion. No displaced fracture.Incidental note is made of a well corticated os trigonum. The remainder of the visualized osseous structures are unremarkable. The joint spaces are well preserved, with no evidence of dislocation or degenerative change.There is mild indistinctness in the fat planes surrounding the peroneal tendons, which is consistent with the reactive tenosynovitis seen on the prior MRI study. No additional focal soft tissue abnormalities are appreciated.

Output: Findings consistent with disuse osteopenia, however, otherwise, no acute abnormalities are appreciated by CT exam. Please see the prior MRI study for further details.


Instruction: Generate impression based on findings.

Input: Pituitary cyst surveillance. There is a non-enhancing well-defined mildly T1 hyperintense and T2 hypointense lesion in the midline of the pituitary gland that measures up to 8 mm, which is unchanged. There is no appreciable mass effect upon the optic apparatus or cavernous sinuses. The infundibulum is intact.

Output: No interval change in the cystic pituitary lesion, which likely represents a Rathke cleft cyst.


Instruction: Generate impression based on findings.

Input: Male, 22 years old, with tongue cancer, evaluate for metastatic spread. A mass is evident centered on the right lateral oral tongue which measures up to 29 mm in maximal length. A small defect within this lesional tissue may represent a site of prior biopsy. The tumor invades the right sublingual space where it approaches the sublingual gland.The remainder of the aerodigestive mucosa is unremarkable. No pathologic adenopathy is detected in the neck. The remaining salivary glands and the thyroid are free of suspicious lesions. The paraspinal soft tissues are unremarkable. The bone marrow signal is within normal limits. No spinal cord abnormalities are seen.The partially visualized brain parenchyma is notable for diffuse volume loss and periventricular white matter signal abnormality which has progressed compared to prior brain MRI.

Output: 1.A tumor is evident within the right lateral tongue with extension inferiorly into the submental space.2.No additional mucosal lesions are seen and no pathologic adenopathy is identified.3.Progressive brain volume loss and white matter signal abnormality are partially visualized.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate spinal anatomy for possible fusion. Signs and symptoms: Pain and weakness. Non-enhanced CT of lumbar spine:Examination redemonstrates destructive changes of the L1 vertebral body with collapse of more than 50% of one. There is fragmentation of the body of L1 vertebrae with expansion into the spinal canal posteriorly. These findings are similar to what was noted on prior MRI of lumbar spine. There is compromise of the AP diameter of thecal sac secondary to retropulsion of fragments into the canal. There is widening of the articulating facets space between T12 -- L1 and L1 -- L2 levels.There is evidence of minimal lytic changes of the inferior endplate of T12 vertebrae as well. This is result of patient's known diskitis/osteomyelitis. The T12 vertebral body and its pedicles are otherwise unremarkable.Very advanced degenerative disk disease throughout the rest of the lumbar spine with significant loss of disk height and sclerotic changes of the adjacent endplates as well as vacuum phenomenon. The alignment of vertebral column is otherwise unremarkable. There is no evidence of any abnormality of the pedicles of the lumbar spine except for partial involvement of pedicles of L1 with technique changes. Very extensive hypertrophic changes of articulating facets bilaterally are noted throughout the lumbar spine. Multilevel mild neural foramina compromise secondary to degenerative changes are suspected.Nonenhanced CT of thoracic spine:A small leak change along the inferior endplate of T12 is consistent with patient's known osteomyelitis/diskitis noted on multiple prior MRI exams. The density of vertebral column in the thoracic spine is otherwise unremarkable. There is no evidence of sclerotic or lytic changes of the rest of thoracic spine. Could the exception of hypertrophic changes no additional abnormality of the facets or the pedicles are detected.The alignment the vertebral column is within normal limits.Mild-to-moderate degenerative disk disease and hypertrophic changes of posterior elements throughout the thoracic spine is noted.

Output: 1.Lytic/destructive changes of L1 vertebrae with retropulsion of fracture body of L1 into the spinal canal and resultant central spinal stenosis. There is also lytic changes involving the anterior aspect of L1 pedicles bilaterally which is also result the patient's osteomyelitis.2.Extensive degenerative changes of lumbar spine of both disks and posterior elements and with multilevel neural frontal compromise as detailed. There is no evidence of any bony defect in the rest of lumber spine other than L1 level.Degenerative changes of disk and posterior elements in thoracic spine. Minimal lytic changes of the inferior endplate of T12 related to patient's known osteomyelitis. Unremarkable CT of thoracic spine otherwise.


Instruction: Generate impression based on findings.

Input: Low back pain BONE MARROW: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. JOINTS: There is perhaps mild osteoarthritis of the hips. Otherwise there is no significant abnormality..ADDITIONAL

Output: No acute pelvic abnormality.


Instruction: Generate impression based on findings.

Input: 50 year old with history of left mastectomy for IDC in 2013. There is extreme amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.Status post left mastectomy. No abnormal enhancement is seen in right breast or left mastectomy bed. No abnormal lymph nodes are identified in either axillary region. Post-surgical seroma is again seen in the left axilla.

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


Instruction: Generate impression based on findings.

Input: Thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.9 x 1.9 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.6 x 1.6 cmISTHMUS MEASUREMENTS: 0.9 cmRIGHT LOBE: Thyroid is markedly heterogeneous in echotexture. There are numerous nodules scattered throughout the right lobe. For reference purposes, a hyperechoic nodule at the upper pole measures 0.9 measured 0.8 x 0.9 cm. There may be a second larger nodule inferiorly in the right lobe but this is difficult to define.LEFT LOBE: The left lobes also heterogeneous in echotexture with numerous scattered nodules and some coarse calcifications. The largest nodule in the left measures 0.4 x 0.3 x 0.3 cm and is located superiorly being hyperechoic in echotexture..ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Subcentimeter nodules inferior to the left lobe may represent an enlarged parathyroid gland.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Markedly heterogeneous thyroid with numerous nodules and coarse calcifications.


Instruction: Generate impression based on findings.

Input: Reason: History of Ulcerative colitis, however several colonoscopy reports suggest Crohn's disease. Assess for evidence of small bowel Crohn's disease. History: nausea and vomiting ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Except for short segment of proximal most jejunum, the small bowel is relatively well distended and is well evaluated. The small bowel is normal in caliber without evidence of abnormal bowel wall thickening, signal, or enhancement. No small bowel strictures are identified. The terminal ileum appears within normal limits. The appendix is normal in caliber. The ascending and transverse colon demonstrate normal haustration and caliber without abnormal wall thickening, signal, or enhancement.There is loss of haustration, mild circumferential wall thickening, mildly increased enhancement, mild restricted diffusion, and increased mesenteric vascularity involving the descending colon and rectum compatible with subacute/chronic inflammatory changes.There is no associated evidence of fistulization.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is surgically absent. The ovaries are not well visualized and may also be surgically absent. There is a cystic structure in the left hemipelvis to the left of the bladder with reference measurements below which has a thin septation but otherwise simple appearance and could be related to prior surgery (lymphocele) or an adnexal cyst. There are no adjacent significant inflammatory changes. Scattered foci of susceptibility artifact within the pelvis may be related to prior surgery.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/22/2016 13:00:00)LEFT PELVIC CYST: 4.5 x 4.1 cm (Image 30, Series 7).

Output: 1.Findings compatible with subacute/chronic colitis contiguously involving the rectum and descending colon.2.No specific evidence of inflammatory bowel disease within the small bowel.3.Left pelvic cyst which has a benign appearance and could be related to prior surgery or an adnexal cyst. Comparison with prior examinations could confirm stability.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (12/8/15) performed at St. Anthony Hospital. There is a biopsy proven DCIS in the left breast. BREAST MRI (12/8/15):The study was performed with a protocol outlined in the outside radiology report.LEFT BREAST:There is a regional non-mass enhancement (NME) in the left breast at upper outer quadrant measuring 31 x 30 x 22 mm (AP x LR x CC), consistent with biopsy proven DCIS. A clip artifact is seen within this NME.Posterior to this NME, there is an enhancing mass measuring 6 x 6 x 9 mm, at posterior 12:00 position. This is possible an additional malignancy, and MR directed ultrasound is recommended. AP distance including NME and this mass is 45 mm.In addition, there is an enhancing focus, which is relatively larger than other enhancing foci, at central left breast.RIGHT BREAST:No abnormal enhancement is seen in right breast. AXILLAE:Axillary regions are somewhat limited in visualization due to artifacts. There are no definitely abnormal lymph nodes in either axillary region.

Output: 1. Non-mass enhancement at upper outer quadrant in the left breast, corresponding to the site of proven DCIS. The size of abnormal enhancement is larger than that of clustered calcifications on mammogram.2. Enhancing mass at posterior 12:00 position in the left breast. MR-directed ultrasound with possible biopsy is recommended. If no sonographic correlation is detected, MR guided biopsy should be considered. 3. No MR evidence for malignancy in the right breast or either axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dysarthria and anarthria. Epilepsy, unspecified, not intractable, without status epilepticusClinical question: new strokeSigns and Symptoms: Right side weakness, confusion The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of encephalomalacia present in the left temporal lobe involving the posterior aspects of the left middle and superior temporal gyri which extends to the adjacent parietal lobe.There is FLAIR signal hyperintensity within the white matter surrounding the occipital horn of the left lateral ventricle associated with obliteration of the occipital horn. The trigone of the left lateral ventricle is dilated as a result of ex vacuo effect.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The visualized portions of the paranasal sinuses are grossly clear. The visualized portions of the orbits are grossly intact.Images are degraded by patient motion.

Output: 1.Exam is limited due to patient motion which may obscure more subtle abnormalities as well as the patient's inability to complete the exam. If clinically indicated and possible, the use of sedation or anesthesia may help obtain a more complete exam.2.To the extent of visualization there is no acute cerebral infarction identified.3.There is encephalomalacia centered along the left temporal lobe and extending into the left parietal lobe as detailed above.4.There is obliteration of the occipital horn of the left lateral ventricle. The possibility of edema due to an underlying lesion cannot be excluded on this limited exam. Additional imaging may be helpful to further evaluate this.


Instruction: Generate impression based on findings.

Input: Clinical question: No evidence of intracranial hemorrhage. Signs and symptoms: Status post PEA arrest, intubated weaning sedation. Pre and post enhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates a very irregularly shaped focus of heavy in the sitting position in the right basal ganglia extending superiorly and abutting posterior aspect of the body of right lateral ventricle. There is extensive blooming effect and susceptibility MR images. There are small internal foci of T2 hyperintensity throughout the length of this finding and there is evidence of ex vacuo dilatation of right lateral ventricle adjacent to this lesion. Small surrounding FLAIR hyperintensity is also noted with this finding. Examination also demonstrate minimal amount of hemosiderin deposition along the ependymal lining of right lateral ventricle adjacent to this finding. The finding could represent a hemorrhagic infarct in the distribution of right lenticulostriate arteries. Post enhanced images demonstrate enhancement within the center of the lesion using an irregular pattern and without convincing evidence of an associated developmental venous anomaly. Prior head CT examination from 7-27-15 demonstrated a focus of encephalomalacia and with no detectable calcification at this site.Lack of a distinct cavity formation, presence of internal tiny foci of T2 hyperintensity and enhancement within this finding also raises the possibility of a chronic hemorrhagic cavernoma. The lesion is very irregular for precise measurements however the largest dimensions are at approximately 14 x 20 x 20 mm. There is evidence of mild right-sided pulmonary and degeneration best appreciated on axial FLAIR series 601 on images 11 through 17Examination an additional minute demonstrate few primarily periventricular and minimally subcortical foci of FLAIR hyperintensity which are nonspecific, nonhemorrhagic and nonenhancing. Findings are suggestive of mild chronic small vessel ischemic strokes.Unremarkable calvarium, orbits and paranasal sinuses.

Output: 1.Negative diffusion weighted series.2.Irregular focus of heavy hemosiderin deposition in the right basal ganglia with internal tiny foci of T2 hyperintensity, internal focus of enhancement, associated ex vacuo dilatation of right lateral ventricle and valerian degeneration and without evidence of calcification on prior head CT as detailed above. The findings could represent a chronic hemorrhagic lacunar infarct however possibility of an underlying chronic hemorrhagic cavernous malformation cannot be entirely excluded.3.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes is also noted.


Instruction: Generate impression based on findings.

Input: Reason: eval for midshaft femur fx History: thigh pain for 6 weeks with running There is patchy red marrow in the left femur which is within normal limits. There is minimal increased edema type signal within the proximal femoral diaphysis on the left, when compared to the right, as seen on the large field-of-view STIR images suggesting a mild stress reaction. There is also mild focal thickening of the medial femoral cortex at this level with a 6 mm linear focus of intermediate signal intensity and minimal increased signal intensity adjacent to the periosteum on the fluid sensitive sequences. The remainder of the femur is normal in appearance. The musculature of the thigh is normal.

Output: Stress reaction/fracture of the proximal femoral diaphysis with very mild edema.


Instruction: Generate impression based on findings.

Input: 71 year-old female with history of CVA in 2006. Breast cancer oblique radiation and now with (unreadable ward), MR presurgical evaluation No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. A very small area of increased soft tissue density overlapping the ependymal lining of the right trigone is noted this finding measures approximately 6 mm times 7-mm on axial image 15. This finding is not associated with any edema and no definitive enhancement. Further follow-up with an MRI scan is recommended to exclude metastatic lesion.Calvarium, partially visualized paranasal sinuses and mastoid air cells remain within normal limits.

Output: 1. Localized increased soft tissue density on the ependymal lining of the trigon of right lateral ventricle is concerning for metastatic lesion and should be further evaluated with an MRI. Please see above comments. 2.Unremarkable CT examination of brain and calvarium otherwise.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:5/13/1957)Reason: assess for complications of lupus History: memory lossPROVIDER/ATTENDING NAME: ADIL JAVED SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 minor opacities in the left sphenoid sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for intracranial mass lesion or other abnormality to explain the patient's memory loss on the basis of this exam.


Instruction: Generate impression based on findings.

Input: Left hip pain Examination is limited by motion artifact.ACETABULAR LABRUM: Within the limits of a nonarthrogram study, the visualized labrum appears grossly intact. ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: There is mild fatty atrophy of the pelvic musculature, particularly of the gluteus maximus and tensor fascia lata. The remaining soft tissues otherwise appear unremarkable. ADDITIONAL

Output: No evidence of acute left hip pathology.


Instruction: Generate impression based on findings.

Input: 59-year-old male with known IPMN ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Mild diffuse dilation of the main pancreatic duct, greatest in the body measuring up to 6 mm. There is mild relative narrowing at the head of the pancreas where the duct is tortuous, unchanged. Appropriate response to secretin with decreased compliance of the main pancreatic duct.There is a 7 x 5 mm cystic lesion in the uncinate process demonstrating a connection to the main pancreatic duct, previously measuring 5 x 3 mm. No abnormal enhancement.Unchanged tiny cystic lesion in the body of the pancreas is unchanged (series 7, image 74). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Minimally complex left inferior pole renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slight interval increase in size of a cystic lesion in the uncinate process demonstrating connection to the main pancreatic duct most compatible with an IPMN. No suspicious features are evident.2.Unchanged relative narrowing at the head of the pancreas with diffuse dilation of the main pancreatic duct as described above.3.Unchanged minimally complex left inferior pole cyst.


Instruction: Generate impression based on findings.

Input: Reason: Chiari 1 malformation-assess for syrinx, CT outside images-PLEASE DO CSF FLOW STUDY History: back pain, headache CSF flow study demonstrates normal biphasic flow at the level of foramen magnumThe cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The cerebellar tonsils appear to be mildly low lying extending approximately 3 mm below the level of foramen magnum.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.The cerebellar tonsils are low lying.2.CSF flow study is within normal limits.


Instruction: Generate impression based on findings.

Input: Recent falls, lower extremity weakness. Metastatic colon cancer. Partially imaged brain demonstrates T2 hyperintensity in the pons which is incompletely evaluated but may be related to chronic small vessel ischemic disease.Cervical spine:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from loss of cervical lordosis. Bone marrow signal is benign. There is T2 hyperintensity in the cervical cord bilaterally at the C3-C4 level which may represent myelomalacia with possible component of edema.Degenerative changes are seen in the cervical spine as described below:C2-3: There is a central/left paracentral disc extrusion with mild cranial and caudal extension and associated deformity of the cervical cord and moderate to severe spinal canal stenosis overall. Neural foramina are patent.C3-4: There is a disc osteophyte complex including a right paracentral disc protrusion component with associated moderate to severe spinal canal stenosis, although to a lesser degree than C2-C3. There is abnormal T2 cord signal bilaterally at this level. There is moderate to severe left neural foraminal stenosis and mild to moderate right neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C4-5: Mild spinal canal and mild bilateral neural foraminal narrowing, predominantly on a developmental basis.C5-6: Mild spinal canal mild bilateral neural foraminal narrowing, predominantly on a developmental basis.C6-7: There is disc osteophyte complex including uncovertebral hypertrophy. There is mild spinal canal stenosis involving the left aspect of the spinal canal. There is moderate bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal. Mild bilateral neural foraminal narrowing. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Thoracic and lumbar spine MRI evaluation limited to sagittal sequences per cord compression protocol:There is no high-grade stenosis in the thoracic spine. Spinal canal is developmentally narrow. In the lumbar spine, there are degenerative changes with grade 1 anterolisthesis of L4 and L5. There is advanced facet arthropathy at this level with edema. Up to moderate degree of spinal canal stenosis is suspected at the L3-L4 and L4-L5 levels. There is severe neural foraminal stenosis suspected bilaterally at the L4-L5 levels and at least mild-to-moderate in degree at the L5-S1 levels. These findings can be better assessed with dedicated lumbar spine imaging.There is straightening of the cervical, thoracic, and lumbar curvature. No findings to suggest pathologic compression fractures. No large infiltrating lesions in the cervical, thoracic, or lumbar spine are appreciated. No gross evidence of epidural tumor. T12 vertebral body lesion is consistent with a hemangioma. There is a heterogeneous mass in the pelvis which is partially imaged.

Output: 1. Examination was performed per acute cord compression protocol, with additional complete cervical spine imaging. 2. There is moderate to severe spinal canal stenosis at the C2-C3 level and to a slightly lesser degree C3-C4 level. There is a prominent left paracentral disc extrusion at the left C2-C3 level which is associated with cord deformity.3. T2 hyperintensity within the cervical cord at the C3-C4 level which may represent myelomalacia with possible component of edema.4. Limited examination of the thoracic and lumbar spine per acute cord compression protocol. No findings to suggest acute cord compression in the thoracic or lumbar spine. There is moderate degree of spinal canal stenosis at the L3-L4 and L4-L5 levels which is also on a degenerative basis. There is grade 1 anterolisthesis of L4 and L5. There also appears to be severe neural foraminal stenosis at the L4-L5 levels bilaterally. Dedicated lumbar spine imaging can be considered for better evaluation of these findings as clinically indicated.


Instruction: Generate impression based on findings.

Input: TIA. Brain MRI: There are multiple small areas of encephalomalacia in the left coronal radiata, right frontal lobe centrum semiovale, right thalamus, and left cerebellar hemisphere. There is a background of diffuse patchy cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small retention cyst in the right maxillary sinus.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Neck MRA: There appears to be mild narrowing of the origins of the bilateral vertebral arteries. There is no otherwise evidence of significant steno-occlusive lesions in the other neck arteries.

Output: 1. Multifocal chronic lacunar infarcts and probable chronic small vessel white matter ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Apparent mild narrowing of the origins of the bilateral vertebral arteries, but no evidence of significant steno-occlusive lesions in the rest of the major head and neck arteries.


Instruction: Generate impression based on findings.

Input: Male 58 years old Reason: Evaluate meniscus, chondral surfaces History: lateral knee pain MENISCI: Intrasubstance degeneration of the posterior medial and lateral meniscus, but no discrete meniscus tear is identified.ARTICULAR CARTILAGE AND BONE: Tibial osteotomy with screw fragment in the tibial tubercle is again noted with resulting metallic artifact. Articular cartilage is intact.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Intrasubstance meniscal degeneration, with no discrete meniscal tear.


Instruction: Generate impression based on findings.

Input: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is heterogenous but benign. The conus medullaris is normal in position.Mild multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L4-L5: Right paracentral disc protrusion with effacement of the lateral recess and possible impingement of the traversing L5 nerve root. There is also mild to moderate central canal stenosis related to epidural fat and ligamentum flavum thickening and facet arthropathy. No significant neural foraminal stenosis.L5-S1: Left paracentral disc protrusion with effacement of the left lateral recess and possible impingement of the traversing left S1 nerve root. No significant central canal or neural foraminal stenosis.Mild facet arthropathy in the lower lumbar spine. Visualized sacroiliac joints are unremarkable. Paraspinous soft tissues are within normal limits.

Output: 1. Degenerative changes with right paracentral disc protrusion at L4-5 and left paracentral disc protrusion at L5-S1. There is associated narrowing of the lateral recesses which may be impinging on the traversing right L5 and left S1 nerve roots, respectively. 2. Mild to moderate central canal stenosis at L4-5.


Instruction: Generate impression based on findings.

Input: Reason: ?meniscal tear History: pain and limited flexion, not improved with physical therapy. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Moderate cartilage degeneration of the medial facet of the patella. The remainder of the cartilage appears intact.The bone marrow signal intensity is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Edema within the superolateral aspect of the infrapatellar fat, which can be seen in patellar tendon lateral femoral condyle friction syndrome (Hoffa's fat pad impingement).2.Cartilage degeneration involving the medial patellofemoral joint.3.No meniscal tear.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient is status post football injury, does this patient's right hand numbness and tingling come from the neck. Nonenhanced cervical MRI:Examination demonstrates unremarkable signal intensity and normal anatomical alignment of vertebral. There is no detectable post traumatic bony or soft tissues of cervical spine on this study.Foramen magnum is unremarkable.There is generalized uniform narrowing than expected caliber of the spinal canal which is believed to represent a congenitally small spinal canal.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative disc disease and shallow small central disc protrusion which in combination with congenitally small canal results in mild central spinal stenosis without compromise of neural foramina.C4-C5 demonstrate mild disc degeneration, shallow central and right paramedian disc protrusion with resultant partial effacement of subarachnoid space and mild flattening deformity of the ventral aspect of the cord on the right. This finding also in combination with congenitally small canal results in mild central spinal stenosis however without neural foraminal compromise.C5-C6 demonstrate mild degenerative disc disease without spinal stenosis or neural foraminal compromise. There is a tiny right paramedian linear T2 hyperintensity within the annulus of the disc (axial T2 series 5 image 24) consistent with a small annular fissure.C6/C7 demonstrate moderate disc disease and loss of disc height, central and rightward broad base disc protrusion with resultant effacement of ventral subarachnoid space and mild flattening deformity of the ventral aspect of the cord and resultant mild central spinal stenosis and moderate right neural foraminal compromise.C7-T1 demonstrate mild degenerative disc disease and mild asymmetric right-sided facet hypertrophic changes. There is resultant moderate right neural foraminal compromise and no central spinal stenosis.The signal intensity of the cervical and upper most visualized cord remains within normal.

Output: 1.No detectable acute post traumatic findings.2.Uniformly smaller than expected caliber of the spinal canal representing congenital anatomical variation of small canal/short pedicles.3.C3-C4 demonstrate central disc protrusion with resultant mild central spinal stenosis.4.C4-C5 demonstrate a small central/right paracentral disc protrusion and mild central spinal stenosis.5.C5-C6 demonstrate a right paramedian annular fissure.6.C6-C7 demonstrate a broad-based central and rightward disc protrusion with resultant central spinal stenosis and right neural foraminal compromise.7.There are neural foraminal compromise as detailed level above. Please see above comments.


Instruction: Generate impression based on findings.

Input: Right hip pain. Evaluate for labral tear. ACETABULAR LABRUM: There is a linear tear of the anterior superior labrum (series 1201, image 10).ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. There are small subchondral cysts in the anterior acetabulum indicating minimal osteoarthritis. Bone marrow signal intensity is otherwise within normal limits.SOFT TISSUES: No significant abnormality.ADDITIONAL

Output: Tear of the anterior superior labrum.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Clinical question: Spinal cord? Signs and symptoms: Neck pain. Nonenhanced cervical spine MRI:Foramen magnum is unremarkable.C2 -- C3 demonstrate minimal degenerative changes and unremarkable otherwise.C3 -- C4 demonstrate mild degenerative changes and unremarkable otherwise.C4 -- C5 demonstrate mild degenerative changes and unremarkable otherwiseC5 -- C6 demonstrate mild disk disease and loss of disk height and mild bilateral facet degenerative changes. There is resultant mild to moderate left neural foraminal compromise and no central spinal stenosis.C6 -- C7 demonstrate moderate disk disease and loss of disk height and minimal facet disease. There is a broad-based disk -- osteophyte complex on the left with resultant effacement of the left subarachnoid space without detectable mass effect on the cord. There is mild central spinal stenosis and significant left neural foraminal compromise.C7 -- T1 demonstrate mild degenerative changes and unremarkable otherwise.Normal signal intensity of the cervical and upper most visualized thoracic cord.

Output: 1.C6 -- C7 demonstrate degenerative changes, broad-based disk osteophyte complex on the left with resultant mild central spinal stenosis and significant left neural foraminal compromise.2.Degenerative changes at C5 -- C6 with resultant mild to moderate left neural foraminal compromise.3.Mild degenerative changes at other levels without spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: There is a well marginated ovoid shaped pineal gland sized about 5.5mm x 7.2mm on sagittal plane with internal small T2 hyperintensities. This is likely normal pineal gland but may represent small internal pineal cysts. If clinically indicated, follow up MRI with Gad enhancement can be considered.There is a punctate nonspecific T2/FLAIR hyperintensity in the right lower centrum semiovale. There are no diffusion restriction or susceptibility abnormalities. There is no evidence of low-lying cerebellar tonsils. Ventricular size is normal. There is no midline shift. Vascular flow voids are unremarkable.CSF Flow study using phase contrast MRA over the foramen magnum demonstrates bidirectional flow through the foramen magnum without showing evidence of flow restriction.There is small round T2 isointense lesion in the lateral aspect of the left sphenoid sinus, most representing mucosal retention cyst.

Output: 1. Normal pineal gland with internal small T2 high signal intensities indicating possible internal small pineal gland cysts. Follow up MRI can be considered with Gad enhancement if clinically indicated. 2. No evidence of Chiari malformation.3. CSF Flow study demonstrates bidirectional flow over the foramen magnum.4. Mucous retention cyst in the left sphenoid sinus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Newly diagnosed cT2N0M0 left oral tongue squamous cell carcinoma, p16 negative. There is what appears to be an ulcerated left oral tongue mass that measures up to approximately 3 cm. The tumor does not extend across the midline, does not invade the root of the tongue, and does not grossly involve the mandible. There is no evidence of significant cervical lymphadenopathy. The salivary glands and thyroid appear unremarkable. There are small posterior disc-osteophyte complexes at C5-6 and C6-7. The orbits and imaged intracranial structures are grossly unremarkable.

Output: 1. The left oral tongue mass that measures up to approximately 3 cm corresponds to the known squamous cell carcinoma.2. No evidence of significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Ms. Donovan is a 37 year old female with a family history of breast cancer in her sister, diagnosed at the age of 39. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Leg pain/lumbar radiculopathy. There are postoperative findings related to L4-5 posterior spinal fusion and intervertebral disc spacer insertion. Susceptibility artifact somewhat limits evaluation of these levels. There is approximately 10 mm of anterolisthesis of L4 on L5, which is unchanged. There is moderate right and mild left neural foraminal narrowing, as well as mild right spinal canal stenosis at this level. There is also a disc bulge and hypertrophy of the ligamentum flavum at L3-4, which results in mild bilateral neural foraminal narrowing, as well as slight impingement on the lateral recesses bilaterally. The vertebral body heights are preserved.

Output: 1. Postoperative findings related to L4-5 fusion with persistent grade 1 anterolisthesis of L4 on L5 and moderate right and mild left neural foraminal narrowing, as well as mild right spinal canal stenosis at this level. 2. A disc bulge and hypertrophy of the ligamentum flavum at L3-4 results in mild bilateral neural foraminal narrowing, as well as slight impingement on the lateral recesses bilaterally.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Brain: There are several, approximately 5, foci of T2 hyperintensity the periventricular white matter. The largest of these measures up to 5 mm in the subcortical white matter of the left superior frontal gyrus. In addition, a few of the lesions demonstrate mild enhancement. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no evidence of acute infarction or intracranial hemorrhage. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Thoracic Spine: There are subcentimeter foci of high T2 signal in the lower thoracic spinal cord, at the level of the T2 vertebra, without convincing associated enhancement. There is also mild prominence of the central canal of the lower spinal cord, measuring up to 2 mm in width. The vertebral column alignment is within normal limits. There are Schmorl nodes in multiple vertebral bodies. The vertebral body and disc space heights are otherwise preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Several lesions within the cerebral white matter, some of which demonstrate associated enhancement, and lesions in the ower spinal cord may represent a demyelinating process. Infection and vasculitis are differential considerations.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Abnormal reflex Other specified personal history presenting hazards to health(V15.89)Clinical question: r/o intracranial lesionsSigns and Symptoms: umnl on rightWeakness of right leg MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is a right paramedian broad based disk protrusion associated with mild posterior ligamentous hypertrophy, endplate and uncovertebral osteophytes and effacement of CSF ventral and posterior to the spinal cord. There is encroachment of the right sided exiting nerve roots at this level. Overall there is mild to moderate spinal stenosis at this level.At C6-7 there is no significant compromise to the spinal canal . There is encroachment of the left sided exiting nerve roots at this level due to osteophytes and disk material.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is mild to moderate spinal stenosis at C5-62.There is encroachment of left sided exiting nerve roots at C6-7 and right sided exiting nerve roots at C5-6.3.There is no evidence for acute ischemic cerebral infarction and no evidence for intracranial mass.