Instruction: Generate impression based on findings.

Input: Reason: CT head from outside facility showing crowding of cerebellar tonsils at framen magnum, r/ochiari type malformation History: headaches, dizziness,lightheadness The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk desiccation present.The cerebellar tonsils extend through the foramen magnum and lie approximately 9 mm below the level of the foramen magnum.CSF flow study demonstrates normal biphasic flow.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. There is a minor disk bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery is larger than the left vertebral artery.

Output: 1. Chiari I malformation . There is no significant CSF obstruction at the level of the foramen magnum appreciated based on the CSF flow study.2.There is no significant compromise of cervical spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: MRI brain: There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRA brain: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There are bilateral small P-comm arteries. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRV brain: The left transverse sinus is somewhat hypoplastic. The superior sagittal sinus, inferior sagittal sinus, right transverse sinus, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. There is no evidence of venous thrombosis.

Output: 1. No evidence of acute ischemia, hemorrhage or mass.2. Unremarkable MRA brain.3. No evidence of deep venous thrombosis.


Instruction: Generate impression based on findings.

Input: Clinical question:? Spinal stenosis. Signs and symptoms: Radicular arm and leg pain. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild to moderate degenerative changes resulting in severe right and moderate left neural foraminal compromise and moderate central spinal stenosis.C4-C5 demonstrate moderate degenerative changes resulting in moderate central spinal stenosis and significant bilateral neural foraminal compromise.C5-C6 demonstrate moderate to advanced disc disease and to a lesser degree degenerative/hypertrophic changes of posterior elements. Findings results in moderate central spinal stenosis and significant (right greater than left) neural foraminal compromise.C6-C7 demonstrate moderate to advanced disc disease and loss of disc height with mild hypertrophic changes of posterior elements. There is mild central spinal stenosis and moderate left and mild to moderate right neural foraminal compromise.C7-T1 is unremarkable with the exception of mild degenerative changes.The signal intensity of the cervical and upper most visualized thoracic cord remains within normal.Nonenhanced thoracic MRI:There is normal anatomical alignment of vertebral column.There is normal signal intensity and caliber of thoracic cord.There is no evidence of central spinal stenosis at any level.T1-T2 is unremarkable.T2-T3 is negative for spinal stenosis or neural foraminal compromise. There is however a small) median disc protrusion with resultant mild effacement of ventral subarachnoid space (axial T2 series 12 image 13).T3-T4 is unremarkable.T4-T5 is unremarkable.T5-T6 is unremarkable.T6-T7 is unremarkable.T7-T8 is unremarkable.T8-T9 demonstrate mild left neural foraminal compromise and unremarkable otherwise.T9-T10 demonstrate moderate right and mild left neural foraminal compromise.T10-T11 demonstrate moderate right and mild left neural foraminal compromise.T11-T12 is unremarkable.T12-L1 is unremarkable.Nonenhanced lumbar MRI:T12-L1 is unremarkable.L1-L2 demonstrate mild degenerative disc disease and mild bilateral ligamentum flavum hypertrophy and minimal facet disease. No central spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild disc disease, moderate bilateral ligamentum flavum hypertrophy, mild bilateral facet disease and left facet effusion. There is mild grade 1 retrolisthesis. Constellation of changes results in mild central spinal stenosis and moderate right and mild left neural foraminal compromise. Examination also demonstrates a focus of increased T2 signal intensity within the annulus of the disc in the right para median location suggestive of an annular fissure.L3-L4 demonstrate mild degenerative disc disease and mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No central spinal stenosis however mild to moderate bilateral (right greater than left) neural foraminal compromise is present.L4-L5 mild disc disease and loss of disc, shallow broad-based bulging disc, moderate to significant bilateral ligamentum flavum hypertrophy, mild facet disease however with evidence of bilateral facet effusion. There is a tiny synovial cyst within the left ligamentum flavum without significant mass effect. Constellation of findings results in moderate central spinal stenosis and significant right and moderate left neural foraminal compromise. Tiny synovial cysts is also noted projecting to the left of the spinous process and posterior to the right articulating facet.L5-S1 demonstrate mild disc disease, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis however mild bilateral neural foraminal compromise is present.

Output: 1.Nonenhanced MRI of cervical spine demonstrate degenerative changes throughout the cervical spine involving the discs and posterior longitudinal ligament and to a lesser degree of the posterior elements. Findings results in multilevel central spinal stenosis at C3-C4, C4-C5, C5-C6 and to a lesser degree at C6-C7 levels as well as multilevel bilateral neural foraminal compromise (some significantly) as detailed per level above. The signal intensity of the cord remains within normal.2.Nonenhanced MRI of thoracic spine demonstrate mild to moderate disc disease and mild hypertrophic changes of posterior elements. There is no central spinal stenosis. There are however multilevel mild to moderate neural foraminal compromise as detailed per level above. The signal intensity of the cord remains within normal.3.Nonenhanced MRI of lumbar spine demonstrate moderate central spinal stenosis at L4-L5 and mild spinal stenosis at L2-L3. Multilevel neural foraminal compromise as detailed per level. Multilevel facet effusion and tiny synovial cysts as detailed.


Instruction: Generate impression based on findings.

Input: Headache and diplopia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain and brainstem parenchyma appear unremarkable. There is flattening of the pituitary gland. 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: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Flattening of the pituitary gland is nonspecific, but can be a manifestation of pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Female, 87 years old, with new lung cancer diagnosis, evaluate for brain metastases. Moderately extensive scattered periventricular T2 hyperintensities are seen. No evidence of parenchymal edema or mass effect is detected. Diffusion-weighted images are within normal limits. No pathologic parenchymal or extra-axial enhancement is observed. No evidence to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits. Bone marrow signal characteristics are unremarkable.

Output: 1.No findings to suggest intracranial metastatic disease.2.Moderately extensive periventricular lesions are noted which statistically most likely represent chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: 77-year-old man with history of bleeding hepatic lesion seen on outside imaging status post embolization in October 2014. ABDOMEN:LIVER, BILIARY TRACT: In segment 3 of the liver (series 4, image 15) there is a 35 x 33 mm subcapsular lesion which is hyperintense on T2 sequences, has discontinuous peripheral early enhancement, and gradually filling-in on delayed imaging (series 103, image 50). This lesion measured 35 x 33 mm on the prior examination. Adjacent to this lesion (series 4, image 12) there is a T2 hyperintense cyst measuring 25 x 24 mm, also unchanged.There is a gallstone at the gallbladder neck, otherwise the gallbladder is normal.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Bilateral renal cysts are unchanged in the kidneys enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted of the partially visualized small bowel and colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable liver lesion with postcontrast appearance favoring a hemangioma.


Instruction: Generate impression based on findings.

Input: History of cholangiocarcinoma, presents for restaging. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. There is severe intrahepatic ductal dilatation which abruptly terminates at Klatskin's point (series 8/92), where there is a suspected mass lesion measuring 1.2 x 1.0 cm which progressively enhances (series 12/32), suspicious for cholangiocarcinoma. The more distal common bile duct appears normal in caliber.There is extensive intrahepatic bile duct wall thickening and postcontrast enhancement predominantly involving the right hepatic lobe which extends peripherally to several lobular mass lesions which demonstrate postcontrast heterogeneous and rim enhancement. Periductal hyperenhancement also seen. Right posterior portal vein not well seen, suspicious for thrombosis. The proximal right and common hepatic arteries are patent, the left hepatic artery is suboptimally visualized.The visualized hepatic veins are patent.Cholelithiasis within a normally distended gallbladder without specific evidence of acute inflammation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Extensive intrahepatic ductal dilatation which tapers abruptly at Klatskin's point with focal lesion suspicious for cholangiocarcinoma. Extensive periductal enhancement and thickening predominantly involving the right hepatic lobe which extends to peripherally based heterogeneous enhancing/rim-enhancing lesions. The extent of periductal thickening and enhancement favors an infectious etiology, i.e., suppurative cholangitis with associated abscess formation. While an element of periductal infiltrating cholangiocarcinoma cannot be entirely excluded, considered less likely based on extent seen. Right posterior portal vein not well seen, suspicious for thrombosis.


Instruction: Generate impression based on findings.

Input: 29-year-old girl with history of chronic pelvic and rectal pain, question of duplication cyst. PELVIS:UTERUS, ADNEXA: The uterus and adnexa are normal. Ovarian follicles are seen bilaterally.BLADDER: The bladder is normal.LYMPH NODES: There is no significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality of the visualized small bowel or colon.BONES, SOFT TISSUES: There is an 18 x 9 mm cystic lesion which does not enhance in the left paracolic gutter (series 601, image 10).OTHER: No significant abnormality noted.

Output: 1.No etiology for pelvic/rectal pain.2.Cystic lesion in the left paracolic gutter without suspicious enhancement. Please correlate to prior outside imaging if available.


Instruction: Generate impression based on findings.

Input: 4-year-old female is status post peak versus auto . Nonenhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and gray -- white matter differentiation is unremarkable. There is mild crowding of cerebellar tonsils into the foramina magnum. This finding is best appreciated on sagittal reformatted images. Please correlate with clinical history and follow-up with an MRI may be necessary.Calvarium is intact. No definitive abnormality of soft tissues of the scalp.Limited view of the orbits, mastoid air cells, middle ear cavities and paranasal sinuses are unremarkable.

Output: 1.No evidence of acute posttraumatic findings.2.With the exception of mildly ectopic cerebellar tonsils this non-infused CT examination of brain is unremarkable.


Instruction: Generate impression based on findings.

Input: Female, 33 years old. Ulnar pain. Evaluate for lunate triquetral and TFCC tear. A mid carpal intra-articular injection was requested. Intra-articular contrast was injected within the mid carpal space. There is no evidence of contrast within the radiocarpal or radioulnar spaces.LIGAMENTS: The scapholunate ligament appears intact. The lunotriquetral ligament is also intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The TFCC is grossly intact without definite evidence of tear.TENDONS: No significant abnormality noted. BONES: There is no bone marrow edema.ADDITIONAL

Output: No findings to account for the patient's ulnar pain. Specifically, no definite tear of the scapholunate ligament, lunotriquetral ligament, or triangular fibrocartilage complex.


Instruction: Generate impression based on findings.

Input: Metastatic thyroid cancer for evaluation of single thyroid metastases. There are postsurgical findings related to a right frontal craniotomy. There is interval resolution of subcentimeter nodular enhancement along the posterior aspect of the resection cavity with areas of intrinsic T1 hyperintensity and susceptibility that remain, which likely represent blood products. There is residual confluent T2 hyperintensity in the adjacent brain parenchyma. There is also an unchanged nonspecific punctate focus of susceptibility effect in the right basal ganglia. The ventricles and sulci are unchanged. There is no midline shift or mass effect. There is no evidence of acute infarction. There is a small mucous retention cyst in the right maxillary sinus. There is an unchanged subcentimeter posterior nasopharynx retention cyst or Thornwaldt cyst. There is unchanged partially imaged asymmetric hyperenhancement of the left parotid gland, which may be treatment-related.

Output: Post-treatment findings related to resection of a right frontal lobe metastasis with interval resolution of enhancement along the margins of the resection cavity, without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: There is a focus of high-T2 and low-T1 signal without enhancement around the cerebral aqueduct at the level of the midbrain (series 501 image 12) with possible additional T2 hyperintensity involving the right pulvinar. No mass effect or abnormal enhancement. Remainder of the brain demonstrates no evidence of acute infarct, intracranial mass effect or abnormal parenchymal or meningeal enhancement.There is no abnormal enhancement or mass involving the bilateral cisternal segments of the trigeminal nerve, Meckel cave, or cavernous sinuses; please note however exam is not tailored for optimal evaluation of these cranial nerves. There is preserved fat signal in both pterygopalatine fossae. The ventricles and basal cisterns are normal in size and configuration without hydrocephalus. There is no midline shift or herniation. There is a small mucus retention cyst in the right maxillary sinus. The skull and extracranial soft tissues are unremarkable.

Output: 1. No acute infarct, mass effect, or pathologic intracranial enhancement. Particularly no abnormal enhancement or mass is seen involving the cisternal segment of the trigeminal nerve, Meckel cave, or cavernous sinuses. Please note exam is not tailored for optimal evaluation of cranial nerve V and additional imaging can be considered if there is continued suspicion for a structural lesion.2. Abnormal T2 hyperintensity surrounding the cerebral aqueduct at the level of the midbrain, right greater than left, with additional small T2 hyperintensity involving the right thalamus (coronal T2 19/32, axial T2 12-14/28) . No mass effect or abnormal enhancement. Differential is broad and includes prior insult from ischemia, demyelination, infection/inflammation, or prior toxic-metabolic injury (such as Wernicke's). MRI of the brain is otherwise unremarkable with no other lesions to suggest multiple prior infarcts or demyelinating disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Again seen are multiple compression fractures throughout the thoracic spine including T5, T7, T10, and T11 with evidence of cement augmentation at the T7, T10, and T11 levels. Minimal cement extravasation dorsally to the T10 vertebral body is again seen. No evidence of interval height loss, edema, or evidence of new compression fracture in the thoracic spine. Again seen is evidence of prior laminectomy and posterior fusion from T4 to T6 including placement of two cages at the T5 level. Paraspinous rods and pedicle screws are unchanged better assessed on same-day CT. Areas of solid bony bridging from T4 to T6 better assessed on same-day CT.Mild exaggeration of the thoracic kyphosis with apex at the T5 level is again noted. Osseous retropulsion at the T5 level is again noted into the anterior epidural space with the spinal canal surgically decompressed posteriorly at this level. Unchanged mild deformity of the ventral cord at the T5 level without cord signal abnormality. Remainder of the thoracic spine demonstrates mild multilevel degenerative changes without significant spinal canal stenosis. There is moderate T8-T9 and right T10-T11 neural foraminal stenosis and to a milder degree at additional levels. Prominent facet arthropathy at the T10-T11 level again seen with mild effacement of the posterior lateral thecal sac.Bone marrow signal abnormality at the T5 compression fracture is not well assessed due to the hardware. There is no however appreciable change or new soft tissue mass to suggest tumor growth. No evidence of epidural tumor or neoplastic involvement at additional levels. LUMBAR SPINE

Output: 1. Multiple compression fractures involving the thoracic and lumbar spine as described above are again seen. No evidence of interval height loss, new bone marrow edema, or new compression fracture since 10/15/2013.2. No suspicious enhancement within the thoracic or lumbar spine to definitively suggest neoplasm. Heterogeneous bone marrow including areas of mild enhancement in the pelvis are not significantly changed and compatible with history of lymphoma. Suggest correlation with PET for any evidence of active disease.3. Postoperative changes of fusion from T4 to T6 again seen and better assessed on CT thoracic spine from same day.4. Unchanged effacement of the ventral epidural space and mild deformity of the ventral cord at the T5 level related to osseous retropulsion. Spinal canal is posteriorly decompressed at this level. No new mass effect or evidence of cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Disturbance of skin sensation, numbness of hand bilaterally. The cranial-cervical junction is normal. There is slight straightening of cervical spine with minimal kyphotic angulation at the level of C4-5. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is no evidence of no neuroforaminal narrowing or spinal stenosis from C2-3 to C7-T1 level.

Output: Loss of normal cervical lordosis with minimal kyphotic angulation at the level of C4-5.Otherwise unremarkable C-spine MRI.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There is a similar pattern of scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific but may represent mild chronic small vessel ischemic changes and/or post treatment changes. There is no pathological enhancement. A left frontal developmental venous anomaly is again incidentally noted. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Again seen is a left maxillary sinus mucosal retention cyst.

Output: 1. No evidence of recurrent nasopharyngeal tumor.2. No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Plantar fibroma Examination of the left midfoot and forefoot reveals a small mass in the plantar subcutaneous fat that is less than 1 cm. This mass demonstrates decreased signal intensity on the T1 and the T2 weighted images consistent with a fibrous lesion such as a plantar fibroma.Note is made of a hallux valgus deformity

Output: Subcutaneous plantar fibrous mass


Instruction: Generate impression based on findings.

Input: Medial knee pain. Medial meniscal tear/medial condyle chondromalacia? MENISCI: The menisci appear normal.ARTICULAR CARTILAGE AND BONE: Articular cartilage appears normal. Bone marrow signal intensity is normal.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

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


Instruction: Generate impression based on findings.

Input: Altered mental status. The images are generally degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is extensive cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution, but also in the pons. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are bilateral maxillary sinus retention cysts. There is a right cheek lipoma that measures up to 15 mm. There is incomplete fusion of the anterior and posterior arches of C1.

Output: Extensive probable chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: There is increased signal intensity throughout much of the supraspinatus tendon indicating moderate tendinosis. Furthermore, there is disruption of the articular and bursal surface fibers of the tendon indicating at least partial-thickness tearing of the distal 1.5 cm of the tendon with perhaps a network of full-thickness tearing; however we see no discrete fluid-filled gap or frank tendon retraction. The supraspinatus muscle is normal. The tendinosis and surface tearing extends posteriorly to involve the anterior portion of the infraspinatus tendon; however more posteriorly, the infraspinatus tendon is intact. Small cysts are identified within the greater tuberosity which are likely degenerative in nature. There is mild fatty infiltration along the myotendinous junction of the infraspinatus tendon but the muscle is otherwise normal. Although the teres minor tendon is intact, there is mild to moderate diffuse fatty atrophy of the teres minor muscle which is of uncertain etiology. A small (6 mm) linear focus of fluid signal intensity of the subscapularis tendon is seen at its insertion which represents a small focal tear that appears to involve the majority of the thickness of the tendon; this is of questionable clinical significance. The subscapularis muscle is normal. SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint with the distal clavicle appearing enlarged, possibly representing an old healed fracture; there is mild impression upon the superior fibers of the supraspinatus. A small amount of fluid is present within the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal and there is no joint effusion. There is linear increased signal intensity traversing the anterior superior labrum which may represent a tear or normal variant sublabral foramen. The remainder of the labrum is normal within the limits of a non-arthrogram study.BICEPS TENDON: There is a small amount of fluid within the biceps tendon sheath likely representing mild tenosynovitis given the lack of fluid within the joint space. The biceps tendon otherwise appears normal.

Output: 1. Increased signal throughout much of the supraspinatus tendon extending to involve the anterior fibers of infraspinatus tendon which reflects a combination of moderate tendinosis and surface tearing. We cannot exclude the possibility of a network of tears creating a full-thickness defect but we see no fluid-filled gap or frank tendinous retraction. There is also a small focal insertional tear of the subscapularis.2. Moderate osteoarthritis of the acromioclavicular joint with mild enlargement/deformity of the distal clavicle which may represent a remote healed fracture.3. Additional findings described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic lung cancer, brain metastases, status post RT, ALK+, status post 4 cycles of Alectinib. Please compare with prior exam. Signs and symptoms: Pain metastases. Pre- and post enhanced brain MRI:Examination demonstrates interval improvement in metastatic disease since prior study.Few smaller lesions seen on prior exam are no longer identified. Several remaining metastatic lesions are measured and all appear smaller since prior exam. As for example a right posterior cerebellar metastatic lesion measuring at 7 mm compared to prior study measurement of 11.A right anterior temporal metastatic lesion measuring at 3.8 mm compared to prior study measurement of 7.6 mm.A right caudate head metastatic lesion measuring at 7 mm compared to prior study measurement of 8.A left basal ganglia metastatic lesion measuring at 6.5 mm compared to prior study measurement of 8.2 mm.A left frontal periventricular white matter metastatic lesion measuring at 7 x 7.5 mm compared to prior study measurement of 10 x 8.2 mm.Similar to prior exam nearly all metastatic lesions demonstrate internal hemorrhage is. Minimal surrounding vasogenic edema of several metastatic lesions are present however with interval improvement since prior exam. There is no evidence of any appreciable mass effect or midline shift.There is no detectable calvarial metastatic lesions.Unremarkable images through the orbits.

Output: 1.Interval improvement of intracranial diffuse metastatic lesions since prior study.2.Interval near-complete resolution of few of the smaller previously seen metastatic lesions.3.Intervertebral decreased size of several remaining metastatic lesions as detailed/measured above.4.No evidence of any significant mass effect or midline shift.5.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Planning for stereotactic brain biopsy. Enhanced head CT:80 cc of Omnipaque 350 is administered for this study.Stealth enhanced head CT for stereotactic brain biopsy protocol is utilized.There is poor visualization of a previously known mass in the inferior fourth ventricle. Compared to priors stealth brain MRI protocol there is no definitive operation interval change. This tumor however it is very poorly defined on this exam and precise measurement is not possible.This is study is otherwise unremarkable.

Output: stealth enhanced head CT for surgical planning. Exam very poorly visualizes patient's known tumor in the inferior fourth ventricle.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule-out brain hemorrhage. Signs and symptoms: Fall and alteration of mental status. Nonenhanced head CT:No detectable acute intracranial hemorrhage, edema, mass effect, mass, midline shift or hydrocephalus.There is a focus of low-attenuation in the left posterior temporal subcortical and periventricular white matter with no involvement of overlapping cortex. This finding demonstrates no mass effect on the adjacent parenchyma or the ventricle. The finding likely represents a focus of encephalomalacia. Two entirely evaluate this finding recommend follow-up with an MRI exam. This finding could represent an area of chronic ischemic stroke however further evaluation is recommended.Calvarium is intact.Visualized paranasal sinuses, mastoid air cells and orbits are unremarkable.

Output: 1.No acute intracranial findings. CT is insensitive for early detection of acute ischemic strokes.2.Focus of low attenuation in the left posterior temporal subcortical/periventricular white matter could represent a focus of encephalomalacia however follow-up with an MRI is highly recommended to exclude other possibilities.


Instruction: Generate impression based on findings.

Input: There are post surgical findings in the left frontal scalp region. Along the anterior margin of the resection cavity, there is a subcentimeter focus of enhancement with slight extension into a portion of the underlying calvarium. Other portions of the skin graft region posteriorly demonstrate diffuse enhancement. There are several supratentorial and infratentorial punctate foci of susceptibility effect, including within the left cerebellar hemisphere, without corresponding enhancement. There are mild areas of cerebral white matter T2 hyperintensity, which are unchanged. There is no evidence of acute infarction. The ventricles and sulci are unchanged. There is no midline shift or mass effect. There is a subcentimeter nodular focus in the left parotidectomy bed region, which does not appear to enhance centrally.

Output: 1. Postsurgical changes in the left frontal scalp with a subcentimeter focus of enhancing tissue along the anterior resection margin, which likely represents post-treatment effect, such as scar tissue.2. Multiple nonspecific foci of supratentorial and infratentorial punctate foci of susceptibility effect may represent hypertensive microhemorrhages, amyloid angiopathy, or perhaps less likely non-enhancing metastatic lesions.3. A subcentimeter nodular focus in the left parotidectomy bed region is nonspecific and may represent a post-operative fluid collection versus less likely tumor. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 35 years old, with history of grade 3 oligodendroglioma with 1p 19q deletion, status post re-RT 4 weeks ago with concomitant temozolamide and Avastin, on clinical trial. Findings are redemonstrated compatible with a wide left parietotemporal craniotomy. A resection cavity incorporating parts of the left frontal operculum and temporal lobe is stable in size. Thickened T2 hyperintense tissue along the posteromedial cavity margin is again seen demonstrating intrinsic T1 hyperintensity and some mild superimposed enhancement. Since the prior examination, this tissue has decreased in overall bulkiness. For example, the thickest portion previously measured up to 19 mm, and the same area now measures only 12 mm. The degree of enhancement within this tissue is also reduced. The entire region surrounding the resection cavity correlates with reduced rCBV.Contiguous with the resection cavity, there appears to be an extra-axial fluid collection following CSF on all sequences which tracks superiorly and posteriorly along the left parietal lobe exerting mild mass effect on adjacent parenchyma. This is also unchanged.T2 hyperintensity extending inferiorly from the resection cavity into the left temporal lobe is unchanged. Ill-defined T2 hyperintensity along the left ventricular atrium is also unchanged. Vague T2 hyperintensity along the right atrium may be mildly progressed.No additional suspicious or new intracranial lesions are seen. A cystic lesion within the right paramedian parietal lobe was present on all prior examinations and shows no significant interval change, likely representing a developmental cyst. Ex vacuo dilatation of the left lateral ventricle is unchanged.

Output: 1. Stable size and shape of the resection cavity involving the left frontal and temporal lobes.2. Since the prior examination, thickened tissue along the posterior medial margin of the cavity has decreased in overall bulkiness along with decreasing enhancement. The entire region correlates with reduced rCBV. Given the patient's ongoing therapeutic regimen, the interval changes may reflect either true disease response or pseudo-respopnse.


Instruction: Generate impression based on findings.

Input: History of coccygeal chordoma status post resection Again seen are surgical changes relating to prior coccygeal resection which are unchanged from the prior exam. There is increased signal abnormality on fluid sensitive sequences, which does not enhance on postcontrast images most consistent with postoperative changes. Note is made of foci of metallic susceptibility artifact in the surrounding area which are postoperative in etiology. No pathologic enhancement is identified on postcontrast sequences. No evidence of residual or recurrent tumor.The patient is status post hysterectomy. There is a focus of increased signal abnormality on both T1 and T2-weighted images within the S2 vertebral body, which demonstrates fat signal intensity on all sequences, likely representing a hemangioma, appearing similar to the prior study. Similar marrow signal changes are noted at the S3 and S4 which are also unchanged. Although this examination was not protocoled for evaluation of the lumbar spine, again seen is disc protrusion at the level of L5/S1, which results in narrowing of the lateral recess and posterior displacement of the S1 nerve root as well as left neural foramen narrowing. Overall these findings are unchanged from the prior exam. There is also an apparent disc protrusion at the level of L4/L5 but these findings are better evaluated on the corresponding MRI of the lumbar spine.

Output: Postoperative changes without evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Patient with history of prostate cancer, status post spinal decompression, evaluate thoracic and lumbar spine. Patient status post T3-T5 and T11-L1 laminectomies on 6/24/2016. Thoracic spine:Redemonstrated are numerous foci of signal abnormality within the visualized osseous structures compatible with widespread osseous metastatic disease. There is slightly exaggerated thoracic kyphosis. Postsurgical changes the T3-T5 laminectomy are noted. At the level of the decompressive laminectomy at T4, there is increased CSF dorsally in the thecal sac as compared to prior exam, however there is residual effacement of the spinal canal laterally with persistent deformity of the cord. The epidural tumor at this level is better appreciated on prior postcontrast sequences from 6/23/2016. There is pathological compression fracture of the T4 vertebral body, progressed compared to the prior exam (approximately 30 percent loss of height on current study, minimal height loss previously). Thoracic cord signal abnormality at this level is again seen slightly more prominent/apparent.Postsurgical changes of T11-L1 laminectomies are present with spinal cord appearing well decompressed at this level. Residual epidural tumor at this level is noted without significant mass effect on the cord. No new level of significant thoracic spinal canal stenosis. Aside from the T4 level, vertebral body heights are grossly maintained. Small epidural as well as posterior paraspinous fluid collections are seen at the level of the decompressive laminectomy.Expansile lesion involving the right posterior chest wall is again seen.Lumbar spine:There are numerous foci of signal abnormality within the visualized osseous structures in the lumbar spine compatible with widespread osseous metastatic disease. Vertebral body heights are preserved. Multilevel disc desiccation is present. There is no significant spinal canal stenosis. Multilevel degenerative changes including disc bulges, mild to moderate multilevel neural foraminal stenoses, and facet arthropathy. Conus medullaris terminates at the level of the L1-L2.

Output: 1.Widespread osseous metastatic disease again seen. 2.Patient is status post T3-T5 laminectomies for surgical decompression, where there is relatively improved but persistent deformity of the spinal cord at the T4 level. Cord signal abnormality at this level appears slightly more prominent/more apparent than prior.3.Patient is status post T11-L1 laminectomies for surgical decompression, where the spinal canal is well decompressed.4.Pathologic compression fracture of T4 has progressed compared to the prior exam of 6/23/2016.


Instruction: Generate impression based on findings.

Input: Ewing sarcoma, restaging Note that the evaluation of the femur is severely limited secondary to the presence of a femoral endoprosthesis and hip arthroplasty.The surgical changes in the lateral soft tissues of the right upper thigh with a linear tract extending from the skin to the the vastus lateral and intermedius are again observed. There is persistent low signal intensity on T1 and bright signal on T2 although the extent of T2 hyperintensity within the musculature again appears slightly improved from the prior exam. There is persistent heterogeneous enhancement of the left thigh without discrete mass. The fullness of the lateral thigh, thought to be related to muscular herniation or scarring, is similar to the prior exam. There is generalized mild fatty atrophy of the thigh musculature which is similar to the prior exam.

Output: Within the limits of the exam, there is no discrete enhancing mass or definite evidence of recurrence where evaluation is available.


Instruction: Generate impression based on findings.

Input: Abdominal pain in right lower quadrant, CBD dilatation ABDOMEN:LIVER, BILIARY TRACT: Mild to moderate intrahepatic and hepatic biliary duct dilatation, CBD measures up to 1.2 cm, gradual tapering seen distally. No intraluminal signal void seen to suggest underlying choledocholithiasis. No definite obstructing lesion seen. Extensive adenomyomatosis. Gallbladder sludge. No secondary signs of acute cholecystitis.SPLEEN: Splenic calcification.PANCREAS: Prominent pancreatic duct, measuring up to 5 mm at pancreatic head level.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal/left para-aortic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Intrahepatic and extrahepatic as well as mild pancreatic ductal dilatation, no choledocholithiasis, no obstructing lesion delineated. Findings suggest underlying benign ampullary stricture, further evaluation with ERCP for confirmation suggested.


Instruction: Generate impression based on findings.

Input: 46 years, Female, right-sided numbness. Rule out stroke.. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is a nonspecific focus of FLAIR hyperintensity in the left frontal centrum semiovale. Minimal additional scattered foci of T2/FLAIR hyperintensity in the supratentorial white matter are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is minimal bilateral mastoid air cell opacification. There is also minimal scattered paranasal sinus mucosal thickening, relatively greater in the left posterior ethmoid region. Cystic foci in the midline nasopharyngeal region are compatible with Tornwaldt cyst.

Output: 1. Brain parenchyma is essentially unremarkable for age. 2. There are minimal scattered foci of T2/FLAIR hyperintensity in the white matter, including a relatively more prominent focus in the left frontal lobe. These are nonspecific but may represent minimal chronic small vessel ischemic changes. The left frontal focus described above may also be related to prominent perivascular spaces in this region which are a normal variant.


Instruction: Generate impression based on findings.

Input: Reason: hemoglobin SS c/o memory loss History: hemoglobin SS c/o memory loss MRI of the brainNo diffusion weighted abnormalities are appreciated.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.MRA brain:There is a 3mm aneurysm directed superiorly, medially and anteriorly present at the proximal portion of the opthalmic segment of the right internal carotid artery.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There is a 3mm aneurysm at the proximal portion of the ophthalmic segment of the right internal carotid artery. CTA would help confirm this.2.No evidence for cerebrovascular occlusive disease.3.No evidence for act ischemic cerebral infarction.Findings were emailed to Dr E. Drumm who is not available by pager and a voice message left at the given Referring Call Back: (773)702-6808


Instruction: Generate impression based on findings.

Input: Worsening back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal anterolisthesis of L4 and L5, which appears slightly worse than prior. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: There is a small right foraminal disc protrusion which is worse since prior from 7/13/2010. There is no significant spinal canal stenosis. There is mild right neural foraminal narrowing. No significant left neural foraminal narrowing. Mild facet arthropathy.L3-L4: There is mild disc bulge which is slightly more prominent than prior with a small central extrusion component. There is no significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal narrowing, relatively worse on the right. Mild facet arthropathy.L4-L5: There is moderate bilateral facet arthropathy, ligamentum flavum thickening, and minimal bulge. Trace anterolisthesis. No significant spinal canal stenosis. There is mild left and minimal right neural foraminal narrowing.L5-S1: There is moderate bilateral facet arthropathy and ligamentum flavum thickening. There is no significant spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes which have slightly progressed 7/13/2014. There is no significant spinal canal stenosis at any level. Neural foraminal narrowing is relatively worse at the L3-L4 level where there is mild to moderate stenosis. Again seen is multilevel facet arthropathy, relatively worse at the L4-5 and L5-S1 levels, which may be contributing to patient's back pain but grossly similar to prior.


Instruction: Generate impression based on findings.

Input: 50-year-old male with history of rectosigmoid cancer, status post resection. Evaluate for possible recurrence. PELVIS:PROSTATE/SEMINAL VESICLES: There is a left mid zone to base slightly T2 hypointense lesion in the peripheral zone with corresponding low ADC signal (series 5, image 34). BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is suggestion of an end to side anastomosis in the sigmoid without definite contrast enhancement or thickening to suggest tumor recurrence.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific findings to suggest rectosigmoid tumor recurrence.2.Abnormal prostatic lesion as above. Correlate clinically for prostatitis and/or with PSA to exclude neoplasm.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with sudden onset neck pain and weakness in left arm 3 days ago. Cervical radiculopathy and concern for epidural abscess. MRI brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. A small area of encephalomalacia in the head of the left caudate nucleus is suggestive of a chronic lacunar infarct. Patchy mild T2 hyperintensity in the pons is seen, left side more than right. 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 on T2 imaging. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI C-spine:Artifact from patient motion limits examination. The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. There is a relatively large lipoma subcutaneously in the right lower neck. Paraspinous soft tissue structures otherwise appear within normal limits. No pathologic enhancement is identified.Degenerative changes are seen in the cervical spine as described below:C2-3: Mild bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.C3-4: Small posterior disc osteophyte complex mildly narrowing the spinal canal and effacing the ventral thecal sac. Bilateral uncinate hypertrophy and facet arthropathy. Moderate right and moderate to severe left neural foraminal narrowing.C4-5: Small posterior disc osteophyte complex, which effaces the ventral thecal sac. Bilateral uncinate hypertrophy and facet arthropathy. Mild spinal canal stenosis. Moderate to severe bilateral neural foraminal narrowing.C5-6: Small posterior disc osteophyte complex. Bilateral uncinate hypertrophy and facet arthropathy. No significant spinal canal stenosis. Moderate to severe bilateral neural foraminal stenosis.C6-7: Small posterior disc osteophyte complex. Bilateral uncinate hypertrophy and facet arthropathy. No significant spinal canal stenosis. Moderate to severe bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.

Output: 1. No evidence of acute infarct, intracranial mass or pathologic intracranial enhancement. Small chronic lacunar infarct in the head of the left caudate nucleus. Mild non-specific signal abnormality in the pons, perhaps also related to small vessel ischemic disease.2. No evidence of spinal epidural abscess, spinal cord compression, or abnormal spinal cord signal. Multilevel degenerative changes in the cervical spine resulting in mild spinal canal stenosis at C3-4 and C4-5. Moderate to severe neural foraminal narrowing on the left at C3-4 and bilaterally at C4-5 and C5-6.


Instruction: Generate impression based on findings.

Input: Rule out metastasis. Headache. Known neoplastic process. There is a right frontoparietal extra axial hyperdense lesion again identified, measuring two x 5 0.1-cm [image 17]. It is adjacent to the right craniotomy defect, very similar in appearance when compared to prior MRI 5/13/2009. Large amount encephalomalacia involving the right frontal lobe is again seen with ex vacuo dilatation of the right lateral ventricle. There are calcifications seen within the displaced falx, as well as the periphery of this extra-axial lesion. There is no other evidence of intracranial hemorrhage. Left frontal encephalomalacia again seen. Left lateral ventricle is moderately dilated. The basal cisterns are patent. Mild vascular calcifications. Diffuse thickening , with lucent and sclerotic appearance of the right lower frontal temporal calvarium as well as the sphenoid bones and are identified, underlying metastasis cannot be excluded.

Output: No acute intracranial abnormalities. Again identified is a large right extra-axial frontal parietal hyperdense collection, similar in appearance when compared to prior MRI 5/13/2009.


Instruction: Generate impression based on findings.

Input: 55-year-old female. Evaluate for metastatic brain lesions, hydrocephalus and posterior fossa. Signs and symptoms: Recurrent falls Findings of the extensive white matter low attenuation is noted. These findings are nonspecific however was noted on prior CT examination from 6 -- 6 and 2009 and MRI examination from 5 -- 15 -- 2009. Findings may represent residual edema from patient's multiple previously noted (not present on the current exam) enhancing metastatic lesions). Post infusion images demonstrate no evidence of any abnormal enhancement of the brain parenchyma or the leptomeninges. No metastatic lesions to the brain, leptomeninges or the calvarium is detected. Cortical sulci and ventricular system are within normal size. Follow-up exam with an MRI is highly recommended to exclude other etiologies for a white matter abnormalities.90 CC of Omnipaque 350 was utilized for this a study.

Output: 1.No evidence of metastatic lesion to the brain, leptomeninges or calvarium.2.Extensive periventricular and subcortical low attenuation without enhancement as detailed above.


Instruction: Generate impression based on findings.

Input: 51-year-old female with question of lateral epicondylitis. LIGAMENTS: Radial ulnar collateral ligaments are intact.TENDONS: Mild tendinosis and interstitial at the insertion site of the common extensor tendon onto the lateral epicondyle.ARTICULAR SURFACES AND BONE: The articular surfaces of the elbow appear intact.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Mild tendinosis and partial-thickness tearing of the insertion of the common extensor tendon onto the lateral epicondyle.


Instruction: Generate impression based on findings.

Input: 70-year-old female with history of SRS for arteriovenous malformation in January 2015: one year follow-up. There is an enhancing arteriovenous malformation in the left superior frontal gyrus, which has decreased in size measuring 11 mm x 9 mm x 14 mm, previously 13 mm x 13 mm x 11 mm. There is no associated residual surrounding edema. There is a mildly prominent draining vein extending to the superior sagittal sinus. The left anterior cerebral artery is larger in caliber in comparison with the right, which is unchanged. There is no evidence of flow limiting stenosis. There is a 1 mm wide outpouching along the origin of an anterior temporal branch of the left posterior cerebral artery. There is an unchanged 2 mm thick area of extra-axial enhancement along the left parietal convexity, which may represent a prominent venous complex or meningioma. There are scattered foci of T2 hyperintensity within the subcortical and periventricular cerebral white matter without restricted diffusion. There is no evidence of acute intracranial hemorrhage. The ventricles and sulci are unchanged in appearance and there is no midline shift. There is a small right ethmoid sinus retention cyst. The orbits appear unremarkable.

Output: 1. Interval decrease in size of the left superior frontal gyrus arteriovenous malformation, along with interval resolution of the associated surrounding vasogenic edema. 2. A 1 mm wide outpouching along the origin of an anterior temporal branch of the left posterior cerebral artery may represent a aneurysm or prominent infundibulum.3. Chronic small vessel ischemic disease, without evidence of acute infarction.


Instruction: Generate impression based on findings.

Input: Clinical question: Newly diagnosed small cell cancer. Signs and symptoms: SOB. Discussion Pre and post enhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates normal anatomical development, morphology and with normal signal intensity of brain parenchymal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination for age.There is no detectable abnormal parenchymal or leptomeningeal enhancement.Normal signal intensity of the calvarium and soft tissues of the scalp without abnormal enhancement. Next line unremarkable images through the orbits and including axial fat sat post enhanced series.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: Unremarkable pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with bilateral upper extremity weakness and recent fall. Rule out hemorrhage/other acute processes. Signs and symptoms: Bilateral upper extremity weakness. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for the attention of acute nonhemorrhagic ischemic strokes.Cerebral cortex, cortical sulci and the ventricular system are within normal for patient stated age.The gray -- white matter differentiation is preserved.Calvarium and soft tissues of the scalp are unremarkable.Visualized paranasal sinuses, mastoid air cells and middle ear cavities are pneumatized and unremarkable. Very small retention cyst in the left maxillary sinus however is present.Nonenhanced cervical CT:There is no detectable bony fracture of the cervical spine.There is very significant degenerative changes of cervical spine with resultant near complete fusion of C3 and C4 , significant loss of intervertebral disk at C4 -- C5 and advanced degenerative changes at C5 -- C6 and C6 -- C7 levels. There is reversal of cervical lordosis centered at C3 there C4. There is highly suspected central spinal stenosis at C3, C4 and C5 levels.There are also bilateral multi-level neural foraminal compromise at C3 there C4, C4 -- C5 and to a lesser degree at C5 -- C6 and C6 -- C7 levels.No detectable paraspinal soft tissue abnormalities.Heavy vascular calcification of the right carotid bifurcation is noted.Enlargement of thyroid lobes with inhomogeneous pattern is concerning for goiter. There is no deviation or compromise of the trachea.

Output: 1.Negative nonenhanced head CT.No evidence of acute posttraumatic findings of cervical spine. Very advanced degenerative changes of cervical spine with resultant reversal of cervical lordosis and multilevel neural foraminal compromise and suspected central spinal stenosis.


Instruction: Generate impression based on findings.

Input: Again seen are postsurgical changes of prior posterior fossa and upper cervical decompression for Chiari malformation with low-lying cerebellar tonsils again noted. Again seen is extensive T2 signal abnormality involving the right central and dorsal cervical cord from C2 to the C7 level. There is also a associated prominence of the central canal which extends to the lower T1 level on the axial T2 sequence. Overall appearance of the signal abnormality is unchanged since 4/27/2009.Cervical spine alignment is unchanged with reversal of cervical lordosis and mild retrolisthesis of C4 on C5. Bone marrow signal is benign. The vertebral body heights are preserved. No abnormal enhancement. Degenerative changes are specified by the intervertebral level as follows: C2-C3: Minimal disc osteophyte complex without spinal canal stenosis or neural foraminal compromise is identified. C3-C4: Small disk osteophyte complex with mild narrowing of the spinal canal and effacement of the ventral thecal sac.C4-C5: Small disk osteophyte complex with effacement of the ventral thecal sac. There is also ligamentum flavum buckling narrowing the dorsal thecal sac which appears slightly worse than prior. Minimal right foraminal narrowing, otherwise no significant neural foramina stenosis. C5-C6: Disk-osteophyte complex without significant spinal canal or neural foramina stenosis.C6-C7: Small disk osteophyte complex without significant spinal canal or neural foramina stenosis.C7-T1: No central canal stenosis or neural foraminal compromise.

Output: 1.No significant change in extensive right cervical cord myelomalacia with small adjacent syrinx.2.Multilevel degenerative changes as detailed above with mild spinal canal stenosis at C3-C4 and C4-C5 which is minimally worse at the C4-C5 level compared to 4/27/2009. No high-grade spinal canal or neural foramina stenosis.3.Postoperative changes of suboccipital and upper cervical decompression for Chiari malformation.


Instruction: Generate impression based on findings.

Input: 27-year-old female with BRCA1 mutation and family history of breast cancer in her mother. No current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a new suspicious clumped, linear non-mass enhancement, measuring 24 x 13 x 10 mm (AP x LR x CC) at anterior upper outer quadrant in the left breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: New suspicious clumped, linear non-mass enhancement at anterior upper outer quadrant in the left breast. MR guided biopsy is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: 54 years Female (DOB:3/21/1962)Reason: Prior pituitary micoradenoma, last MRI 2014 History: seizuresPROVIDER/ATTENDING NAME: SANDRA LYNN ROSE SANDRA LYNN ROSE MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. A 2 mm-sized focus of signal loss and susceptibility imaging is present in the right frontal subcortical white matter at the level of the superior frontal gyrus.There is a 5 mm T2 and FLAIR hyperintense lesion present in the left external capsule.There is a developmental venous anomaly present in the right periventricular white matter.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.A small cyst which is hypointense on T1 and hyperintense on T2 and does not enhance following gadolinium and is administration is present within the pituitary gland along the midline just behind the pituitary stalk.

Output: 1.There is a small cystic lesion in the pituitary gland centrally which could represent a Rathke's cleft cyst.2.There is a microhemorrhage present in the right frontal lobe which isolation is nonspecific and of unknown clinical significance. There is an associated developmental venous anomaly. It is conceivable this represents a small cerebral cavernous malformation, however, this is nonspecific.3.Small lesion left external capsule is nonspecific and most likely vascular related.


Instruction: Generate impression based on findings.

Input: 31-year-old female status post brain biopsy. There is no evidence of intracranial hemorrhage, mass or edema. Redemonstrated is a heterogeneous mass which is centered about the right medial temporal lobe. The lesion exerts mass effect on the right cerebral peduncle, unchanged. The majority of the mass demonstrates hypoattenuation with occasional calcification, similar in appearance to the previous CT examination dated 4/11/2012. Centrally within the mass is a single punctate focus of hypointensity which most likely represents a focus of air.Associated expected postoperative changes include a right frontal burr hole with overlying surgical sutures a small focus of pneumocephalus is adjacent to the burr hole tract, also within the anterior right frontal subdural space.No abnormal extra-axial collections are identified. No midline shift. No additional basal cistern effacement.The ventricles are normal in size and configuration.The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable appearance of the right medial temporal lobe lesion with pneumocephalus and right frontal burr hole compatible with postbiopsy change. No definitive evidence of hemorrhage.


Instruction: Generate impression based on findings.

Input: Headache [R51] / Arnold-Chiari syndrome without spina bifida or hydrocephalus [Q07.00], Reason for Study: ^Reason: r/o dural enhancement or other signs of intracranial hypotension. Also has a mild Chiari malformation History: Postural headache The left transverse sinus lumen is not fully patent with internal T1 high to intermediate/T2 medium or high signal intensity signal intensity lesions indicating blood product. However, on FLAIR and T2 weighted images, there is no evidence of venous congestive encephalopathy. In addition, on Gad enhanced scan, the left transverse sinus appears to be well enhanced and continuous to the left sigmoid sinus. Comparing to prior MRI/MRV, the left transverse sinus signal intensity has been evolving demonstrating more flow related signal loss. Constellation of above findings indicate the left transverse sinus was incompletely thrombosed and the thrombus has been resolving since prior scan. No evidence of acute ischemic or hemorrhagic lesion. There is a focal area of the vascular conglomeration on the genuine of corpus callosum indicating small developmental venous anomaly. Otherwise there is no evidence of abnormal enhancement.The tonsilar ectopia (about 6.8mm) is seen and no change since prior scan. Phase contrast MR venography showed biphasic CSF flow through the foramen magnum especially anterior aspect of the brainstem. In addition, the forward flow of superior sagittal sinus , internal cerebral vein, vein of Galen and straight sinus toward torcular appears to be well maintained. Cavum septum pellucidum was seen, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Normal flow voids are identified in the major intracranial arteries. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Evolving left transverse sinus incomplete thrombosis since prior scan without associated venous congestive encephalopathy or hemorrhage.2. No acute ischemic or hemorrhagic lesion.3. No change of tonsilar ectopia in terms of its degree.4. Maintained biphasic CSF flow through the foramen magnum, most significant on the anterior aspect of brain stem.


Instruction: Generate impression based on findings.

Input: Left knee chondromalacia MENISCI: There is slight blunting of the inner free edge of the medial meniscus suggestive of mild radial tearing (series 6 image 16). The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a focus of near full-thickness articular cartilage loss of the medial femoral condyle near the medial tibial spine best appreciated on series 601 image 17. There is additional degenerative signal heterogeneity of the articular cartilage of the medial femoral condyle. The articular cartilage of the lateral femoral condyle is intact. The articular cartilage of the patellofemoral compartment is intact.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Small area of near full-thickness articular cartilage loss of the medial femoral condyle.2. Slight blunting of the inner free edge of the medial meniscus suggestive of mild radial tear.


Instruction: Generate impression based on findings.

Input: Male 64 years old with cirrhosis. Assess liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No biliary ductal dilatation or ascites. Hepatic vasculature is patent. Splenorenal shunting is noted.Hepatic segment 5/8 exophytic lesion measures 4.1 x 3.1 cm, an exophytic segment 4 lesion measures 1.7 x 1.3 cm, a segment 7 lesion measures 1.6 x 1.5 cm and a segment 2/4A lesion measures 1.5 x 1.4 cm (series 9, images 109, 117, 118, and 126). All lesions are mildly T2 hyperintense with arterial enhancement and washout and are suspicious for hepatocellular carcinoma.SPLEEN: The spleen measures 12 cm in length.PANCREAS: The pancreas enhances homogeneously. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A subcentimeter T1 hyperintense lesion in the midpole the left kidney does not enhance and is compatible with a proteinaceous/hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Anterior abdominal wall ventral hernia contains only mesenteric fat, unchanged.

Output: 1.Multiple lesions suspicious for hepatocellular carcinoma. The largest is a 4.1 x 3.1 cm exophytic lesion segment 5/8.2.Evidence of portal hypertension with splenorenal shunting


Instruction: Generate impression based on findings.

Input: Reason: degenerative disease; History: neck pain, neuropathy Severe multilevel degenerative changes affect the cervical spine including severe joint space narrowing throughout the cervical spine with relative sparing of C7-T1. There is grade 1 anterolisthesis of C7 on T1. There is severe anterior and posterior vertebral body osteophytosis and multilevel neuroforaminal narrowing, which is better evaluated on recent MRI. There is severe facet joint osteoarthritis. No acute fracture is evident.

Output: Severe multilevel degenerative changes as above.


Instruction: Generate impression based on findings.

Input: 35-year-old female status post thumb injury. Assess the collateral ligaments of the left thumb MCP. Patient presents with thumb pain. LIGAMENTS: The there is perhaps mild thickening and increased signal abnormality within the proximal fibers of the ulnar collateral ligament which otherwise appears intact. These findings are suggestive of a sprain or prior injury of the ulnar collateral ligament. There is no evidence to suggest a Stener lesion. There is increased signal abnormality and indistinctness of the radial collateral ligament, suggesting complete rupture/tearing of the radial collateral ligament.TENDONS: The imaged extensor and flexor tendons are normal in appearance. BONES: No bone marrow signal abnormality is identified. There is slight ulnar subluxation of the proximal phalanx with respect to the first metacarpal. The interphalangeal joint and basilar joint of the first digit are unremarkable.ADDITIONAL

Output: Complete rupture of the radial collateral ligament of the MCP joint of the thumb as described above.


Instruction: Generate impression based on findings.

Input: 13-year-old female with dilated common bile duct ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma is normal in morphology without focal hepatic lesion. No significant intrahepatic biliary ductal dilation. There is mild dilation of the mid common bile duct measuring up to 9 mm (series #701, image 53), previously 9 mm. The dilation extends for approximately 2.5 cm (series #701, image 53-58). The gallbladder is distended, though to a lesser degree than on prior examination.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. The kidneys demonstrate symmetric enhancement without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is normal in caliber without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild fusiform dilation of the mid common bile duct is not significantly changed from prior examination and may represent a type I choledochal cyst.


Instruction: Generate impression based on findings.

Input: 63-year-old female with severe shoulder pain and bacteremia. Evaluate for septic arthritis of the shoulder. ROTATOR CUFF: There is increased signal abnormality within the supraspinatus, infraspinatus, and teres minor muscles as well as within the subscapularis muscle, suspicious for pyomyositis given the stated history of bacteremia. There is thickening and increased signal abnormality of the supraspinatus tendon consistent with moderate tendinosis. Note is made of a full-thickness tear of the supraspinatus tendon approximately 7 mm of retraction. There is also partial thickness tearing of the anterior fibers of the infraspinatus tendon.SUPRASPINATUS OUTLET: Degenerative changes affect the acromioclavicular joint. There is a small amount of fluid within the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a moderate sized glenohumeral joint effusion. Although this examination was not protocol for examination of the glenoid labrum, there appears to be increased linear signal abnormality traversing the posterosuperior glenoid labrum suspicious for degenerative tearing.BICEPS TENDON: There is a small amount of circumferential fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the glenohumeral joint. ADDITIONAL

Output: Findings consistent with pyomyositis/soft tissue infection most pronounced along the anterior aspect of the shoulder with associated abscess formation and glenohumeral joint effusion, raising the question of septic arthritis.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [728.87], Reason for Study: ^Reason: r/o intracranial pathology History: Left sided weakness, numbness, tingling. No evidence of acute ischemic or hemorrhagic lesion on the scan.There are multiple relatively well demarcated nonnecrotic lymph node enlargements on bilateral neck, please correlate with the clinical findings.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no intracranial mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. 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.Multiple bilateral cervical lymph node enlargements, please correlate with the clinical findings.


Instruction: Generate impression based on findings.

Input: Reason: T12 compression fracture History: point tenderness Unenhanced MRI of the thoracic spine:The radiology technologist in the MRI suite noted that patient was unable to lie flat and patient was placed within the gantry and while they head and neck were significant in the off center and superiorly in position. This results in significantly degraded images.The quality of the images are also deteriorated order to severe scoliosis of upper thoracic spine.Examination demonstrates as was noted on prior CT and mild compression fracture of superior endplate of T12 vertebrae and with resultant very minimal expansion of compressed vertebrae into spinal canal. There is no central spinal stenosis. There is mild compromise of the left neural foramina at this level due to degenerative changes. The signal intensity of the cord and its caliber is entirely within normal throughout the thoracic spine.Increased signal intensity on stir sequence within the vertebral body of T12 may indicated below. There is no detectable epidural or paraspinal soft tissue associated abnormality.Signal intensity of the rest of the vertebral bodies and posterior elements of thoracic spine are unremarkable.Without contrast region of metastatic disease cannot be ruled out.Again incidental note is made of bilateral pleural effusion. There is also revisualization of a low signal intensity mass along the superior aspect of the right kidney measuring approximately 70 mm in transaxial dimension. This finding may represent a tumor or a complex cyst of right kidney. A smaller cyst within the left kidney is identified which measures approximately 30 mm in transaxial dimension.Nonenhanced MRI of the cervical spine:Severely compromised exam due to above-described reasons. The alignment the vertebral column is unremarkable. Advanced degenerative disk disease is present. The signal intensity and caliber of the cord is grossly within normal. No definitive significant central spinal stenosis. There is however effacement of subarachnoid space at multiple levels due to bulging disks anteriorly and buckling of hypertrophy of ligamentum flavum posteriorly. Multi-level neural foramina compromise to the degenerative changes. Neural foramina cannot be assessed due to poor quality study.Nonenhanced MRI of thoracic spine:The signal intensity in the alignment of the lumbosacral spine is unremarkable. Mild degenerative disk disease throughout the lumbar spine. No central spinal stenosis at any level. No neural foramina compromise at any level. Axial T1-weighted images demonstrate fatty filum terminalis with slight thickening of the filum extending from L2 -- L3 intervertebral disk level inferiorly to S1.

Output: 1.MRI of cervical spine demonstrates degenerative changes of cervical spine with multilevel neural foramina compromise. Normal signal intensity and the alignment of the vertebral column. Normal signal intensity and caliber of the cord. Unremarkable signal intensity of vertebral column.2.MRI of thoracic spine demonstrates mild compression fracture of superior endplate of T12 with a numeral of the remaining body of T12 and minimal bulge of the compressed vertebra into the spinal canal however with no resultant central spinal stenosis. There is mild compromise of the left neural foramina at this level secondary to degenerative changes. Scoliosis of upper thoracic spine and resultant degenerative changes of the disk at the level of maximum scoliosis. Normal signal intensity and caliber of thoracic cord.3.MRI of thoracic spine is essentially unremarkable for bony abnormality, central spinal stenosis or neural foramina compromise. Fatty filum terminalis with thickening of the filum extends from L2 -- 3 disk space to S1 level.4.Tumor or a complex cyst measuring approximately 70 mm in transaxial dimension arising from the superior pole of right kidney as detailed above.5.Bilateral pleural effusion as described.Fatty filum terminal as detailed above.


Instruction: Generate impression based on findings.

Input: Stage IA cervical cancer PELVIS:UTERUS, ADNEXA: No significant abnormality noted in the uterus. No significant abnormality noted in the ovaries. No dominant cervical mass is seen. Subtle enhancement of the upper left vagina is non-specific and of uncertain etiology.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.No dominant cervical mass seen by MR. Please note that surface or plaque lesions cannot be excluded. 2.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with nausea and headache. Evaluate for PRES, venous thrombosis. MRI brain:Numerous scattered foci of predominant periventricular T2 hyperintensity are seen, progressed from the prior examination. No diffusion restriction is seen. No evidence of edema or mass effect is detected. No intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology. Partially empty sella is noted incidentally. A fluid level is present in the maxillary sinuses.MRI orbits:The globes are round and symmetric. The extraocular muscles demonstrate normal caliber and morphology. The optic nerves are of normal caliber and free of pathologic signal abnormally. The intraorbital fat is clean. No masses are detected.MRA brain:Image quality is slightly degraded by motion artifact. Within this limitation, no high-grade stenosis or occlusion is detected. No aneurysm or vascular malformation is seen. The left A1 segment is hypoplastic. The ACOM artery is prominent. A moderately sized right PCOM artery and a small left PCOM artery are evident. Please note that the venous sinuses are not assessed with MRA technique.

Output: 1.Numerous foci of periventricular T2 hyperintensity are seen, progressed from the prior MRI and most compatible with chronic microvascular ischemic disease.2.No evidence of any acute intracranial abnormality is seen. No findings are detected which would be consistent with PRES. 3.Evaluation the orbits is within normal limits.4.No abnormalities of the intracranial arteries are detected.


Instruction: Generate impression based on findings.

Input: 60-year-old male with a history of tongue cancer presents with seizures. Motion degraded examination. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Note is made of bilateral lens implants. There are bilateral maxillary mucous retention cysts. Note is made of bilateral mastoidectomies. There is a 13 x 21 mm cystic lesion in the preauricular soft tissues along the superficial aspect of the left parotid gland. Bone marrow signal and extracranial soft tissues are otherwise within normal limits.

Output: 1. No evidence of intracranial metastases.2. Cystic lesion in the preauricular soft tissues just superficial to the left parotid gland may reflect a benign cystic lesion such as an inclusion cyst. However, a necrotic lymph node cannot entirely be excluded.3. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Known bilateral breast cancers (multifocal left breast invasive ductal carcinoma and right breast DCIS), evaluate response to therapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The known anterior malignancy in the left outer breast is only minimally enhancing on the late phases of the dynamic sequence compared to background. This measures 1.1 x 0.9 x 0.9 cm. This measured 2.1 x 2.0 x 2.2 cm on November 26, 2014. Along the medial margin of the previous location of the posterior mass there is a 1.0 cm area of non mass enhancement. The posterior mass is not otherwise enhancing above the level of background. It previously measured 2.9 x 2.0 x 2.5 cm.The right medial breast non-mass enhancement is faintly seen on the post contrast images, measuring 0.5 cm, previously 2.9 cm.  No abnormal lymph nodes are identified in either axillary region.A port-a-cath is present in the right superior chest wall.

Output: Significant response to therapy in both breasts with residual tumor measurements given above. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter..


Instruction: Generate impression based on findings.

Input: Corresponding to the recent development of findings on the noncontrast CT, there has been interval worsening of burden of intracranial metastatic disease. There are innumerable round enhancing nodules throughout the parenchyma, with some areas of more gyriform enhancement along the cerebral hemispheres. The associated pattern of FLAIR hyperintense vasogenic edema appears similar to the outside MRI from June 2016, except for prominent progression of paramedian frontal parietal abnormal signal. There is also increased extent of FLAIR abnormality involving a left parietal metastasis and a lateral right frontal lobe metastasis. Diffuse cerebral sulcal effacement is also worsened.Compared to the more remote postcontrast exam from 4/26/2016, there has been severe progression of disease. Reference lesion in the right posterior medial temporal lobe is increased in size, now measuring 13 mm on 1001/169, previously 6 mm. The referenced treated right lateral inferior frontal lobe lesion demonstrates decreased degree of enhancement, measuring 7 mm on 1001/151, previously 6 mm. The referenced left occipital lobe lesion is also been treated, increased central low signal and decreased peripheral enhancement. This measures 7 mm on 1001/122, compared to previous 8 mm. However, many other lesions have significantly enlarged, for example a right caudate head lesion measures 12 x 10 mm on 1001/176, compared to previous 7 x 6 mm. Dorsal left midbrain lesion is also present now.Within the posterior fossa, there is extensive progression of tumor burden, with significant increased extent of FLAIR abnormality in the left cerebellar hemisphere. There is now near complete effacement of the fourth ventricle, measuring 6 mm transverse compared to previous 9 mm in June 2016. There is also mild posterior midline shift to the right, not previously present. In addition, a focal enhancing lesion is identified within the anterior cerebellum just distal to the cerebral aqueduct measuring 5 x 4 mm on 1001/119. A bilobed appearing lesion in the midline cerebellum measures up to 2.0 cm transverse x 1.7 cm AP. As described on the CT, there is significant effacement of CSF space in the posterior fossa and crowding of the foramen magnum, although there is no frank cerebellar tonsillar herniation at this time. Third ventricle is also mildly increased in caliber, now measuring 4 mm transverse compared to previous 2 mm.There is no significant susceptibility identified. There is redemonstration of a calcified lesion along the left anterior falx which may represent a small calcified meningioma. There is no diffusion abnormality to suggest recent ischemia. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures are within normal limits. There is prominent T2 hyperintense fluid signal throughout left mastoid air cells, middle ear, and aerated petrous apex. There is also mild mucosal thickening in the left frontal ethmoidal recess.

Output: 1.Interval worsened intracranial metastatic disease burden, with increased extent of vasogenic edema especially within the cerebellum and also along the paramedian frontal parietal region.2.Interval decreased fourth ventricular caliber due to surrounding mass effect from extensive cerebellar tumor, including the presence of a small lesion just distal to the cerebral aqueduct along the anterior cerebellum. Interval effacement of CSF spaces in the posterior fossa even when compared to 6/11/2016, without frank cerebellar tonsillar herniation at this time.3.Slight increased prominence of the third ventricle which could in part relate to the more distal compromise of the ventricular outflow due to surrounding increased mass effect.4.Evidence of posttreatment changes involving right lateral frontal and left occipital pole metastatic lesions.


Instruction: Generate impression based on findings.

Input: 71 years, Male, brain tumor, for laser ablation. Examination is obtained for operative planning and intraoperative navigation. Enhancing masses involving the posterior frontal lobe along the precentral gyri are again seen, right larger than left. Placement of laser fiber into the larger right frontal lesion is evident. Surrounding vasogenic edema appears similar to prior. Ventricles are also similar to prior. No new midline shift or herniation is evident. Previously seen lateral left cerebellar lesion is not imaged on current study. Punctate lesions near the right superior aspect of the insular cortex and along the left lateral temporal surface are also noted and present previously on 10/5/2016.

Output: 1. Examination for laser ablation of the right posterior frontal mass.2. Multiple additional metastases as described above appears similar to 10/5/2016.


Instruction: Generate impression based on findings.

Input: 14-year-old male with left knee pain. Assess left knee MPFL, trochlear dysplasia, loose bodies, and measure TT-TG. Per the technologist notes, the patient had left knee surgery in 2014 for anchoring the patella. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema within the anterolateral aspect of the medial femoral condyle which appears slightly progressed since prior study. This is nonspecific and may represent a contusion. The previously seen edema within the lateral femoral condyle appears resolved. The articular cartilage of the patella appears intact. The articular cartilage of the trochlea appears intact. There appears to be a moderately deep focal defect within the lateral femoral condyle measuring up to 1.5 cm in AP dimension. This appears more prominent on prior study. The articular cartilage of the medial compartment appears intact. There is a 14 mm osteochondral fragment within the suprapatellar recess.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Osteochondral fragment within the suprapatellar recess as above.2. Small joint effusion with moderately deep focal defect within the lateral femoral condyle.3. No displacement of the patella with respect to the femoral trochlea with measurements as above. 4. No evidence of ligamentous or meniscal injury.


Instruction: Generate impression based on findings.

Input: 49-year-old male with pain. Evaluate for re-tear of the rotator cuff. Somewhat suboptimal examination secondary to patient motion artifact. Note is made of metallic susceptibility artifact within the humeral head consistent with postoperative changes from prior rotator cuff repair.ROTATOR CUFF: There is thickening and increased signal abnormality within the supraspinatus tendon consistent with moderate tendinosis. The supraspinatus tendon and muscle appear intact. The infraspinatus tendon appears intact. There is fatty atrophy of the infraspinatus muscle. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa which may represent a mild bursitis. Moderate degenerative changes affect the acromioclavicular joint with osteophyte formation and subchondral cyst formation within the distal clavicle.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of this non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps is not visualized which may reflect tearing with retraction versus postsurgical changes related to prior tenodesis.ADDITIONAL

Output: 1. Postoperative changes of prior rotator cuff repair without evidence of a rotator cuff re-tear. Supraspinatus tendinosis.2. Fluid within the subacromial subdeltoid bursa may reflect a mild bursitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 60 years Female (DOB:1/15/1956)Reason: L5 radiculopathy History: Paresthesias toePROVIDER/ATTENDING NAME: RODERICK H BIRNIE RODERICK H BIRNIE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is mild multilevel disk dessication present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.Some of the images are degraded due to patient motion.

Output: There are mild degenerative changes in the lumbar spine without compromise to lumbar spinal canal or neural foramina.Some images are degraded due to patient motion. This may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Preoperative planning. Spondylolisthesis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Grade 1 anterolisthesis of L4 and L5 is again seen. Bone marrow signal is benign. The conus medullaris is normal in position.There is developmental narrowing of the lumbar spinal canal with superimposed degenerative changes 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: Disc bulge eccentric to the left contributes to mild left neural foraminal stenosis, progressed since 6/24/2011. No significant spinal canal or right neural foraminal stenosis. L4-L5: Postsurgical changes of left-sided fusion as described on recent CT, new since prior MRI. Vacuum phenomena at this level and absence of fusion better appreciated on recent CT. There is mild spinal canal stenosis. Advanced bilateral facet arthropathy. There is up to moderate bilateral neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Grade 1 anterolisthesis of L4 and L5 with absence of fusion at this level. There is advanced facet arthropathy and up to moderate bilateral neural foraminal stenosis and mild spinal canal stenosis at this level. Hardware loosening better seen on recent CT.2. Mild left L3-L4 neural foraminal stenosis related to eccentric left-sided disc bulge, progressed since prior MRI from 2011.


Instruction: Generate impression based on findings.

Input: Male 17 years old Reason: evaluate for hamstring tear proximal to mid History: hamstring strain acute on chronic High signal in T2 and low signal in T1 of approximately 0.5 cm in diameter fluid collection of the left mid hamstring may represent hematoma due to muscular tear. Superior and inferior insertion sites of the muscle appears to be intact.

Output: Intramuscular hamstring hematoma due to muscular tear with intact insertion sites.


Instruction: Generate impression based on findings.

Input: A 56 year old female with history of ischemic cardiomyopathy, s/p myocardial infarction in 2004 with PCI to LAD, perfusion defects in the LAd, LCx and RCA territories in a recent stress nuclear study. A recent echocardiography showed LVEF of 45-50%. Referred to cardiac MRI to assess viability. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 78 ml/m2 (normal range: 65+/-11), the LVEDV is 160 ml (normal range 109+/-23), the LV end systolic volume index is 48 ml/m2 (normal range 18+/-5), the LVESV is 99 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 81 g (normal range 114+/-24). There is akinesis and thinning of the mid-to-apical segments of the anterior, anteroseptal walls. There is apical aneurysm. Mild tardokinesis is noted of the inferolateral wall. There is transmural late gadolinium enhancement at the entire apex, and up to 50% of the thickness of the mid-distal anterior and anteroseptal walls. A small area of subendocardial late gadolinium enhancement is also noted in the the mid inferoseptum. These findings represent fibrosis secondary to old myocardial infarction. The burden of fibrosis is 31% of the total myocardium. These segments are not viable but the remainder of the myocardium is viable. No intracavitary thrombus was seen.Left AtriumThe left atrium is normal in size. The LA volume is 74 ml.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 45 ml/m2 (normal range 69+/-14), the RVEDV is 91 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 42 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is 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 normal in size with moderately reduced systolic function, the LVEF is 38%. There is akinesis and thinning of the mid-to-apical segments of the anterior, anteroseptal walls. There is apical aneurysm. Mild tardokinesis is noted of the inferolateral wall. There is apical aneurysm. No intracavitary thrombus was seen.2.There is transmural late gadolinium enhancement at the entire apex, and up to 50% of the thickness of the mid-distal anterior and anteroseptal walls. A small area of subendocardial late gadolinium enhancement is also noted in the the mid inferoseptum. These findings represent fibrosis secondary to old myocardial infarction. The burden of fibrosis is 31% of the total myocardium. These segments are not viable but the remainder of the myocardium is viable. 3. The right ventricle is normal in size and systolic function, the RVEF is 54%.