Instruction: Generate impression based on findings.

Input: Diagnosis: Paresthesia of skin. Unspecified abnormalities of gait and mobilityClinical question: Evaluate for stenosis/demyelinating lesionsSigns and Symptoms: paresthesias MRI brain: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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge associated with small uncovertebral osteophytes at this level. There is some right-sided facet hypertrophy at this level.At C3-4 there is no significant compromise to the spinal canal. There is right-sided facet hypertrophy present at this level associated with some mild narrowing of the right neural foramen.At C4-5 there is no significant compromise to the spinal canal. There is a disc bulge associated with small uncovertebral osteophytes at this level. There is mild encroachment of the right-sided exiting nerve roots within the neural foramina at this level.At C5-6 there is no significant compromise to the spinal canal. There is a disc bulge associated with uncovertebral osteophytes at this level. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level. There is mild ligamentum flavum hypertrophy at this level.At C6-7 there is no significant compromise to the spinal canal. There is a disc bulge at this level. There is mild to mild to moderate encroachment of the left-sided exiting nerve roots at this level. In the mild encroachment of the right-sided exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are degenerative changes present in the cervical spine associated with mild encroachment of exiting nerve roots within the neural foramina.2.No abnormal lesions are appreciated within the brain parenchyma or spinal cord to suggest demyelination on this exam.


Instruction: Generate impression based on findings.

Input: 79 years Male (DOB:8/24/1936)Reason: stroke History: weakness, dysarthriaPROVIDER/ATTENDING NAME: NAVNEET CHEEMA RIMAS V LUKAS There is a patchy diffusion restriction present involving small portions of the right centrum semiovale, a short segment of the lateral aspect of the right precentral gyrus and a couple punctate foci along the right insular cortex and right subcentral lobule. On susceptibility imaging there is asymmetrically low signal along the right operculum adjacent to this are of diffusion restriction at the expected location of an M3 branch associated with low SWI signal in the adjacent tissues in a 27x20mm axial dimension area. There is a punctate focus of signal loss along the left half of the genu of the corpus callosum on SWI.There a punctate foci of T2/FLAIR signal hyperintensity present along the right thalamus and right caudate nucleus. The ones in the right caudate nucleus were present on the 7/23/2004 exam.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images with a couple additional punctate FLAIR and T2 hyperintense lesions in the cerebellum. This has mildly progressed since 2004.Normal vascular flow voids are present in the distal carotid and left 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 right vertebral artery flow void is not identified.The visualized portions of the paranasal sinuses demonstrate minimal mucosal thickening in the ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Acute cerebral infarction and microinfarcts involving a small portion of the right MCA territory (small portions of the right centrum semiovale, a short segment of the lateral aspect of the right precentral gyrus and a couple punctate foci along the right insular cortex and right subcentral lobule).2.SWI imaging raises the question of persistent occlusion at an M3 branch of the right MCA associated with adjacent hypoxia.3.Microhemorrhage along the corpus callosum.4.Old lacunar infarcts along the right thalamus and right caudate nucleus.5.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. This has mildly progressed since 2004.6.Possible occlusion of the intracranial RVA which is diminutive. Based on the prior exams and this exam this appears long standing.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out intracranial pathology. Signs and symptoms: Syncope without head trauma. Non-infused CT of brain:There is diffuse prominence of cortical sulci, CSF cisterns and ventricular system. Patchy areas of periventricular low attenuation region represent small vessel disease of indeterminate age. In comparison with the prior MRI examination no gross interval change is appreciated.There is no evidence of hemorrhage, acute cortical stroke, mass effect or midline shift.

Output: 1.Findings consistent with small vessel disease of indeterminate age.2.Prominence of cortical sulci and ventricular system is stable since prior MRI examination.3.No evidence of acute hemorrhage or cortical stroke.


Instruction: Generate impression based on findings.

Input: 17-year-old male with right knee pain We see no findings to account for the patient’s pain. The site of microfracture seen on prior MRI exam is not evident on the current study.

Output: No findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 48-year-old female with left wrist pain, DISI deformity, evaluate SL ligament. LIGAMENTS: Widening of the scapholunate interval with extension of intra-articular contrast through the scapholunate articulation from the mid carpal joint into the radiocarpal joint compatible scapholunate disruption.TRIANGULAR FIBROCARTILAGE COMPLEX: Contrast extends from the radiocarpal joint into the distal radioulnar joint along the medial aspect of the triangular fibrocartilage complex compatible with medial disruption of the triangle fibrocartilage complex.TENDONS: The flexor and extensor compartment tendons appear normal and intact throughout their course.BONES: No significant abnormality noted.ADDITIONAL

Output: Findings compatible with disruption of the scapholunate ligament as well as medial disruption of the triangular fibrocartilage complex.


Instruction: Generate impression based on findings.

Input: Female 66 years old Reason: Evaluation of disease in patient with cervical cancer, undergoing radiation therapy History: None PELVIS:UTERUS, ADNEXA: Again seen is a heterogeneous enhancing mass in the right aspect of the cervix, which now measures approximately 2.7 x 2.0 cm (series 401/40), previously 3.2 x 2.0 cm. The mass demonstrates subjectively less enhancement when compared to the prior examination. There has been interval placement of a cervical sleeve. Right parametrial invasion again present.Leiomyomatous uterus with degenerating fibroids again noted.BLADDER: No significant abnormality noted.LYMPH NODES: The referenced right pelvic sidewall lymph node now measures 1.3 x 0.6 cm (series 1004/14), previously 1.6 x 0.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slight interval decrease in size of the cervical mass with persistent but improved parametrial invasion, but decreased subjective enhancement.2.Slight interval decrease in size of the right pelvic sidewall lymph node.


Instruction: Generate impression based on findings.

Input: 22 years Female (DOB:9/15/1994)Reason: Please evaluate for syrinx - Chiari.- PLEASE DO CSF FLOW STUDY History: HeadachesPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. Cerebellar tonsils extend 3-4 mm below the level of foramen magnumAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The left vertebral artery is larger than the right vertebral artery.Similar pulse sequences are degraded by patient motion artifact.

Output: The cerebellar tonsils extend several millimeters below the level of foramen magnum. There is no evidence for syrinx.


Instruction: Generate impression based on findings.

Input: Head and neck cancer, right frontal meningioma. IMPRESSION:Report Electronically Signed: 2/21/2008 2:23 PM Vivek Sehgal, MD

Output: No significant change. No evidence of tumor. Follow-up is suggested. TECHNIQUE:


Instruction: Generate impression based on findings.

Input: 20 years Male (DOB:8/31/1996)Reason: history of DNET status post resection,, yearly follow up, noted Flair signal in tumor bed History: yearly follow upPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM The patient is status post left sided craniotomy for removal of a left frontal lobe mass. There is a defect present along the left precentral gyrus measuring 14 x 8 mm in axial dimensions and 11 x 8 mm in coronal dimensions. This has not changed since the prior exam. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.Incidental note is made of cavum septum pellucidum The visualized portions of the paranasal sinuses demonstrate partial opacification of the right ethmoid air cells and mucosal thickening in the right maxillary sinus and right frontal sinus. The visualized portions of the mastoid air cells demonstrate some minor opacities in the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.Status post left-sided craniotomy for removal of a left frontal lobe mass known to represent a this dysembryoplastic neuroectodermal tumor. In general the appearance of the tumor bed remains stable including the FLAIR signal hyperintensity. Due to the slow growing nature of this type of tumor residual tumor cannot be excluded on the basis of size changes along a relatively short interval.


Instruction: Generate impression based on findings.

Input: There are unchanged postoperative findings related to partial left temporal lobectomy. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild paranasal sinus mucosal thickening. There is a well-defined T2 hyperintense non-enhancing lesion centered within the left pterygoid process that measures up to 18 mm and has slowly increased in size compared with the April 2010 exam at which time it measured 10 mm. In retrospect, it was present but only partially imaged on a CT head dated 2/23/2007.

Output: 1.Unchanged postoperative findings related to partial left temporal lobectomy. No intracranial mass or mass-effect. No evidence of infarct, hemorrhage, or hydrocephalus.2.Non-enhancing lesion which appears to be centered within the left pterygoid process is not well evaluated on the current or prior studies but favored to represent a benign osseous lesion. Suggest further characterization with sinus CT.


Instruction: Generate impression based on findings.

Input: Reason: hx cervical fusion - eval hardware and fusion and stability History: none- surveillance 4 views of the cervical spine demonstrate anterior plate and screws entering the C3 and C4 vertebral bodies, with resultant fusion of C3 and C4. No radiographic evidence of hardware complication. Severe disc space narrowing is again seen at C6-7. No evidence of malalignment on flexion/extension views.

Output: Postoperative changes related to ACDF, with resultant fusion of C3 and C4, and degenerative disc disease as above.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with neck pain and numbness in the hand. Straightening of the cervical lordosis is likely positional. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is seen. The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are detected. No evidence of significant disc osteophyte formation, spinal canal or foraminal compromise is demonstrated. No interval changes are noted.

Output: No specific findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 7 years, Female, Chiari malformation. Cerebellar tonsils are low-lying measuring up to 7 mm below the foramen magnum, with the left cerebellar tonsil slightly lower than the left, where it extends to the level of the C1 posterior arch. CSF flow sequence demonstrates fairly mildly diminished biphasic CSF flow at the foramen magnum.There are a few tiny foci of T2/FLAIR hyperintensity in the bilateral frontal and right parietal lobes which are nonspecific. There is otherwise no significant parenchymal signal abnormality. 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. Sella and orbits are grossly within normal limits. There is patchy opacification involving the bilateral anterior ethmoid air cells and mild to moderate right and mild left maxillary sinus mucosal thickening. There is also minimal mucosal thickening in the right frontal sinus. Partial opacification of the left-sided mastoid air cells also noted. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.

Output: 1. Findings compatible with a mild Chiari I malformation with very mildly diminished biphasic CSF flow at the foramen magnum.2. Remainder of the brain parenchyma is essentially unremarkable. There are minimal foci of T2/FLAIR hyperintensity in the supratentorial white matter which are nonspecific. 3. Mild paranasal sinus disease, with relatively greater involvement of the right anterior ethmoid and maxillary sinuses. There is also mild opacification of the left mastoid air cells.4. No prior studies are available for comparison and addendum can be issued if made available.


Instruction: Generate impression based on findings.

Input: Possible vascular dementia: memory problems. There is mild, predominantly periventricular cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is deformity of the right orbital floor. There is a small right maxillary sinus retention cyst. The calvarium and scalp soft tissues are grossly unremarkable.

Output: 1. Mild probable chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Deformity of the right orbital floor may be related to prior trauma.


Instruction: Generate impression based on findings.

Input: History of gait balance, tinnitus, lightheadedness with recently discovered cavernous malformation; please compare to June 2016 examination. There is redemonstration of a small left temporal lobe lesion with signal characteristics compatible with a small congenital cavernous malformation measuring up to 7 mm on the T1 weighted sequences, not significant changed. There is no associated significant perilesional edema or mass effect. A small adjacent curvilinear area of enhancement compatible with a developmental venous anomaly also appears unchanged.There is a mildly prominent curvilinear area of increased susceptibility along a left occipital sulcus (802/10) without associated asymmetric vessel prominence on postcontrast images or associated parenchymal abnormality and which is favored to reflect a prominent vessel.Patchy areas of increased T2/FLAIR signal within the periventricular and subcortical white matter are nonspecific but compatible with moderate chronic small vessel ischemic changes, not significantly changed. There is no restricted diffusion to suggest acute ischemic infarction. The ventricles are stable in size and configuration. The basal cisterns remain patent. There is no midline shift or herniation. The major cerebral flow voids are intact. There is persistent mild, patchy opacification of the right mastoid air cells. There is mild patchy opacification of the ethmoid air cells.

Output: Subcentimeter left temporal lobe cavernous malformation with associated developmental venous anomaly, not significantly changed compared to 6/6/2016 and without associated perilesional edema or mass effect.


Instruction: Generate impression based on findings.

Input: There are multiple, asymmetric areas of patchy T2/FLAIR hyperintensity in the subcortical white matter of the bilateral frontal, temporal and parietal lobes, relatively more prominent in the left frontal lobe, and without significant interval change from 2008. There is slightly interval progression of supratentorial and infratentorial parenchymal volume loss, including more focal areas of volume loss in the right lateral cerebellum, which may be related to prior ischemia. No evidence of intracranial hemorrhage or acute infarction. There are no extra-axial fluid collections or subdural hematomas. No evidence of intracranial mass, mass effect, or midline shift. There is no abnormal enhancement within the brain. The ventricles and sulci are otherwise normal in size. Flow-voids are present within the major vessels indicating patency. There is mild mucosal thickening of the right maxillary sinus. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastatic disease.2. Multiple patchy areas of white matter T2/FLAIR signal abnormality in the bilateral cerebral hemispheres remains unchanged since 8/21/2008. The differential diagnosis remains broad, and includes prior inflammation, demyelination, ischemia or other injury.


Instruction: Generate impression based on findings.

Input: 6 week old female with diffuse mucocutaneous hemangiomas and concern for liver involvement vs angiosarcoma of liver. ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly with innumerable enhancing T2 heterogeneous lesions of varying sizes containing flow voids. The largest are as follows:1. Segment 8 lesion measures 7.7 x 4.0 x 4.4 cm (series 30, image 27).2. Segment 4 lesion measures 2.3 x 1.6 x 2.0 cm.3. Segment 6 lesion measures 3.5 x 2.1 x 2.7 cm.There is no intra or extrahepatic hepatic biliary ductal dilatation. The gallbladder is normal in appearance. Hepatic veins and hepatic artery are enlarged. The aorta below the superior mesenteric artery is of small caliber. The IVC at the level of the hepatic veins and above is large in caliber.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is displaced inferiorly secondary to hepatomegaly. The kidneys are normal in appearance. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Cardiomegaly, with a right ventricular hypertrophy. T2 hyperintense lesion at the right posterior cardiophrenic recess measuring 1.2 x 0.8 cm, may represent a bronchogenic cyst or other cyst. The inferior vena cava measures 2.1 x 1.5 cm. The aorta at the same level measures 0.8 x 0.7 cm. Bibasilar subsegmental atelectasis.

Output: Innumerable T2 hyperintense enhancing hepatic high flow lesions, compatible with hemangioendotheliomas. Cardiomegaly, secondary to high flow.


Instruction: Generate impression based on findings.

Input: 66-Year-old female with left lower extremity weakness and history of spine metastases. Evaluate for spinal cord compression. MRI T-Spine:There is prominent kyphosis involving the thoracic spine with the fulcrum at the T8 level where there is a severe (greater than 75% height loss) compression fracture, probably pathologic, which was seen previously. There is no significant change in the fracture compared to the OSH CT CAP from 5/23/2016. There is mild-moderate narrowing of the spinal canal at this level secondary to mild retropulsion with mild cord T2 signal abnormality which is unchanged compared to the exam from 5/23/2016. The remaining vertebral body and disc space heights are unchanged, including a focal peripherally enhancing lesion with T2 hyperintensity involving the posterosuperior endplate of T11. This corresponds with a lucent lesion with sclerotic margins on prior CT exams and likely represents a metastatic lesion. Redemonstrated is a large left apical lung mass better appreciated and characterized on the prior CT chest. The apical mass approaches the left T2 and T3 vertebral bodies and there is enhancement of these vertebral bodies which could either be reactive or due to subtle invasion by tumor. The left T3-4 neural foramen appears infiltrated by tumor. There is no definite epidural extension of tumor in the upper thoracic spine.MRI L-Spine:For the purpose of numbering, there are 13 thoracic vertebrae and 5 lumbar vertebrae. There is lordotic curvature of the lumbar spine with minimal retrolisthesis of L3 on L4 and minimal anterolisthesis of L4 on L5. The vertebral body heights are preserved. There is multi-level disc dessication and disc height loss involving the lower lumbar spine, most prominently involving the L3-4 and L4-5 levels. There is subtle marrow inhomogeneity with a concavity involving the superoanterior endplate of L5 indicating likely metastatic disease. There is also extensive heterogeneity, enhancement and thickening of the sacrum compatible with sclerotic metastatic disease seen on prior CTs. There is also evidence of metastatic osseous disease involving the iliac bones bilaterally. There is evidence of epidural extension into the spinal canal in the sacral region at the S1-2 level with significant spinal canal compromise. The neural foramina of S1 are significantly infiltrated by tumor bilaterally . The S2 neural foramina are infiltrated to a mild degree.The lumbar spinal cord displays normal signal and morphology and terminates at the L1 level. The right adrenal metastasis is visualized and better characterized on the recent CT abdomen and pelvis. Interspace observations:T12-L1 and L1-2: There is no significant compromise to spinal canal or neural foramina.L2-L3: Mild disc bulge. Mild facet arthropathy. No spinal canal or neuroforaminal stenosis.L3-L4: Right greater than left disc bulge. Mild facet arthropathy and ligamentum flavum thickening. Mild spinal canal stenosis. Mild to moderate right and mild left neuroforaminal narrowing. L4-5: Disc uncovering with a disc bulge. Moderate facet arthropathy and ligamentum flavum thickening. Mild spinal canal stenosis. Mild bilateral neuroforaminal narrowing.L5-S1: Moderate facet arthropathy. No spinal canal or neuroforaminal stenosis.

Output: 1.Multiple areas of metastatic involvement in the thoracic and lumbosacral spine, most severely involving the sacrum where there is infiltration of tumor and compromise of the sacral spinal canal at S1-2. There is significant infiltration of the S1 neuroforamina bilaterally by tumor and to a mild degree also involving the S2 neuroforamina. 2.Large left apical lung mass which approaches the left T2 and T3 vertebral bodies and infiltrates the left T3-4 neural foramen . 3.Severe likely pathologic compression fracture (greater than 75% height loss) involving the T8 vertebral body. The severity of the compressed vertebral body, spinal canal narrowing and spinal cord signal abnormality are unchanged compared to the previous exam.4.Right adrenal metastasis is better characterized on the recent CT Abdomen/pelvis from 12/19/2016.5.Additional multilevel degenerative changes in lumbar spine are as described above.


Instruction: Generate impression based on findings.

Input: Ankle pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is mild amount of increased signal intensity within the posterior calcaneus best seen on series 6 image 16. No discrete fracture line is identified. Additionally, there is a small focus of marrow signal abnormality within the posteromedial talus.ADDITIONAL

Output: 1. Small focus of marrow signal intensity within the posteromedial talus suggest the presence of an overlying chondral defect.2. Mild amount of increased edema within the posterior calcaneus suggesting the presence of stress injury without discrete fracture line.


Instruction: Generate impression based on findings.

Input: 71 year old female with left lower extremity pain. Evaluate for new blood.IMAGE ACQUISITIONS: Helical non-contrast enhanced CT of the legs with transverse, coronal, and sagittal reformatted images provided. No hematoma evident. Overall musculature of the left leg shows moderate fatty atrophy compared to right leg. Visualized femur, tibia, and fibula are more demineralized on the left compared to the right. These findings are presumably due to disuse. Although no large mass lesion is identified, multiple small masses of soft tissue density are seen in the lower leg and ankle as described on an accompanying MRI study. These are of uncertain etiology and could represent nerve sheath tumors if patient has a history of neurofibromatosis. Additionally, review of the patient's electronic medical history indicates that the patient has a history of resected glomus tumors and rarely multiple glomus tumors can occur in the leg. A 1 cm nodular soft tissue density posterior to the femur may represent a lymph node.

Output: 1.No evidence of hematoma.2.Diffuse muscular atrophy and bony demineralization on the left relative to the right as described above.3.Multiple nonspecific soft tissue masses as described above.


Instruction: Generate impression based on findings.

Input: Altered gait, hand numbness Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is minimal retrolisthesis of C4 on C5 and grade 1 anterolisthesis of C6 on C7. Degenerative changes are seen throughout the cervical spine with evidence of mild progression compared to 4/27/2011. There is severe loss of disc height at C6-C7 and to a lesser degree at C5-C6. Bone marrow signal is benign. No abnormal signal seen within the cervical cord.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a disc osteophyte complex and ligamentum flavum thickening resulting in moderate spinal canal stenosis with effacement of the ventral and dorsal thecal sacs and flattening of the cord contour. No cord signal abnormality. There is uncovertebral hypertrophy and facet arthropathy with mild to moderate bilateral neural foraminal narrowing.C4-5: Minimal disc osteophyte complex, ligamentum flavum thickening, and uncovertebral hypertrophy with mild spinal canal narrowing at this level and mild bilateral neural foraminal narrowing. Mild facet arthropathy.C5-6: Small disc osteophyte complex and effacement of the ventral thecal sac. No significant spinal canal stenosis at this level. There is mild right and moderate left neural foraminal narrowing. There is bilateral facet arthropathy.C6-7: There is disc osteophyte complex at this level with ligamentum flavum thickening and mild to moderate spinal canal stenosis at this level. There is also mild right and mild to moderate left neural foraminal narrowing. There is bilateral facet arthropathy.C7-T1: No significant compromise to the spinal canal or neural foramina. There is bilateral facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Degenerative changes in the cervical spine which have mildly progressed compared to 4/27/2011. There is moderate spinal canal stenosis at C3-C4 with deformity of the cord contour. No cord signal abnormality is appreciated. Lesser degree of spinal canal stenosis is seen at C4-C5 and C6-C7.2. Multilevel neural foraminal narrowing, relatively worse at the C5-C6 and C6-C7 levels on the left.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease and portal vein thrombosis. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 15.7 cm in craniocaudal dimension. It is normal in contour and morphology.There are small cystic structures adjacent to the central biliary tree which appear to communicate with the biliary tree likely representing small peribiliary cysts. In addition there is mild irregularity and narrowing of the biliary tree centrally and of the proximal hepatic duct which raises the possibility of PSC. No suspicious focal lesion or dominant stricture.There is chronic thrombosis of the portal vein with cavernous transformation including large collateral periportal vessel formation.No suspicious liver lesion.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: Postsurgical changes of the bowel are partially imaged. The colon is full of fluid. The presumed neoterminal ileum is collapsed and suboptimally evaluated.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Chronic portal vein thrombosis with cavernous transformation.2.Mild irregular narrowing of the biliary tree raises the possibility of PSC. No suspicious focal lesion or dominant stricture.


Instruction: Generate impression based on findings.

Input: 22-year-old male with CML status post stem cell transplant with acute mental status changes. Diffuse low density seen throughout the subcortical and periventricular white matter, indicating significant white matter disease, grossly unchanged from MRI performed 5/1/2008. Diffuse intracerebral edema resulting in effacement of sulci and narrowing of the lateral ventricles is unchanged to slightly progressed compared to the prior MRI, though significantly increased from prior CT. There is no evidence of intra-cranial hemorrhage or abnormal extra-axial fluid collections. The ventricles are midline, with no evidence of midline shift.The visualized calvarium and other osseous structures are within normal limits. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Significant diffuse white matter abnormality and cerebral edema, slightly progressed from MRI performed 5/1/2008. Differential considerations include drug reaction or auto-immune reaction to stem cell transplant, less likely infection. Contrast-enhanced MRI may be considered to further evaluate this abnormality.Results were discussed with the clinical service at the time of interpretation.


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine without aura, without mention of intractable migraine without mention of status migrainosusClinical question: evaluation for daily headache possible etiology The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. Incidental note is made of a small developmental venous anomaly in the right cerebellar hemisphere.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.MRI of the brain is within normal limits. No intracranial mass lesions are appreciated to account for the patient's headaches.2.Mild mucosal thickening in the right maxillary sinus is likely inflammatory in nature.


Instruction: Generate impression based on findings.

Input: Female, 22 years old, with multiple sclerosis and paresthesias. Follow-up for progression. Allowing for difference in technique between today's examination and the comparison study, no definite change is seen in the size and morphology of multiple T2 hyperintense white lesions. No new lesions are detected. There is no evidence of significant parenchymal edema or mass effect. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. There is mild prominence of the lateral ventricular atria which may reflect underlying white matter volume loss, unchanged from prior.

Output: No significant change in size or number of multiple white matter lesions compatible with demyelinating disease.


Instruction: Generate impression based on findings.

Input: Evaluate choledocholithiasis. Conjugated hyperbilirubinemia.EXAMINATION: MRI/MRCP without and with contrast administration 10/08/15 ABDOMEN:LIVER, BILIARY TRACT: The liver measures up to 8.0 cm. The gallbladder is collapsed. The common bile duct measures 2 mm. There is a saccular T2 hyperintense lesion within the porta hepatis measuring 1.4 x 0.9 cm, located medial to the common bile duct, with linear area of T2 hyperintensity which appears to connect to the common bile duct, compatible with a Todani type II choledochal cyst/diverticulum.SPLEEN: No significant abnormality noted. The spleen measures 5.5 cm in the coronal plane.PANCREAS: Limited evaluation due to patient movement, however no abnormality is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No pelvicaliceal dilatation. No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction. No ascites.BONES, SOFT TISSUES: No suspicious osseous lesion.OTHER: No significant abnormality noted.

Output: Todani type II choledochal cyst/diverticulum.


Instruction: Generate impression based on findings.

Input: 33 years Male (DOB:2/14/1983)Reason: Evaluate ICH History: ICH with multiple bilateral strokesPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER MRI of the brainThere is susceptibility effect compatible with hemorrhage involving the posterior cerebral artery territories in a gyriform pattern. This involves bilateral lingual gyri including calcarine cortex and extends to the fusiform gyri bilaterally but more so on the left than the right side and the left hippocampus. There is surrounding vasogenic edema and there is mass effect. There is T2 and FLAIR signal hyperintensity involving the posteromedial aspect of the right cerebellar hemisphere approximately 40x25 mm axial dimensions. This is associated with some punctate foci of susceptibility effect. There is a punctate focus of T2/FLAIR signal hyperintensity in the right thalamus. There is an 8mm focus of T2/FLAIR signal hyperintensity centered in the left lateral geniculate nucleus. There is a 4mm focus of T2/FLAIR signal hyperintensity centered in the right posterolateral medulla. A couple punctate foci of T2/FLAIR signal hyperintensity are present in the left cerebellar hemisphere.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 are bilateral vertebral artery dissections which appear worse on the right versus the left side. On the right side there is visible mural thrombus dues to dissection which extends from the C2 vertebra to the dura. The RVA dissection is associated with greater than 50% stenosis. On the left a dissection - associated with less mural thrombus than the right - extends from the vertebral artery foramen of C2 to approximately once cm proximal to the dura. The LVA dissection is associated with less than 50% stenosis. Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is hypoplastic. The posterior communicating arteries are very small. MRA neck:There are bilateral vertebral artery dissections which appear worse on the right versus the left side. On the right side there is visible mural thrombus dues to dissection which extends from the C2 vertebra to the dura. The RVA dissection is associated with greater than 50% stenosis. On the left a dissection - associated with less mural thrombus than the right - extends from the vertebral artery foramen of C2 to approximately once cm proximal to the dura. The LVA dissection is associated with less than 50% stenosis. There is opacification of the great vessels from the aortic arch, carotid arteries and vertebral arteries. The origins of the great vessels from the aortic arch are not included. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations.

Output: 1.Late subacute stage infarctions involving the PCA territories bilaterally (left more than right), right posteromedial cerebellum, right thalamus, left lateral geniculate body and right posterolateral medulla with hemorrhagic conversion of the PCA territory infarcts.2.Bilateral vertebral artery dissections (most likely intimal dissections) associated with stenosis (right worse than left) and mural thrombus. Although the one on the right extends to the dura it does not appear to extend intracranially at this time.


Instruction: Generate impression based on findings.

Input: cT1N2bM0 left base of tongue squamous cell carcinoma, p16+ s/p 3 cycles induction on OPTIMA. The left tongue base mass has decreased in size and is no longer measurable. There is no residual significant cervical lymphadenopathy. The thyroid and salivary glands are unremarkable. There is a disc-osteophyte complex at C5-6, which mildly indents the spinal cord. There is now inflammation at the site of the previously subcutaneous cystic lesion in the posterior left neck. The orbits and imaged intracranial structures are unremarkable.

Output: 1. The left tongue base mass has decreased in size and is no longer measurable.2. No residual significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 48-year-old with history of left mastectomy for IDC in 2007. She is status post left implant reconstruction in 2008, as well as a right breast lift in 2008. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in the right breast.Minimal parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in right breast. Status post left mastectomy and implant placement.The retropectoral implant on the left side appears intact.No abnormal enhancement is seen in the left mastectomy bed.No abnormal lymph nodes are identified in either axillary region.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Demyelinating disease of central nervous system, unspecified [341.9], Reason for Study: ^Reason: MS? New lesions? History: S changes alternating thighs and L breast also poor balance and L iliopsoas weak There are multifocal patchy and somewhat nodular high signal intensity lesions on bilateral white matter. Overall, there are more new lesions comparing to prior scan such as periventricular white matter around right lateral ventricle, left frontal lobe lateral orbital gyrus, right basal ganglia, right thalamus and posterior limb of internal capsule on the right, right side trigone, left side trigone and the largest lesion on the right inferior parietal lobule. However, there are lesions which show interval decrease in size and signal intensity on FLAIR which include left side corpus callosum splenium, left occipital lobe and right temporal lobe lesions.On Gad enhanced scan, most of new lesions show ring enhancement and some patchy enhancement.Constellation of these findings suggest activation of demyelinating disease such as multiple sclerosis. Differential diagnosis include metastatic lesions and infectious origin including multifocal abscess which appear to be lower chance. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal various sized high signal intensity lesions on bilateral white matter, overall there have been significant interval increase in size and number of lesions comparing to prior scan but there are some lesions showed decrease in the size and signal intensity on FLAIR images.Diagnostic possibility include active multiple sclerosis most likely, metastatic lesions and infectious origin as described above.


Instruction: Generate impression based on findings.

Input: None traumatic intracranial hemorrhage. Intractable hypertension. Gross patient motion is most pronounced on the susceptibility-weighted sequences and the postcontrast sequences.BRAIN MRI:While there is apparent increase in the size of the intraparenchymal hemorrhage just deep to the right postcentral sulcus since prior CT scan, this is probably related to better conspicuity of the hemorrhage which was partly isoattenuating on the CT scan. The hemorrhage now measures in the axial plane 4.6 cm x 2.0 cm and 3.7 cm in the sagittal plane. It is heterogeneously T1/T2-hyperintense with T1/T2 central hypointensity and has a complete T2 hypointense rim. It is associated with relatively moderate surrounding T2 hyperintensity, reflecting edema and also mass-effect, which are not significantly changed since the prior CT scan. Accounting for diffusion signal alteration within the hematoma, there is no acute infarct.Despite gross patient motion, there is abnormal contrast enhancement external to the hemosiderin rim. This is most pronounced along the anterior aspect of the hemorrhage. However, contrast enhancement at this stage is nonspecific and may reflect a reactive process. There is no separate focus of abnormal brain contrast enhancement.Susceptibility-weighted imaging is markedly limited by patient motion. There are foci of deep T2-hypointensity in the deep aspect of the right cerebellar hemisphere, right thalamus and brainstem, probably representing hemosiderin staining. These show no associated edema.There are chronic lacunar infarcts involving the head of the right caudate nucleus, pons, and right cerebellar hemisphere. There is also patchy and confluent T2-hyperintensity in the cerebral white-matter, which is nonspecific but likely reflect chronic microvascular ischemia. There is focal thinning involving the mid body of the corpus callosum with increased T2 signal.Chronic right orbital medial and inferior wall blowout fractures are present. There is no other gross orbital abnormality. There is no destructive skull lesion.HEAD MRA:Mild irregularity of the cavernous internal carotid arteries, especially on the left, may reflect atherosclerosis. However, there is no significant stenosis, occlusion or gross aneurysm of the major intracranial arteries.NECK MRA:There is irregularity at the carotid bulbs, right more than left, and the proximal vertebral arteries, suggestive of atherosclerosis. However, there is no flow-limiting stenosis in the cervical carotid or vertebral arteries.

Output: 1.The anterior right parietal intraparenchymal hemorrhage shows heterogeneous signal but is likely late subacute or even chronic at this stage. It is associated with adjacent parenchymal contrast enhancement, the significance of which is difficult to determine as it might be also reactive to the hemorrhage at this stage. Associated perilesional edema and mass-effect are not significant changed since the CT scan from the day prior. 2.There is suggestion of hemosiderin staining without edema in the right cerebellar hemisphere, right thalamus and brainstem. The distribution of these is suggestive of hypertensive etiology. The susceptibility weighted sequences are nondiagnostic because of gross patient motion and other foci of hemorrhage would be difficult to rule out.3.Chronic infarcts are present in the right cerebellar hemisphere, right caudate nucleus and the pons. In addition, there are changes of chronic microvascular ischemia. 4.Cervical and head MRA show atherosclerosis but no significant, flow-limiting stenosis. There is also no gross intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: Patellar dislocation MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the lateral, medial, and patellofemoral compartments is intact. There is a minimal amount of nonspecific marrow edema within the lateral femoral condyle posteriorly.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is patella alta although the patellar tendon is intact. There is lateral translation of the patella with respect to the femoral trochlea although the MPFL appears intact. The TT to TG distance is 1.8 cm and the trochlear depth is 5 mm. There is minimal increased signal superolateral portion of Hoffa's fat pad.ADDITIONAL

Output: 1. Lateral translation of the patella with respect to the trochlea although the MPFL, TT to TG distance, and trochlea depth appear normal.2. Small amount of nonspecific marrow edema within the lateral femoral condyle which may relate to remote patellar dislocation. Mild edema within the superolateral portion of Hoffa's fat pad may also indicate a component of patellar impingement.


Instruction: Generate impression based on findings.

Input: 24 years Female (DOB:9/11/1991)Reason: stroke code activation History: stroke code activation. Left lower extremity weakness status post epidural catheter.PROVIDER/ATTENDING NAME: AMBER TRUEHART AMBER TRUEHART MRI brain: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.The perfusion acquisition could not be post process on Visage or Olea due to a problem with the data. Post processed perfusion information is available on the MRI Philips machine which shows no obvious defect.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The PCOMAs are fairly large. The LVA is small relative to the RVA. There is extracranial origin of he right PICA.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a linear T1 hyperintense and T2 hypointense focus measuring 20 millimeters in length and 2 millimeters in thickness in the posterior aspect of the thecal sac at the L2 vertebral body level located midline and adjacent to nerve roots of the cauda equina.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disk space height and disk dessication 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.

Output: 1.There is an early subacute hemorrhagic appearing focus along the posterior aspect of the thecal sac which could be within a nerve sheath or adjacent to nerve roots in the cauda equina.2.There is no evidence for intracranial cerebrovascular occlusive disease.3.There is no evidence for acute cerebral infarction.


Instruction: Generate impression based on findings.

Input: Pineal cyst with headaches, evaluate for changes: follow up. There is a pineal gland cyst that measures up to 20 mm, with a small amount of susceptibility effect, which may represent chronic blood products. There is no evidence of intracranial hemorrhage or acute infarct. There is a fine surgical tract in the right frontal lobe. The cerebral parenchyma, brainstem, cerebellum, and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement. There are a few unchanged scattered foci of intraventricular susceptibility effect. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact, including a right fetal PCA. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unchanged pineal cyst and post-surgical findings without associated hydrocephalus.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: 3 t scanner recurrent brain tumor Limited sequence exam for pre-surgical localization.Redemonstration of enhancing lesions on the right precentral gyus and left cerebellar lesion, unchanged since prior scan.There is no evidence of new enhancing lesion on this scan.Diffuse bihemispheric dural enhancement, left occipital approach catheter, right middle cranial fossa artifacts, right frontal metallic artifacts and left frontal burr hole are again seen, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Unchanged right pre central gyrus and left cerebellar enhancing lesion since prior scan.2. No evidence of new enhancing lesion.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with diplopia. Preoperative planning for biopsy. Evidence of left pterional craniotomy is again seen. Postcontrast images demonstrate patchy gyriform enhancement through the left frontal lobe with scattered additional areas of enhancement along the left frontal horn ependyma and along the left insula and temporal lobe. These findings are not significantly changed. The degree of associated T2 hyperintensity within the adjacent parenchyma is also unchanged.A nodule of enhancement within the left middle cranial fossa spanning both the intracranial extracranial spaces is also largely unchanged. Heterogeneous enhancing soft tissue is also redemonstrated within the left orbital apex, extending along the anterior clinoid process to involve the cavernous sinus. This finding also appears similar to the prior examination.

Output: 1.Stable patchy gyriform enhancement within the left cerebral hemisphere.2.Stable nodule of enhancement along the anterior left temporal lobe spanning both intracranial and extracranial spaces.3.Stable heterogeneous enhancement within the left orbital apex and cavernous sinus.


Instruction: Generate impression based on findings.

Input: 73 year old diabetic male with history of multivessel CAD by previous catheterization with ongoing chest pain, and recent normal pharmacologic SPECT stress test. He was referred for vasodilator stress CMR to evaluate for possible ischemia. MEDICATIONS: aspirin, atorvastatin, bisoprolol, candesartan, glimepiride, metformin First Pass PerfusionDuring hyperemia, a small, mild perfusion defect is noted in the mid inferolateral wall. The overall myocardial ischemic burden is 3%.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 35 ml/m2 (normal range: 74+/-15), the LVEDV is 71 ml (normal range 142+/-34), the LV end systolic volume index is 14 ml/m2 (normal range 25+/-9), the LVESV is 28 ml (normal range 47+/-19), the LV mass index is 47 g/m2, and the LV mass is 96 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. There is lipomatous hypertrophy of the interatrial septum. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 40 ml/m2 (normal range 82+/-16), the RVEDV is 82 ml (normal range 142+/-31), the RV end systolic volume index is 16 ml/m2 (normal range 31+/-9), and the RVESV is 33 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. There is significant epicardial fat noted.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a small amount of mild ischemia in the mid inferolateral wall. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 61%).4. Normal RV size and systolic function (RVEF 59%).5. There is lipomatous hypertrophy of the inter-atrial septum. 6. Moderate left atrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 21 year old woman with history of Lupus and tachycardia who presents for cardiac MRI to evaluate for LV function and structure and to rule out myocarditis Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 61 ml/m2 (normal range: 65+/-11), the LVEDV is 111 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 40 ml (normal range 31+/-10), the LV mass index is 32 g/m2 (normal range 67+/-11), and the LV mass is 58 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is normal in sizeRight VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 66 ml/m2 (normal range 69+/-14), the RVEDV is 121 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 48 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThe pericardium along the basal anterior border of the heart has evidence of increased T2-signal, early gadolinium enhancement, and late gadolinium enhancement, which suggests the diagnosis of acute focal pericarditis.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. Normal left ventricular size and systolic function (LVEF 64%) without evidence an underlying myocardial fibrosing, infiltrative, or inflammatory process. 2. Normal right ventricular size and systolic function (RVEF 61%).3. There is evidence of acute focal pericarditis along the basal anterior border of the heart.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out malignant otitis, rule out abscess. Signs and symptoms: Right ear pain. Enhanced CT of the maxillofacial:Examination demonstrates a low-density mass within the left submandibular gland measuring 21.5 mm x 15.2-mm in trans-axial dimensions on image 14 and 32.3-mm in cranial -- cephalad axis on sagittal reformatted image 36. There is no detectable enhancement of this lesion. The left submandibular gland is expanded and surrounds this lesion however it be done CT of the remaining gland remains within normal limits. There is no evidence of any calcification with this finding. Recommend further follow all with an MRI examination for better characterization of this lesion. The finding although could represent a says possibility of a tumor is high and should be further evaluated. There is no associated lymphadenopathy with this finding on this limited view of upper neck. There is also no evidence of any inflammatory changes of the adjacent fascial planes. No evidence of any mass effect on the airway and no evidence of any osseous or cartilaginous erosion.Images through the oral cavity and floor of the mouth are otherwise unremarkable.Normal appearing bilateral parotid glands.Images through the skull base and bilateral petrous bones demonstrate well pneumatized mastoid air cells and middle ear cavities as well as external auditory canals bilaterally. The ossicular chain are unremarkable. There is no evidence of any inflammatory changes in the periauricular region. The external year and has normal density and morphology. The TMJs are well-visualized and unremarkable. The sphenoid sinus/sphenoid bone is within normal limits. Minimal chronic sinus disease of bilateral maxillary sinuses are noted. No detectable abnormality at the level of nasal findings, oral findings is detected.

Output: Examination demonstrates a low-density nonenhancing mass within the left submandibular gland measuring 21.5 x 15 times 32.3-mm in size. Follow up with an MRI examination is recommended. This lesion is not associated with any enhancement, inflammatory changes, abnormal calcification within the gland or the lesion and no evidence of any dilated ducts within the gland or any visible adenopathy on this exam. The left submandibular gland beyond the mass/cyst has normal density and pattern of enhancement. Enhanced CT of the maxillofacial is otherwise entirely unremarkable and in particular no evidence of otitis or mastoiditis is detected.


Instruction: Generate impression based on findings.

Input: Elevated PSA. Per medical record, referred for ongoing management of elevated PSA. His PSA was elevated to 10.84 ng/mL in January 2009, so a TRUS guided biopsy was performed in March 2009 and was reportedly negative for prostate cancer. He was subsequently followed with serial PSA exams and in July of 2013 his PSA had risen to 16.8 ng/mL. He was recommended to undergo repeat biopsy but was actually lost to follow up. Recently underwent biopsy which revealed benign tissue. PELVIS:PROSTATE:Prostate Size: 6.2 cm LR x 4.3 cm AP x 6.5 cm CC. Peripheral Zone: The study is limited due to T1 hyperintense signal throughout the midportion of the left half of the peripheral zone from the base to apex and much of the right peripheral zone. Although, there is diffuse hypointensity of this region on the ADC, given the diffuse bright T1 signal, suggesting hemorrhage we do not favor tumor. No suspicious early arterial enhancing lesions on the dynamic contrast-enhanced images.Central Gland: Heterogenous and enlarged with nodules, compatible with severe BPH.There is an ill-defined focus in the anterior apex measuring 1.3 x 0.7 cm (series 1504/184) which demonstrates restricted diffusion and T2-weighted hypointensity. This may be a portion of the transition zone, however tumor is a consideration.Seminal Vesicles: No evidence of seminal vesicle invasionExtracapsular Extension: No evidence of extracapsular extension. BLADDER: No significant abnormality noted.LYMPH NODES: Non-specific right external iliac/femoral lymph node measuring 7 mm in short-axis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Ill-defined 1.3 cm focus in the anterior apex may be part of the transition zone, however tumor is a consideration.2.Otherwise, limited study due to extensive T1 hyperintense signal of the peripheral zone suggesting hemorrhage. No suspicious focus in the peripheral zone is evident.


Instruction: Generate impression based on findings.

Input: Status post second stage L2 tumor decompression for renal cell carcinoma metastasis. Interval postoperative findings related to debulking of the enhancing epidural component of the L2 vertebral body metastatic lesion and further resection of the left L1-2 facet complex. There is a small amount of residual epidural enhancing tissue on the left, with improvement in the overall degree of spinal canal stenosis and mass effect on the left cauda equina nerve roots at this level, although bone and cement remain retropulsed into the spinal canal. Otherwise, there is a larger amount of residual tumor in the left vertebra and paraspinal space. There are other prior postoperative findings related to resection of the left L2 lamina, pedicle, and part of the transverse process. The operative bed contains a drainage catheter, a small amount of fluid and small amounts of air. There is unchanged compression deformity of the L2 vertebral body with evidence of prior kyphoplasty. There is also unchanged mild compression deformity of the L5 vertebral body with evidence of prior kyphoplasty. In addition, moderate compression deformity of the L1 vertebral body is also unchanged. There is nonspecific enhancement along the superior and anterior aspect of the L3 vertebral body. The bone marrow of the lumbar spine otherwise displays diffusely fatty signal compatible with prior radiotherapy. The distal spinal cord and conus are within normal limits. Aside from the L2 level, there is no significant spinal canal compromise. However, there is mild right or neural foraminal narrowing at L4-5 due to facet hypertrophy. There has been right nephrectomy.

Output: 1. Interval aadditional debulking of tumor at the L2 level, small amount of residual epidural enhancing tissue on the left, with improvement in the overall degree of spinal canal stenosis and mass effect on the left cauda equina nerve roots at this level. Otherwise, there is persistent retropulsion of bone and bone cement from prior kyphoplasty at this level. 2. Moderate compression deformity of the L1 vertebral body appears to be unchanged.3. Mild compression deformity of the L5 vertebral body with evidence of kyphoplasty is unchanged. 4. Nonspecific enhancement along the superior and anterior aspect of the L3 vertebral body.5. Diffuse fatty bone marrow related to radiation effects with osteopenia.


Instruction: Generate impression based on findings.

Input: 71-year-old male with history of CKD 4 on bisphosphates with low platelets and lung mass on CT. Evaluate lymph node size. Known right renal complex cysts. Status post right midpole partial nephrectomy in 9/07. This examination is limited by the absence of intravenous contrast.ABDOMEN:LUNG BASES: Extensive coronary artery calcifications. Transvenous pacemaker leads are present in the right ventricular apex. Old right posterior lateral rib fracture at image 35 of series 3.LIVER, BILIARY TRACT: Cholelithiasis. Punctate calcification in the right hepatic lobe is probably due to old granulomatous disease.SPLEEN: Splenomegaly with overall length of 16 cm. PANCREAS: Atrophic pancreas. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Exophytic 2 cm diameter cyst at right upper pole has attenuation of 23 HU, so contrast enhanced evaluation with CT or MRI would be helpful to better characterize the lesion. This lesion has increased in size since 2007, from 1.5 then to 2 cm now. Deformity of the right kidney lower pole is probably post-operative. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: There are numerous enlarged pelvic lymph nodes which are predominately replaced with fat, unchanged from 2008.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes involve the spine and pelvis.OTHER: Superficial anterior left thigh collateral vessels are enlarged. Probably due to iliac vein occlusion on the left.

Output: Slowly enlarging right upper pole lesion is now 2 cm in diameter. Enlarged benign fat-replaced pelvic lymph nodes are stable since 2008. No other significant interval change.


Instruction: Generate impression based on findings.

Input: 66-year-old male with headache, nausea, vomiting. There is no evidence of acute intracranial hemorrhage, mass or edema. Right parieto-occipital cortical hypodensity may represent subacute infarction. MRI is recommended for further evaluation. Left parietal subcortical white matter hypodensity is likely due to small vessel ischemic disease.The ventricles and basal cisterns are normal in size and configuration.There is a benign-appearing round ossific density in the right frontal bone.The visualized paranasal sinuses and mastoid air cells are normally pneumatized. There is a fluid attenuation structure anterior to the left globe, incompletely imaged.

Output: Right parieto-occipital cortical hypodensity, which may represent subacute infarction. MRI is recommended if clinical concern for acute ischemia remains.


Instruction: Generate impression based on findings.

Input: Right hip pain. History of surgery, right hip labral repair, CAM October 2014. Evaluate healing of labrum. ACETABULAR LABRUM: Best seen on images 9 and 10 of radial series 1301 is gadolinium filling a small defect of the undersurface of the anterosuperior labrum at the 1-2 o'clock position. Additional gadolinium appears to extend into the substance of the labrum (image 10). These findings are suspicious for tear, although could conceivably be due to prior surgery. The posterior labrum appears intact. ARTICULAR CARTILAGE AND BONE: I see no fluid-filled articular cartilage defects, although linear low signal intensity within the articular cartilage of the acetabulum adjacent to the aforementioned suspected labral tear can be seen with delamination. Bone marrow signal intensity is normal. There is scalloping of the anterior margin of the femoral head/neck junction likely representing femoral osteoplasty. There is cranial acetabular retroversion which can be associated with pincer-type femoral-acetabular impingement.SOFT TISSUES: There is thickening and irregularity of the anterior capsular structures the hip representing scarring from prior surgery. The ligamentum teres appears intact. The musculature of the hip appears normal.

Output: 1.Surgical changes of the right hip as described above.2.Tear of the anterior superior labrum as described above, with possible adjacent articular cartilage delamination.3.Cranial acetabular retroversion which may be associated with pincer-type femoral-acetabular impingement in the correct clinical context.


Instruction: Generate impression based on findings.

Input: Reason: Scaphoid Fx History: Pain, Tenderness There is edema concentrated within the waist of the scaphoid likely due to a nondisplaced fracture. The fracture line itself is not well defined on this study. Although this study was not protocoled for detailed evaluation of the intrinsic ligaments of the wrist, there is increased signal intensity traversing the membranous portion of the scapholunate ligament likely representing a tear. The lunotriquetral ligament appears intact. There is mild edema at the styloid attachment of the long radiolunate ligament which may represent a sprain or partial tear. The triangular fibrocartilage complex appears intact. The flexor and extensor tendons are normal in appearance.

Output: Nondisplaced fracture of the middle third of the scaphoid and other findings as described above.


Instruction: Generate impression based on findings.

Input: Bilateral knee pain. Check for meniscal injury Left knee:MENISCI: The medial meniscus demonstrates increased signal throughout the apical aspect of the body extending into the posterior horn. A small tear cannot be excluded with horizontal extension along the superior articular surface of the posterior horn (Image 22 series 7). The medial meniscus is otherwise intact.ARTICULAR CARTILAGE AND BONE: Marked tricompartmental cartilaginous thinning most pronounced in the medial compartment. No underlying discrete acute osseous abnormality. Moderate degenerative changes correlating with plain film are observedLIGAMENTS: Ligaments are intact throughout, however mild thickening of the MCL is observed without evidence of acute additional findings. This may represent an old healed scarring in remote injury.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Bilateral knee effusions with medial meniscal abnormalities greater on the right, see detail provided.


Instruction: Generate impression based on findings.

Input: GBM, on TMZ/Avastin. Evaluation for tumor progression. Again seen are postsurgical changes of right temporoparietal craniotomy for partial tumor resection involving the right temporal lobe. Please note some of the sequences on the current and prior studies are motion degraded; within this limitation, the nodular enhancement surrounding the right temporal resection cavity is not significantly changed. Again noted is enhancement extending along the right periatrial white matter towards the splenium which is stable to minimally decreased in the interval. Separate focus of enhancement involving the right temporal lobe cortex more anterolaterally is also stable to minimally decreased in the interval allowing for differences in technique. No new area of enhancement. Compared to most recent MRI dated 9/10/2015, there is no significant change in T2/FLAIR hyperintensity surrounding the resection cavity, particularly involving the right superior temporal and inferior frontal lobes. There is however interval increase in T2/FLAIR hyperintensity involving the right posterior frontal centrum semiovale and corona radiata without associated mass effect. When compared to 7/24/2015, there is bilaterally increased T2/FLAIR hyperintensity symmetrically in the periventricular region along the frontal horns and body of the lateral ventricles. Thicker T2/FLAIR hyperintensity surrounding the left occipital horn is not significantly changed in the interval. There is no significant change in size of the ventricular system which remains prominent.No evidence of acute infarct or acute hemorrhage. No new mass effect, midline shift, or herniation.

Output: Compared to 9/10/2015, there is no convincing evidence of tumor progression. FLAIR hyperintensity and enhancement surrounding the right temporal resection cavity is similar to 9/10/2015 and decreased since 7/24/2015 related to Avastin therapy. Satellite lesion involving the right lateral temporal lobe is also not significantly changed. There is interval increased T2/FLAIR hyperintensity involving the right posterior frontal centrum semiovale and corona radiata compared to 9/10/2015. Compared to 7/24/2015, there is also increased T2/FLAIR hyperintensity bilaterally involving the periventricular white matter. These findings are favored to represent posttreatment change.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with cerebral infarct, assess for RCVS versus vasculitis versus ischemia versus neurosyphilis. The pattern of mild cortical restricted diffusion affecting the bilateral frontal and parietal lobes, right side more than left, has not significantly changed. No definite evidence of any new diffusion restricting lesion is seen. FLAIR hyperintensity within the cortical and subcortical tissues corresponding to the areas of restricted diffusion is also unchanged. The affected gyri are mildly edematous, but there is no significant generalized mass effect, midline shift or brain herniation. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricles remain normal in size and morphology. On postcontrast images, the affected tissues demonstrate gyriform enhancement. MRA images of the head are limited due to motion. However, no significant intracranial vascular stenosis is appreciated. Azygos configuration of the ACA is again demonstrated.

Output: Findings are again seen compatible with subacute ischemia affecting the cortex of the bilateral frontal and parietal lobes, right side more than left. Since the prior examination, there has been no significant expansion in the abnormality, and no generalized mass effect is seen.


Instruction: Generate impression based on findings.

Input: Female 57 years old Reason: 57F with h/o biliary stent - now with persistently elevated alk phos History: as above ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is mild ductal dilatation involving the right hepatic lobe ducts. There are areas of narrowing involving the right hepatic lobe duct with possible areas of stricture formation. No definite choledocholithiasis. There is circumferential thickening of the common bile duct which possibly representing inflammation. The lack of intravenous contrast limits evaluation for solid hepatic lesions.SPLEEN: Spleen is enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild right intrahepatic biliary ductal dilatation with areas of stricturing.2.No specific evidence for choledocholithiasis.3.Circumferential wall thickening of the common bile duct possibly due to inflammation. Follow-up is suggested.4.Lack of intravenous contrast limits evaluation for solid hepatic lesions.


Instruction: Generate impression based on findings.

Input: Swelling of the right hand LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: Abnormal fluid collection likely abscess at the dorsum aspect of the hand as described above.


Instruction: Generate impression based on findings.

Input: 56-year-old male with shoulder pain. Evaluate rotator cuff. ROTATOR CUFF: There is a near complete to complete tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity with approximately 4 cm of retraction of the proximal tendon fragment. There is mild atrophy of the supraspinatus muscle. There is partial thickness tearing of the anterior fibers of the infraspinatus tendon. The infraspinatus muscle appears intact. The teres minor and subscapularis muscles and tendons appear intact. Note is made of metallic susceptibility artifact within the superolateral humeral head presumably representing postsurgical changes from prior rotator cuff repair.SUPRASPINATUS OUTLET: There is a moderate amount of fluid within the subacromial subdeltoid bursa. Intra-articular gadolinium extends into the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint. Note is made of a high riding humeral head. GLENOHUMERAL JOINT AND GLENOID LABRUM: Note is made of a high riding humeral head. The glenohumeral joint alignment is anatomic. Moderate to severe degenerative changes affect the glenohumeral joint including osteophyte formation and articular cartilage degeneration. There is near full-thickness articular cartilage degeneration along the superior aspect of the humeral head as well as along the glenoid. There is heterogeneity and increased signal intensity within the superior posterior glenoid labrum which may reflect degeneration/tearing. No fluid-filled or gadolinium filled labral defects are identified.BICEPS TENDON: There is thickening and intermediate signal abnormality within the extra-articular portion of the long head of the biceps indicating tendinosis. There is an apparent longitudinal split tear of the intra-articular portion of the long head of the biceps tendon.ADDITIONAL

Output: 1. Near complete to complete tear of the supraspinatus tendon with retraction. Partial-thickness tearing of the infraspinatus tendon.2. Osteoarthritic changes of the glenohumeral joint.3. Findings consistent with a longitudinal split tear and tendinosis of the long head of the biceps. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Vulvar abscess, concern for bony extension There is a large ulceration packing material within the medial soft tissues of the left thigh which extends to but does not appear to invade the rectum. There is marked edema and enhancement throughout the pelvic musculature bilaterally, left greater than right but there is no discrete fluid collection identified.There is a small focus of edema and enhancement within the left inferior pubic ramus but there is no corresponding low signal intensity on T1 to confirm osteomyelitis in these findings likely reflect reactive osteitis. There is marked abnormal signal intensity and enhancement of the left hip involving both the acetabulum and femoral head/neck. There is a trace amount of joint fluid but no joint effusion. Abnormal signal intensity and enhancement is also present within the posterior column of the right acetabulum which is presumably degenerative in nature. A Foley catheter in place.

Output: 1. Large ulceration of the medial soft tissues of the left pelvis without definite evidence of osteomyelitis or discrete fluid collection. There is abnormal signal intensity the left inferior pubic ramus which is likely reflects reactive osteitis given the lack of corresponding low T1 signal intensity.2. Severe osteoarthritis of the left hip with associated degenerative marrow signal changes.3. Diffuse edema and enhancement of the adductor musculature bilaterally which may represent myositis but is also likely in part related to prior radiation therapy.


Instruction: Generate impression based on findings.

Input: Male 71 years old Reason: eval rotator cuff History: subscap weakness, shoulder pain ROTATOR CUFF: There is full-thickness tearing of the supraspinatus tendon at the 12:00 position with partial retraction of some of its fibers (series 7, image 9; series 6, image 9). There is associated moderate atrophy of the supraspinatus muscle. The infraspinatus, teres minor and subscapularis are intact.SUPRASPINATUS OUTLET: There is a type I acromion. Severe osteoarthritis and joint effusion of the AC joint narrows the supraspinatus outlet.GLENOHUMERAL JOINT AND GLENOID LABRUM: Osteoarthritis affects the glenohumeral joint with subchondral cysts in the humeral head. The glenoid labrum appears intact.BICEPS TENDON: Biceps tendon is situated in the bicipital groove and normal in appearance. ADDITIONAL

Output: 1.Full-thickness tearing and partial retraction of the supraspinatus tendon with associated muscle atrophy. Supraspinatus outlet is narrowed by severe AC joint osteoarthritis.2.Osteoarthritis of the glenohumeral joint.


Instruction: Generate impression based on findings.

Input: Gait instability, enlarged ventricles, concern for NPH. There is prominence of the lateral and third ventricles, perhaps slightly out of proportion to some of the sulci. In fact, bilateral parietal lobe sulci are prominent. There is moderate cerebral white matter T2 hyperintensity, mainly in a periventricular distribution. There are also punctate foci of T2 hyperintensity in the bilateral thalami. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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. Prominence of the lateral and third ventricles, perhaps slightly out of proportion to some of the sulci may represent normal pressure hydrocephalus superimposed on cerebral volume loss. 2. Cerebral white matter T2 hyperintensity, mainly in a periventricular distribution, is nonspecific, but may represent chronic small vessel ischemic disease, and lesions in the bilateral thalami may represent chronic infarcts. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity numbness, tingling, genital numbness. Evaluate for cord compression. The vertebral bodies are appropriate in the overall alignment and height. Degenerative changes are noted in the cervical spine with disc osteophyte complex at the C4-C5 level resulting in moderate spinal canal stenosis. There is possible associated cord signal abnormality. Abnormal cord signal is also suspected in the upper cervical cord at the C1-C2 level. Questionable patchy cord signal abnormality involving the thoracic cord is also suspected although examination is suboptimal for the evaluation of cord signal. No high-grade stenosis in the thoracic spine is seen. In the lumbar spine, there are degenerative changes including disc bulge at L3-L4 which results in mild to moderate spinal canal stenosis. No appreciable high-grade stenosis within the lumbar spine is demonstrated. Facet arthropathy is noted in the lumbar spine with distention of the L3-L4 facet joints.

Output: This is a limited exam specific for the exclusion of cord compression only and does not adequately assess more subtle lesions such as intrinsic cord abnormalities. Patchy cord signal abnormality is suspected, specifically at C1-C2 and questionably at additional levels in the thoracic spine. There is moderate spinal canal stenosis at the C4-C5 level related to prominent disc osteophyte complex. Mild to moderate lumbar spinal canal stenosis at the L3-L4 level also noted. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine. Suggest dedicated cervical and lumbar spine MRI and possibly brain and thoracic MRI to better assess the etiology of the multiple areas of cord signal abnormality (such as demyelinating/inflammatory disease).


Instruction: Generate impression based on findings.

Input: 58-year-old male patient with pancreatic nodule noted on CT. Patient has history of prostate cancer. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum is noted. There is a 1.6 x 1.2 cm lesion along the anterior neck of the pancreas (series 8 image 21). The lesion is homogenously hypointense on T2 and hyperintense on T1-weighted images and does not demonstrate enhancement. There is no pancreatic ductal dilatation.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: Lesion in the pancreatic neck is favored to represent subacute hemorrhage and may be sequela of possible prior pancreatitis or intervention. Follow up imaging with CT may be obtained to confirm resolution.


Instruction: Generate impression based on findings.

Input: 55-year-old male with history of colorectal cancer. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple perirectal lymph nodes measuring less than 5 mm noted within the perirectal fat. The closest is located on the left approximately 6 mm from the mesorectal fascia.BOWEL, MESENTERY: Near-circumferential mildly enhancing fungating mass of the upper rectum/sigmoid junction measuring 16 mm in maximal axial thickness and approximately 5 cm craniocaudally. The adjacent serosal surface is slightly indistinct as well as fat stranding suggesting tumor involvement. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Colonic mass in the upper rectum (near rectosigmoid colon) with invasion to level of serosa and adjacent mild infiltration of adjacent fat noted. Multiple small perirectal lymph nodes. The mesorectal fascia is uninvolved.


Instruction: Generate impression based on findings.

Input: Altered mental status. Found down. Evaluate for fracture. Primary lung cancer with metastasis There are marrow replacing lesions present involving the vertebral body, right pedicle and right lamina of T1, the vertebral body, right pedicle right transverse process, right lamina and spinous process of T2 and the pedicles, right posterolateral vertebral body and spinous process of T3.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 dessication present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes and loss of disk space height at this level. There is narrowing of the neural foramina bilaterally at this level with mild encroachment of the exiting nerve roots bilaterally.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Lesions are present at T1, T2 and T3 which are suspicious for metastases.2.There are degenerative changes in the cervical spine which are worse at C5-6 where there is mild encroachment of exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other symptoms and signs involving the musculoskeletal systemClinical question: Rule out focal brain findingSigns and Symptoms: Upper and lower extremity weakness, altered mental status Minimal artifact from patient's dentition distorts the appearance of the frontal lobes and obviates visualization of the orbits.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.

Output: Examination is partially degraded due to metal artifact which obscures some visualization of the orbits and paranasal sinuses and degrades visualization of the frontal lobes. The brain is only partly visualized on susceptibility imaging (which would be used to identify foci of hemorrhage). To extent of visualization no abnormal mass lesion is appreciated to account for the patient's upper and lower extremity weakness and altered mental status.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness. Fall. Confusion. Atrial fibrillation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild T2 hyperintensity with volume loss in the left medial occipital lobe, compatible with a chronic infarct. There is mild ex vacuo dilation of the occipital horn of the left lateral ventricle. There is minimal high T2 signal bilateral periventricular white, which likely represents chronic small vessel ischemic changes. There is no midline shift or herniation. There is possibly a 4 mm outpouching of the right internal carotid artery within the cavernous sinuses. The skull and extracranial soft tissues are unremarkable. There are bilateral lens implants.

Output: 1. Limited exam demonstrates a chronic left posterior cerebral artery territory infarct, but no evidence of acute cerebral infarction.2. Possible apparent 4 mm outpouching of the right internal carotid artery within the cavernous sinuses, which may be to to slice selection effects of the normal curving vasculature versus an aneurysm. Further evaluation via CTA or MRA may be useful for further elucidation.Findings conveyed to Dr. Gao by telephone on 4/18/15 at 10:55am.


Instruction: Generate impression based on findings.

Input: Ms. Chen is a 34 year old female with a personal history of left breast mastectomy in 2008 for DCIS along with bilateral implants placed in 2008. Family history includes maternal aunt with ovarian cancer. Patient is status post left breast mastectomy with implant based reconstruction. There is extreme amount of fibroglandular tissue in the right breast. Bilateral implants are intact. There is no abnormal enhancement seen in the left reconstructed breast or chest wall. There is no abnormal enhancement seen in the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for change in meningioma. Signs and symptoms: Meningioma, subcutaneous lesion. Pre-and post enhanced brain MRI:No diffusion weighted abnormality.Examination redemonstrates a stable dural based extra axial meningioma in the left posterior frontal region. It measures approximately 26.5 mm at the base and 17-mm cranial cephalad axis which has remained stable since prior study. It results in subtle indentation of the adjacent parenchyma without detectable signal abnormality.A shallow dural broad-based extra axial enhancing mass in the left pterion is again identified and without change. Finding is consistent with an additional tiny meningioma measuring at 12-mm at the base and 7-mm in height.Additional tiny focus of T2 hyperintensity in the right frontal high convexity with several rim enhancement similar to prior study. The finding could represent a heavy calcified meningioma without change and measuring approximately 6.4 mm in size.The scattered periventricular and subcortical foci of flair hyperintensity without appreciable change since prior exam and likely are presenting mild chronic small vessel ischemic strokes.Unremarkable cortical sulci, ventricular system and the CSF spaces. No detectable abnormal parenchymal or meningeal enhancement.Stable nonspecific isointense enhancing mass in the subcutaneous right occipital region without change and measuring at 19 x 13.5-mm.

Output: 1.No acute or new intracranial findings since prior exam.2.Stable meningioma in the left frontal, left pterion and high convexity right frontal as detailed/measured above.3.Findings suggestive of mild chronic small vessel ischemic strokes without significant change.4.Nonspecific well-demarcated uniformly enhancing mass in the right occipital subcutaneous region without change.


Instruction: Generate impression based on findings.

Input: Reason: rule out rotator cuff pathology History: pain and weakness with forward flexion and abduction ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus indicating mild tendinosis and perhaps minimal superficial fraying at its insertion on the greater tuberosity. There is cyst formation within the underlying greater tuberosity. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. There is focal intermediate signal intensity within the distal fibers of the subscapularis likely representing mild insertional tendinosis, but we see no fluid-filled tear. The subscapularis muscle appears intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Small amount of fluid within subacromial subdeltoid bursa of questionable significance. There is minimal, if any, osteoarthritis affecting the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Linear signal abnormality traverses the anterior superior labrum from the 2 to 3 o'clock position. While we cannot entirely exclude the possibility of a labral tear, this may represent a normal variant sublabral foramen. The remainder of the labrum appears normal given the limitations of a non arthrogram study.BICEPS TENDON: The tendon to long head of the biceps appears intact ADDITIONAL

Output: Mild rotator cuff tendinosis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Prematurity, staring spells and cafe au lait x 2. Evaluate for structural abnormality. The bilateral hippocampi are symmetric. There is no evidence of gray matter heterotopia or cortical dysplasia. There is no evidence of intracranial hemorrhage or mass effect. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is fluid within the right mastoid air cells. The left mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.

Output: 1. No evidence of seizure focus.2. Fluid within the right mastoid air cells, which is nonspecific. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: Male 50 years old Reason: knee pain r/o meniscal tear History: same MENISCI: The lateral meniscus is intact. There is an oblique branching tear involving the posterior horn of medial meniscus that extends to the body.ARTICULAR CARTILAGE AND BONE: There is cartilage thinning in the medial and lateral compartments. There is cartilage thinning and fissuring involving the medial and lateral facets of the patella.There is marrow edema involving the medial tibial plateau adjacent to the meniscal tear which is likely reactive.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Tear of the body and posterior horn of medial meniscus with associated marrow edema involving the medial tibial plateau.Tricompartmental cartilage wear constituting mild osteoarthritis.Small joint effusion.